scholarly journals Improving care transfers for homeless patients after hospital discharge: a realist evaluation

2021 ◽  
Vol 9 (17) ◽  
pp. 1-186
Author(s):  
Michelle Cornes ◽  
Robert W Aldridge ◽  
Elizabeth Biswell ◽  
Richard Byng ◽  
Michael Clark ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Standard Care ◽  
Data Linkage ◽  
Realist Evaluation ◽  
Specialist Care ◽  
Work Package ◽  
Care And Support ◽  
Different Types ◽  
Step Down ◽  
The Uk

Background In 2013, 70% of people who were homeless on admission to hospital were discharged back to the street without having their care and support needs addressed. In response, the UK government provided funding for 52 new specialist homeless hospital discharge schemes. This study employed RAMESES II (Realist And Meta-narrative Evidence Syntheses: Evolving Standards) guidelines between September 2015 and 2019 to undertake a realist evaluation to establish what worked, for whom, under what circumstances and why. It was hypothesised that delivering outcomes linked to consistently safe, timely care transfers for homeless patients would depend on hospital discharge schemes implementing a series of high-impact changes (resource mechanisms). These changes encompassed multidisciplinary discharge co-ordination (delivered through clinically led homeless teams) and ‘step-down’ intermediate care. These facilitated time-limited care and support and alternative pathways out of hospital for people who could not go straight home. Methods The realist hypothesis was tested empirically and refined through three work packages. Work package 1 generated seven qualitative case studies, comparing sites with different types of specialist homeless hospital discharge schemes (n = 5) and those with no specialist discharge scheme (standard care) (n = 2). Methods of data collection included interviews with 77 practitioners and stakeholders and 70 people who were homeless on admission to hospital. A ‘data linkage’ process (work package 2) and an economic evaluation (work package 3) were also undertaken. The data linkage process resulted in data being collected on > 3882 patients from 17 discharge schemes across England. The study involved people with lived experience of homelessness in all stages. Results There was strong evidence to support our realist hypothesis. Specialist homeless hospital discharge schemes employing multidisciplinary discharge co-ordination and ‘step-down’ intermediate care were more effective and cost-effective than standard care. Specialist care was shown to reduce delayed transfers of care. Accident and emergency visits were also 18% lower among homeless patients discharged at a site with a step-down service than at those without. However, there was an impact on the effectiveness of the schemes when they were underfunded or when there was a shortage of permanent supportive housing and longer-term care and support. In these contexts, it remained (tacitly) accepted practice (across both standard and specialist care sites) to discharge homeless patients to the streets, rather than delay their transfer. We found little evidence that discharge schemes fired a change in reasoning with regard to the cultural distance that positions ‘homeless patients’ as somehow less vulnerable than other groups of patients. We refined our hypothesis to reflect that high-impact changes need to be underpinned by robust adult safeguarding. Strengths and limitations To our knowledge, this is the largest study of the outcomes of homeless patients discharged from hospital in the UK. Owing to issues with the comparator group, the effectiveness analysis undertaken for the data linkage was limited to comparisons of different types of specialist discharge scheme (rather than specialist vs. standard care). Future work There is a need to consider approaches that align with those for value or alliance-based commissioning where the evaluative gaze is shifted from discrete interventions to understanding how the system is working as a whole to deliver outcomes for a defined patient population. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 17. See the NIHR Journals Library website for further project information.

scholarly journals SAT0640-HPR RHEUMATOLOGY CARE OF MIGRANTS FROM SUB-SAHARAN AFRICA; A QUALITATIVE PILOT STUDY OF PATIENTS’ PERSPECTIVES

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1279.1-1279
Author(s):  
Z. Rutter-Locher ◽  
J. Galloway ◽  
H. Lempp
Keyword(s):  
Rheumatoid Arthritis ◽  
Health Care ◽  
Health Care Providers ◽  
Unmet Need ◽  
Primary Care Providers ◽  
Sub Saharan Africa ◽  
Care Providers ◽  
Specialist Care ◽  
Sub Saharan ◽  
The Uk

Background:Rheumatological diseases are common in Sub-Saharan Africa [1] but specialist healthcare is limited and there are less than 150 rheumatologists currently serving 1 billion people in Sub-Saharan Africa [2]. Rheumatologists practising in the UK NHS are likely to be exposed to migrant patients. There is therefore, an unmet need for health care providers to understand the differences in rheumatology healthcare provision between Sub-Saharan Africa and the UK and the barriers which migrants face in their transition of rheumatology care.Objectives:To gain an understanding of the experiences of patients with rheumatological conditions, about their past healthcare in Sub-Saharan Africa and their transition of care to the UK.Methods:A qualitative study using semi-structured interviews was conducted. Participants were recruited from two rheumatology outpatient clinics in London. Thematic analysis was applied to identify key themes.Results:Seven participants were recruited. Five had rheumatoid arthritis, one had ankylosing spondylitis and one had undifferentiated inflammatory arthritis. Participants described the significant impact their rheumatological conditions had on their physical and emotional wellbeing, including their social and financial implications. Compared to the UK, rheumatology healthcare in Sub-Saharan Africa was characterised by higher costs, limited access to specialists, lack of investigations and treatments, the use of traditional medicines and poor communication by clinicians. Barriers to transition of rheumatology care to the UK were: poor understanding of rheumatological conditions by the public and primary care providers, lack of understanding of NHS entitlements by migrants, fear of data sharing with immigration services and delayed referral to specialist care. Patient, doctor and public education were identified by participants as important ways to improve access to healthcare.Conclusion:This study has described, for the first time, patients’ perspectives of rheumatology health care in Sub-Saharan Africa and the transition of their care to the UK. These initial findings allow healthcare providers in the UK to tailor management for this migrant population and suggests that migrants need more information about their NHS entitlements and specific explanations on what non-clinical data will be shared with immigration services. To increase access to appropriate care, a concerted effort by clinicians and public health authorities is necessary to raise awareness and provide better education to patients and migrant populations about rheumatological conditions.References:[1]G. Mody, “Rheumatology in Africa-challenges and opportunities,” Arthritis Res. Ther., vol. 19, no. 1, p. 49, 2017.[2]M. A. M. Elagib et al., “Sudan and Sweden Active Rheumatoid Arthritis in Central Africa: A Comparative Study Between,” J. Rheumatol. J. Rheumatol. January, vol. 43, no. 10, pp. 1777–1786, 2016.Acknowledgments:We are grateful to the patients involved in this study for their time and involvement.Disclosure of Interests:None declared

Physiotherapy via telehealth for acute respiratory exacerbations in paediatric cystic fibrosis

2021 ◽  
pp. 1357633X2199820
Author(s):  
Cloe Benz ◽  
Anna Middleton ◽  
Alison Elliott ◽  
Adrienne Harvey
Keyword(s):  
Cystic Fibrosis ◽  
Young People ◽  
Adverse Events ◽  
Travel Time ◽  
Standard Care ◽  
Limiting Factor ◽  
Specialist Care ◽  
Face To Face ◽  
Respiratory Exacerbations ◽  
Hybrid Group

Introduction The demand for Hospital in the Home has increased, especially as an avenue for treatment of respiratory exacerbations. However, a limiting factor of Hospital in the Home efficiency is excess travel. Telehealth can potentially increase in-home access to specialist care such as physiotherapy. This study examined clinical outcomes achieved with a hybrid telehealth model and assessed safety and efficiency. Method This study was an observational benchmarking study of Hospital in the Home physiotherapy episodes of care during respiratory exacerbations between January 2017–June 2019. The participants were young people aged 8–18 years, with cystic fibrosis receiving intravenous antibiotics and bi-daily physiotherapy. The intervention was physiotherapy via either a hybrid model (1× telehealth, 1× face-to-face session) or standard care (2× face-to-face sessions). The outcomes were frequency of return to at least 95% of baseline percentage predicted forced expiratory volume in the first second (ppFEV1), ppFEV1 change, adverse events, travel time and distance saved. Results There were 82 episodes of Hospital in the Home; 41 hybrid and 41 standard care. Return to at least 95% of baseline was achieved in 49% of the hybrid group and 32% of standard care. Median ppFEV1 change was +6% for the hybrid group and +2% standard care. There were no adverse events. Estimated travel time and distance saved was 16,520 min and 12,301.2 km. Conclusion Preliminary information supports a hybrid telehealth physiotherapy model as an alternative to standard care for young people with cystic fibrosis during an exacerbation. Safety of telehealth in conjunction with home visits favoured its use to improve efficiency and capacity without added risk.

Impact of length of stay in psychiatric intensive care on the episode trajectory

2021 ◽  
Author(s):  
H. Thomas de Burgh ◽  
Jeremy McCabe ◽  
Kamal Gupta
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
Extended Period ◽  
Post Discharge ◽  
Readmission Rates ◽  
Rapid Turnover ◽  
Complex Patients ◽  
Step Down ◽  
The Uk ◽  
Relationship Of

Background: Length of stay (LOS) on admission to psychiatric intensive care in the UK varies widely, with few studies examining the relationship of LOS to clinical outcomes. Data from two South London male PICUs delivering care with the contrasting philosophies of rapid turnover versus slower stepdown were investigated to determine if additional LOS correlated with clinical benefit.Method: Data on admissions to the PICUs were collected over six months and assessed for outliers and then for variance using Levene’s test. The variables were compared using independent samples t-tests. Pearson correlations were alsocalculated for the major variables.Results: Mean LOS was 8.4 days higher on PICU 1 (p = 0.026) and readmission rates to hospital 6 months post discharge were 27% higher on PICU 1 (p = 0.025). There were no strong correlations between LOS on either PICU and the other five variables examined.Conclusion: It was intuitive to expect better outcomes in the PICU with a slower turnover where complex patients could receive an extended period of re-evaluation of pharmacological treatments and engagement with services and could achieve a fuller recovery from the episode. However, this group had no reduction in LOS following step-down to the wards, readmission rates to PICU during in the index episode or re-hospitalisation six months following discharge. The PICU with a policy of rapid-turnover, concentrating on reducing acuity and risk and rapid step down, was equally effective on the measures evaluated.

scholarly journals Investigating the Extent to Which Personality Traits and Demographics Affect Job Satisfaction

2016 ◽  
Vol 4 (1) ◽  
pp. 70 ◽  
Author(s):  
Muhammad Sajid Saeed
Keyword(s):  
Job Satisfaction ◽  
Personality Traits ◽  
Negative Relationship ◽  
Demographic Variables ◽  
The Other ◽  
Retail Sector ◽  
Primary Concern ◽  
Different Types ◽  
The Uk ◽  
Ranking Analysis

The primary concern of this paper is to investigatethe extent to which three variables (i.e. personality traits, demographic variables, and job satisfaction) are interrelated with each other and what effect they have on each other in relation to the UK retail sector. The four different types of retail stores i.e. Tesco, Primark, Ikea and WH Smith were selected for survey purpose to minimise the class biasness.Total 300 close-ended questionnaires were distributed and 220 responses were obtained.The findings reveal that ‘Neuroticism’ is negatively associated with job satisfaction as well as with ‘Extraversion’. However, it is positively correlated with other three personality groups including ‘Agreeableness’, ‘Conscientious’, and ‘Openness’. On the other hand, ‘Openness to experience’ has a negative relationship with ‘Agreeableness’.It is also found from the ranking analysis that employees with ‘Agreeableness’ and ‘Conscientiousness’ personalities are more successful in their career and consequently they are more satisfied with their jobs.

Modelled evaluation of multi-component meningococcal vaccine (Bexsero®) for the prevention of invasive meningococcal disease in infants and adolescents in the UK

2013 ◽  
Vol 142 (9) ◽  
pp. 2000-2012 ◽  
Author(s):  
J. HUELS ◽  
K. M. CLEMENTS ◽  
L. J. McGARRY ◽  
G. J. HILL ◽  
J. WASSIL ◽  
...  
Keyword(s):  
Meningococcal Disease ◽  
Standard Care ◽  
Demographic Data ◽  
Time Frame ◽  
Transmission Dynamics ◽  
Transmission Model ◽  
Meningococcal Vaccine ◽  
Catch Up ◽  
The Uk

SUMMARYNeisseria meningitidis is the main cause of bacterial meningitis and sepsis in the UK, and can potentially be lethal or cause long-term sequelae. Bexsero® (4CMenB) is a new multi-component vaccine approved by the European Commission for use in individuals aged ⩾2 months. A theoretical transmission model was constructed to assess the long-term effectiveness of Bexsero compared to standard care. The model was populated with UK-specific demographic data and calibrated to ensure that the transmission dynamics of meningococcal disease in the UK were adequately simulated. The model showed the best strategy to be a routine vaccination programme at ages 2, 3, 4, 12 months and 14 years combined with a 5-year catch-up programme in toddlers aged 12–24 months and adolescents aged 15–18 years. This would lead to a 94% reduction in meningococcal cases or 150 000 cases and 15 000 deaths over a 100-year time-frame.

scholarly journals COVID-19 Pandemic: The Urgent Dental Hub experience from a primary care perspective

2021 ◽  
Vol 10 (3) ◽  
pp. 41-45
Author(s):  
Zohaib Khwaja ◽  
Awais Ali ◽  
Manraj Rai
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Dental Care ◽  
Specialist Care ◽  
Health Message ◽  
Face To Face ◽  
General Dental Practitioner ◽  
Public Health Message ◽  
The Uk

In response to the nationwide lockdown on 23 March 2020 in the UK, urgent dental hubs (UDHs) were established in the community to provide emergency dental care. Consecutive referrals to a primary care UDH were prospectively analysed over a one-month period, from 18 May 2020 to 18 June 2020. Of 400 referrals received, the most common were in relation to pain (87%). In 63% neither a radiograph nor photograph was provided with the referral. Seventy percent of patients were telephone triaged within 24 hours of receipt of referral. Fifty-three percent of referrals were accepted for face-to-face treatment, of which 69% were treated by extraction. Of rejected referrals (n=179; 45%), 79% were due to symptoms having settled or being manageable by the time of triage. A small number of referrals were redirected for specialist care. Referrals that were accepted were more likely to have been prescribed antibiotics and less likely to have been referred by the general dental practitioner (GDP) they regularly saw (p <0.01). Patients that were older and those that identified themselves as not having a regular GDP were less likely to have been referred to an UDH. The quality of referrals was poor and there may be a role for virtual consultations moving forwards. We found pre-referral antimicrobial prescriptions were high and a confused public health message may have been sent.

scholarly journals ABCD position statement on risk stratification of adult patients with diabetes during COVID-19 pandemic

2021 ◽  
Author(s):  
Dinesh Nagi ◽  
Emma Wilmot ◽  
Karissa Owen ◽  
Dipesh Patel ◽  
Lesley Mills ◽  
...  
Keyword(s):  
Diabetes Care ◽  
Clinical Care ◽  
Position Statement ◽  
Specialist Care ◽  
Long Term Conditions ◽  
Use Of Technology ◽  
Patients With Diabetes ◽  
Long Term Impact ◽  
The Uk

At the time of submission of this manuscript, the COVID-19 pandemic had cost nearly 60,000 lives in the UK. This number currently stands at over 120,000 deaths. A high proportion (one third) of these lived with diabetes. The huge acute and emergency medicine effort to support people with COVID-19 has had a major knock-on impact on the delivery of routine clinical care, especially for long-term conditions like diabetes.Challenges to the delivery of diabetes services during this period include a reduction in medical and nursing staff, limitations placed by social distancing on physical clinical space, and balancing virtual vs face-to-face care. There is a need to re-group and re-organise how we deliver routine out-patient adult diabetes services during the ongoing COVID-19 pandemic. We offer some suggestions for how patients can be stratified into red (urgent), amber (priority) and green (routine) follow up with suggestions of how often people should be seen. We also offer recommendation on how we can identify those at highest risk and try and minimise the long- term impact of COVID on diabetes careDuring the COVID pandemic we have seen things happen in days that previously took years. The restart of diabetes services has triggered a more widespread use of virtual consultations and data management systems, but also offers an opportunity for more joined-up and cohesive working between primary and specialist care. While we do our best to keep our patients and colleagues safe, this pandemic is already proving to be a catalyst for change, accelerating the appropriate use of technology in diabetes care and implementing innovative solutions. To achieve this aspiration, further work – currently led by the Association of British Clinical Diabetologists in collaboration with Diabetes UK and the Primary Care Diabetes Society – to make recommendations on future proofing diabetes care in UK is in progress.

scholarly journals It's time to talk: rekindling the relationship with primary care

2008 ◽  
Vol 14 (2) ◽  
pp. 84-85 ◽  
Author(s):  
Roger Banks ◽  
Linda Gask
Keyword(s):  
Mental Health Problems ◽  
Mental Healthcare ◽  
Strategy Training ◽  
Specialist Care ◽  
Healthcare Provision ◽  
Policy And Strategy ◽  
Working Together ◽  
Strategic Policy ◽  
The Uk ◽  
The Relationship

Healthcare provision in the UK is in a process of continual change. The structures and processes by which people with mental health problems and people with learning disabilities receive support from statutory services have been, and continue to be, subject to many and varied strategic, policy and professional influences. Integrated and collaborative ways of working between generalist (‘primary’) and specialist (‘secondary’) care have become eroded over time and yet they may be needed more than ever. In this editorial we encourage a collaborative approach between practitioners in generalist and specialist care in studying and developing three strands of work: policy and strategy; training; and professional behaviour. Above all, we advocate strongly for a renewed and dynamic dialogue between psychiatrists and general practitioners in working together to provide high-quality mental healthcare.

scholarly journals Crossing borders . . . shifting sands: An investigation of Chinese students’ study experiences in the UK and China

2019 ◽  
Vol 9 (3) ◽  
pp. 451-472
Author(s):  
Kashmir Kaur
Keyword(s):  
Higher Education ◽  
Student Mobility ◽  
Chinese Students ◽  
Focus Group Interviews ◽  
Different Types ◽  
English Medium Instruction ◽  
English Speaking ◽  
Group Interviews ◽  
The Uk ◽  
Learning Issues

In the current landscape of higher education in the UK, international students play a key role. It is an environment in which they not only cross borders physically but also transition through various identities as they develop their professional and linguistic confidence and skills to fully access and contribute to their programme of study and beyond. The aim of this paper is to outline the results of an empirical investigation into Chinese students’ perceptions of their study experiences in the context of student mobility and English-medium instruction in higher education. It reports on a study of two groups of Chinese students – one group studying in an English-speaking environment, the other in their home country where instruction is delivered through the medium of English. Semi-structured focus group interviews were conducted at each site which focused on the transition of “crossing borders” for educational purposes. The data was analysed using thematic analysis (Clarke & Braun, 2016). The main finding was that both groups experienced remarkably similar learning issues, despite being located in very different learning environments and crossing different types of borders.

Sign in / Sign up

Export Citation Format

Share Document