scholarly journals Bridging the second gap in translation: a case study of barriers and facilitators to implementing Patient-initiated Clinics into secondary care

2017 ◽  
Vol 5 (1) ◽  
pp. 129 ◽  
Author(s):  
Victoria Goodwin ◽  
Jo Day ◽  
Richard Byng ◽  
Paul McArdle ◽  
Eline Kieft
Keyword(s):  
Secondary Care ◽  
Barriers And Facilitators ◽  
Healthcare Organisation ◽  
Long Term Conditions ◽  
Team Members ◽  
Knowledge To Action ◽  
Theoretical Support ◽  
Feasible Alternative ◽  
Implementation Plans

Rationale: Patient-initiated Clinics (PIC) have been found to be safe and have patient and service benefits in terms of satisfaction and cost. This paper reports our experiences of implementing PIC and the practical challenges of translating research into practice.Methods: The Knowledge to Action framework was used to inform the design of implementation plans in three different departments in one secondary healthcare organisation. A focused ethnographic approach was utilised to collect data on barriers and facilitators to implementation which were analysed using iterative qualitative analytic techniques. The Promoting Action on Research Implementation in Health Services framework was used to develop the analysis and data presentation. Results: The success of implementation was mixed across the three departments. Despite evidence of effectiveness, contextual issues at a department level, such as empowered leadership and team members, trust in colleagues and patients and capacity to make changes, impacted on the progress of implementation. Discussion: Patient-initiated Clinics can offer a useful and feasible alternative for follow-up care of some groups of patients with long-term conditions in secondary care and can be implemented through strong leadership and teamwork and a positive attitude to change. Although Implementation Science as an emerging field offers useful tools and theoretical support, its complexity may create additional challenges to implementation of specific interventions and so further contribute to the second gap in translation.

scholarly journals Benefits and Costs of Digital Consulting in Clinics Serving Young People With Long-Term Conditions: Mixed-Methods Approach (Preprint)

2018 ◽  
Author(s):  
Sung Wook Kim ◽  
Jason Madan ◽  
Melina Dritsaki ◽  
Carol Bryce ◽  
Vera Forjaz ◽  
...  
Keyword(s):  
United Kingdom ◽  
Cost Effectiveness ◽  
Young People ◽  
Health Professionals ◽  
Direct Costs ◽  
Long Term Conditions ◽  
Team Members ◽  
The United Kingdom ◽  
Part Model

BACKGROUND Since the introduction of digital health technologies in National Health Service (NHS), health professionals are starting to use email, text, and other digital methods to consult with their patients in a timely manner. There is lack of evidence regarding the economic impact of digital consulting in the United Kingdom (UK) NHS. OBJECTIVE This study aimed to estimate the direct costs associated with digital consulting as an adjunct to routine care at 18 clinics serving young people aged 16-24 years with long-term conditions. METHODS This study uses both quantitative and qualitative approaches. Semistructured interviews were conducted with 173 clinical team members on the impacts of digital consulting. A structured questionnaire was developed and used for 115 health professionals across 12 health conditions at 18 sites in the United Kingdom to collect data on time and other resources used for digital consulting. A follow-up semistructured interview was conducted with a single senior clinician at each site to clarify the mechanisms through which digital consulting use might lead to outcomes relevant to economic evaluation. We used the two-part model to see the association between the time spent on digital consulting and the job role of staff, type of clinic, and the average length of the working hours using digital consulting. RESULTS When estimated using the two-part model, consultants spent less time on digital consulting compared with nurses (95.48 minutes; P<.001), physiotherapists (55.3 minutes; P<.001), and psychologists (31.67 minutes; P<.001). Part-time staff spent less time using digital consulting than full-time staff despite insignificant result (P=.15). Time spent on digital consulting differed across sites, and no clear pattern in using digital consulting was found. Health professionals qualitatively identified the following 4 potential economic impacts for the NHS: decreasing adverse events, improving patient well-being, decreasing wait lists, and staff workload. We did not find evidence to suggest that the clinical condition was associated with digital consulting use. CONCLUSIONS Nurses and physiotherapists were the greatest users of digital consulting. Teams appear to use an efficient triage system with the most expensive members digitally consulting less than lower-paid team members. Staff report showed concerns regarding time spent digitally consulting, which implies that direct costs increase. There remain considerable gaps in evidence related to cost-effectiveness of digital consulting, but this study has highlighted important cost-related outcomes for assessment in future cost-effectiveness trials of digital consulting.

scholarly journals Long-term condition management in adults with intellectual disability in primary care: a systematic review

BJGP Open ◽  
2018 ◽  
Vol 2 (1) ◽  
pp. bjgpopen18X101445 ◽  
Author(s):  
Peter Hanlon ◽  
Sara MacDonald ◽  
Karen Wood ◽  
Linda Allan ◽  
Sally-Ann Cooper
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Intellectual Disability ◽  
General Population ◽  
Intellectual Disabilities ◽  
Barriers And Facilitators ◽  
Long Term Conditions ◽  
Health Checks ◽  
Adults With Intellectual Disabilities

BackgroundAdults with intellectual disabilities have higher morbidity and earlier mortality than the general population. Access to primary health care is lower, despite a higher prevalence of many long-term conditions.AimTo synthesise the evidence for the management of long-term conditions in adults with intellectual disabilities and identify barriers and facilitators to management in primary care.Design & settingMixed-methods systematic review.MethodSeven electronic databases were searched to identify both quantitative and qualitative studies concerning identification and management of long-term conditions in adults with intellectual disability in primary care. Both the screening of titles, abstracts, and full texts, and the quality assessment were carried out in duplicate. Findings were combined in a narrative synthesis.ResultsFifty-two studies were identified. Adults with intellectual disabilities are less likely than the general population to receive screening and health promotion interventions. Annual health checks may improve screening, identification of health needs, and management of long-term conditions. Health checks have been implemented in various primary care contexts, but the long-term impact on outcomes has not been investigated. Qualitative findings highlighted barriers and facilitators to primary care access, communication, and disease management. Accounts of experiences of adults with intellectual disabilities reveal a dilemma between promoting self-care and ensuring access to services, while avoiding paternalistic care.ConclusionAdults with intellectual disabilities face numerous barriers to managing long-term conditions. Reasonable adjustments, based on the experience of adults with intellectual disability, in addition to intervention such as health checks, may improve access and management, but longer-term evaluation of their effectiveness is required.

scholarly journals The value of embedded secondary-care-based psychology services in rheumatology: an exemplar for long-term conditions

2020 ◽  
Vol 7 (Suppl 1) ◽  
pp. s21-s21
Author(s):  
Theresa Barnes ◽  
Lou Taylor ◽  
Charlotte Eost-Telling ◽  
Thomas Joy
Keyword(s):  
Secondary Care ◽  
Long Term Conditions

scholarly journals Exploring the facilitators, barriers, and strategies for self-management in adults living with severe mental illness, with and without long-term conditions: A qualitative evidence synthesis

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258937
Author(s):  
Abisola Balogun-Katung ◽  
Claire Carswell ◽  
Jennifer V. E. Brown ◽  
Peter Coventry ◽  
Ramzi Ajjan ◽  
...  
Keyword(s):  
Mental Illness ◽  
Physical Health ◽  
Severe Mental Illness ◽  
Evidence Synthesis ◽  
Barriers And Facilitators ◽  
Self Management ◽  
Qualitative Evidence Synthesis ◽  
Long Term Conditions ◽  
Qualitative Evidence

Background People living with severe mental illness (SMI) have a reduced life expectancy by around 15–20 years, in part due to higher rates of long-term conditions (LTCs) such as diabetes and heart disease. Evidence suggests that people with SMI experience difficulties managing their physical health. Little is known, however, about the barriers, facilitators and strategies for self-management of LTCs for people with SMI. Aim To systematically review and synthesise the qualitative evidence exploring facilitators, barriers and strategies for self-management of physical health in adults with SMI, both with and without long-term conditions. Methods CINAHL, Conference Proceedings Citation Index- Science, HMIC, Medline, NICE Evidence and PsycInfo were searched to identify qualitative studies that explored barriers, facilitators and strategies for self-management in adults with SMI (with or without co-morbid LTCs). Articles were screened independently by two independent reviewers. Eligible studies were purposively sampled for synthesis according to the richness and relevance of data, and thematically synthesised. Results Seventy-four articles met the inclusion criteria for the review; 25 articles, reporting findings from 21 studies, were included in the synthesis. Seven studies focused on co-morbid LTC self-management for people with SMI, with the remaining articles exploring self-management in general. Six analytic themes and 28 sub-themes were identified from the synthesis. The themes included: the burden of SMI; living with co-morbidities; beliefs and attitudes about self-management; support from others for self-management; social and environmental factors; and routine, structure and planning. Conclusions The synthesis identified a range of barriers and facilitators to self-management, including the burden of living with SMI, social support, attitudes towards self-management and access to resources. To adequately support people with SMI with co-morbid LTCs, healthcare professionals need to account for how barriers and facilitators to self-management are influenced by SMI, and meet the unique needs of this population.

scholarly journals Barriers and facilitators to implementing a longitudinal dementia education programme into undergraduate healthcare curricula: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yvonne Feeney ◽  
Stephanie Daley ◽  
Breda Flaherty ◽  
Sube Banerjee
Keyword(s):  
Qualitative Study ◽  
Educational Programme ◽  
Barriers And Facilitators ◽  
Educational Institutions ◽  
Curricular Change ◽  
Teaching Staff ◽  
Long Term Conditions ◽  
The Common ◽  
Common Barriers

Abstract Background As the numbers of people with dementia worldwide rises, there is a need for improved knowledge and awareness about the condition across the healthcare workforce. There are concerns that traditional models of healthcare education, which focus on short-term episodes of care, limit student understanding of long-term conditions. We therefore designed and delivered the Time for Dementia programme at five Universities in the UK. Through longitudinal contact with families living with dementia, healthcare students gain increased understanding about the experiences of living with dementia. However, implementing new educational models brings challenges. To enable implementation of similar programmes in other educational institutions, this study aimed to identify the common barriers and facilitators of implementing these types of longitudinal programmes at scale. Methods To understand the facilitators and barriers of implementing a longitudinal dementia educational programme, a qualitative study was completed. Between October and December 2018, twelve in-depth semi-structured interviews were completed with university teaching staff (n = 6), programme administrators (n = 4), and Alzheimer’s Society staff (n = 2) that had key responsibilities for implementing Time for Dementia. Interview questions explored participants experiences, the facilitators, and the challenges encountered when implementing the programme. Interviews were audio recorded, transcribed verbatim, and analysed using inductive thematic analysis. Results The analysis identified five key themes: “Leadership characteristics”, “Organisational and student buy-in”, “Perceived value and motivating factors”, “Team coalition and support”, and “Time and fit”. Implementation of the programme was enhanced by resilient leaders managing the challenges of curricular change. Their belief in the value of the programme, stakeholder buy-in, and supportive team working enabled challenges to be overcome. Workload was reduced and student buy-in increased as time progressed and as more resources became available. A flexible approach to implementation was recommended to ensure the programme fits within the established curriculum. Conclusion Curricular change is a challenging task, yet necessary, if we are to improve care for people with long term conditions such as dementia. This study highlights the common barriers and facilitators experienced when implementing a longitudinal educational programme at scale. The findings presented in this study can be used by other educational institutions to manage curricular change efforts.

scholarly journals Is multidisciplinary teamwork the key? A qualitative study of the development of respiratory services in the UK

2009 ◽  
Vol 102 (9) ◽  
pp. 378-390 ◽  
Author(s):  
Hilary Pinnock ◽  
Guro Huby ◽  
Alison Tierney ◽  
Sonya Hamilton ◽  
Alison Powell ◽  
...  
Keyword(s):  
Primary Care ◽  
Secondary Care ◽  
Educational Needs ◽  
Service Development ◽  
Multidisciplinary Teams ◽  
Successful Implementation ◽  
Clinical Services ◽  
Long Term Conditions ◽  
England And Wales

Summary Objectives Using frameworks, such as the long-term conditions pyramid of healthcare, primary care organizations (PCOs) in England and Wales are exploring ways of developing services for people with long-term respiratory disease. We aimed to explore the current and planned respiratory services and the roles of people responsible for change. Setting A purposive sample of 30 PCOs in England and Wales. Design Semi-structured telephone interviews with the person responsible for driving the reconfiguration of respiratory services. Recorded interviews were transcribed and coded, and themes identified. The association of the composition of the team driving change with the breadth of services provided was explored using a matrix. Results All but two of the PCOs described clinical services developed to address the needs of people with respiratory conditions, usually with a focus on preventing admissions for chronic obstructive pulmonary disease (COPD). Although the majority identified the need to develop a strategic approach to service development and to meet educational needs of primary care professionals, relatively few described clearly developed plans for addressing these issues. Involvement of clinicians from both primary and secondary care was associated with a broad multifaceted approach to service development. Teamwork was often challenging, but could prove rewarding for participants and could result in a fruitful alignment of objectives. The imminent merger of PCOs and overriding financial constraints resulted in a ‘fluid’ context which challenged successful implementation of plans. Conclusions While the majority of PCOs are developing clinical services for people with complex needs (principally in order to reduce admissions), relatively few are addressing the broader strategic issues and providing for local educational needs. The presence of multidisciplinary teams, which integrated primary and secondary care clinicians with PCO management, was associated with more comprehensive service provision addressing the needs of all respiratory patients. Future research needs to provide insight into the structures, processes and inter-professional relationships that facilitate development of clinical, educational and policy initiatives which aim to enhance local delivery of respiratory care.

scholarly journals Automated conflict resolution between multiple clinical pathways: a technology report

2018 ◽  
Vol 25 (3) ◽  
pp. 142-148 ◽  
Author(s):  
Ian Litchfield ◽  
Alice Turner ◽  
Ruth Backman ◽  
João Bosco Ferreira Filho ◽  
Phil Weber ◽  
...  
Keyword(s):  
Secondary Care ◽  
Fundamental Problem ◽  
Clinical Pathways ◽  
Software Tool ◽  
Care Pathways ◽  
Long Term Conditions ◽  
Type Method ◽  
The Uk

BackgroundThe number of people in the UK with three or more long-term conditions continues to grow and the management of patients with co-morbidities is complex. In treating patients with multimorbidities, a fundamental problem is understanding and detecting points of conflict between different guidelines which to date has relied on individual clinicians collating disparate information.ObjectiveWe will develop a framework for modelling a diverse set of care pathways, and investigate how conflicts can be detected and resolved automatically. We will use this knowledge to develop a software tool for use by clinicians that can map guidelines, highlight root causes of conflict between these guidelines and suggest ways they might be resolved.MethodOur work consists of three phases. First, we will accurately model clinical pathways for six of the most common chronic diseases; second, we will automatically identify and detect sources of conflict across the pathways and how they might be resolved. Third, we will present a case study to prove the validity of our approach using a team of clinicians to detect and resolve the conflicts in the treatment of a fictional patient with multiple common morbidities and compare their findings and recommendations with those derived automatically using our novel software.DiscussionThis paper describes the development of an important software-based method for identifying a conflict between clinical guidelines. Our findings will support clinicians treating patients with multimorbidity in both primary and secondary care settings.

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