Co-Designing Health Service Evaluation Tools That Foreground First Nation Worldviews for Better Mental Health and Wellbeing Outcomes

It is critical that health service evaluation frameworks include Aboriginal people and their cultural worldviews from design to implementation. During a large participatory action research study, Elders, service leaders and Aboriginal and non-Aboriginal researchers co-designed evaluation tools to test the efficacy of a previously co-designed engagement framework. Through a series of co-design workshops, tools were built using innovative collaborative processes that foregrounded Aboriginal worldviews. The workshops resulted in the development of a three-way survey that records the service experiences related to cultural safety from the perspective of Aboriginal clients, their carer/s, and the service staff with whom they work. The surveys centralise the role of relationships in client-service interactions, which strongly reflect their design from an Aboriginal worldview. This paper provides new insights into the reciprocal benefits of engaging community Elders and service leaders to work together to develop new and more meaningful ways of servicing Aboriginal families. Foregrounding relationships in service evaluations reinstates the value of human connection and people-centred engagement in service delivery which are central to rebuilding historically fractured relationships between mainstream services and Aboriginal communities. This benefits not only Aboriginal communities, but also other marginalised populations expanding the remit of mainstream services to be accessed by many.

Cardiology referrals before and during the COVID-19 pandemic: a health service evaluation

Background/Aims The COVID-19 pandemic has resulted in unprecedented changes to healthcare services. This study aimed to evaluate the impact of the COVID-19 pandemic on referrals to cardiology services in a tertiary hospital. Methods Royal Stoke University Hospital has a cardiac assessment nurse team that provides rapid access to specialist cardiology opinion. All referrals are recorded on a database, which was used to determine how COVID-19 affected the number and types of referrals to cardiology during March–September 2019 and March–September 2020. Results A total of 12 447 referrals were made to the cardiac assessment nurse teams over the evaluation period. Compared to the average number of referrals across all months, there was a decline of 10.5%, 31.2% and 18.5% during March, April and May 2019 respectively. Comparing 2020 to 2019, there were more 999 calls (17.7% vs 15.7%) and accident and emergency referrals (46.5% vs 45.0%), and fewer interhospital referrals (16.0% vs 19.6%). In terms of advice provided for the 999 referrals, a greater number were advised to go to the accident and emergency department (10.5% vs 0%) and direct phone advice provided to those in other settings increased (11.7% vs 0.1%) in 2020. Conclusions The COVID-19 pandemic was associated with a reduction in the number of overall referrals to cardiology, while also demonstrating a shift towards more advice to attend the accident and emergency department for assessment or direct phone advice being provided about management in the community.

Self-perceived evaluation of prenatal care: a hierarchical analysis by the users of Primary Health Care services in Brazil

Objective: to analyze the factors associated with positive self-perceived evaluation of prenatal care among users of Primary Health Care (PHC). Methods: the analytical cross-sectional study was carried out with secondary data from the 3rd Module of the 2nd cycle (2013 / 2014) of the External Evaluation of the Improvement of Access and Quality of Primary Care Program (PMAQ-AB – Portuguese acronym), collected from users in the Basic Health Units (BHU) that joined the PMAQ-AB in Brazil. The hierarchical analysis was performed using a theoretical model and logistic regression was performed between the self-perceived evaluation (positive - very good/good or negative - regular/poor/very bad) and the sociodemographic characteristics, prenatal care and health service evaluation (p<0.05). Results: the sample consisted of 9,922 women and 81.7% rated care as very good/good. In the final model, positive evaluation was associated to women with incomplete higher education or over (OR=1.05; CI95%=1.01-1.09; p=0.010), who underwent the VDRL exam (OR=1.07; CI95%=1.01-1.14; p=0.020), consultation with the same professional (OR=1.07; CI95%=1.02-1.12; p=0.010), received guidance on the gynecological preventive exam (OR=1.05; CI95%=1.01-1.08; p=0.007), believed that guidance helped with pregnancy and child care (OR=1.24; CI95%=1.05-1.46; p=0.012), evaluated the BHU structure as very good/good (OR=1.19; CI95%=:1.14-1.24; p<0.001) and would not change BHU or team (OR=1.62; CI95%=1.48-1.68; p<0.001). Conclusion: the positive evaluation of prenatal care was associated with sociodemographic factors, prenatal care and health service evaluation.

Therapeutic Ride: Health Service Evaluation and Satisfaction of Patients and Their Caregivers

Objective: To evaluate the health service and the satisfaction of patients and their caregivers in relation to the therapeutic ride, in Integrated Continuous Care. Methods: Cross-sectional, descriptive study, conducted between January 2017 and January 2018, using a specific form for data collection and interview conducted before hospital discharge. Results: The study included 23 patients and 27 caregivers. Regarding the evaluation of the service related to the therapeutic ride, 95.6% (22/23) of the patients and 70.4% (19/27) of the caregivers confirmed that they understood the objectives of this practice. The duration of the therapeutic ride was considered sufficient by 69.6% (16/23) of patients and 70.4% (19/27) of caregivers. Most patients (52.2%) and caregivers (70.4%) declared to be very satisfied with the result of the therapeutic ride. Conclusion: The therapeutic ride demonstrates its differential aspect by adding training, contributing greatly to the safe transition from the hospital to the home.

Tinnitus healthcare: a survey revealing extensive variation in opinion and practices across Europe

Tinnitus remains a scientific and clinical problem whereby, in spite of increasing knowledge on effective treatment and management for tinnitus, very little impact on clinical practice has been observed. There is evidence that prolonged, obscure and indirect referral trajectories persist in usual tinnitus care.ObjectiveIt is widely acknowledged that efforts to change professional practice are more successful if barriers are identified and implementation activities are systematically tailored to the specific determinants of practice. The aim of this study was to administer a health service evaluation survey to scope current practice and knowledge of standards in tinnitus care across Europe. The purpose of this survey was to specifically inform the development process of a European clinical guideline that would be implementable in all European countries.DesignA health service evaluation survey was carried out.SettingThe survey was carried out online across Europe.ParticipantsClinical experts, researchers and policy-makers involved in national tinnitus healthcare and decision-making.Outcome measuresA survey was developed by the study steering group, piloted on clinicians from the TINNET network and underwent two iterations before being finalised. The survey was then administered to clinicians and policy-makers from 24 European countries.ResultsData collected from 625 respondents revealed significant differences in national healthcare structures, use of tinnitus definitions, opinions on characteristics of patients with tinnitus, assessment procedures and particularly in available treatment options. Differences between northern and eastern European countries were most notable.ConclusionsMost European countries do not have national clinical guidelines for the management of tinnitus. Reflective of this, clinical practices in tinnitus healthcare vary dramatically across countries. This equates to inequities of care for people with tinnitus across Europe and an opportunity to introduce standards in the form of a European clinical guideline. This survey has highlighted important barriers and facilitators to the implementation of such a guideline.

Developing the role of midwives as ‘contraceptive champions’ to support early access to effective postnatal contraception for women

ObjectiveTo evaluate the acceptability of the new contraceptive champion role to the first hospital and community midwives in NHS Lothian trained in this role.DesignHealth service evaluation.PopulationHospital and community midwives trained as contraceptive champions, NHS Lothian, Scotland, UK.MethodsQualitative research: 1:1 semi-structured interviews (baseline and follow-up) with five contraceptive champions.Main outcome measureQualitative data on views of the new contraceptive champions on the first 6 months of the role.ResultsAll contraceptive champions stated increased confidence in their knowledge of postnatal contraception. They reported that women had not questioned the role of midwives in inserting contraceptive implants postnatally in hospital and at home. Midwife colleagues and hospital doctors had been supportive.ConclusionThe new role of contraceptive champion is reported by midwives to have been well received in its first year by women, the midwives themselves and their healthcare colleagues.