Health and Social Care Delivery Research (HSDR) Programme Logic Model

. As such, it aims to contribute to the NIHR's mission of improving the health and wealth of the nation by funding research that assesses the clinical and cost-effectiveness of healthcare treatments in comparison with the current best alternative(s), and that is therefore immediately useful to patients, clinical practice, and policy or decision-makers. More information about the programme can be found on the NIHR website. A logic model is a visual way of showing how an activity, programme or intervention is expected to work and bring about the benefits and changes it intends to achieve. By summarising the core elements, a logic model can be used to support programme planning, implementation and evaluation. NIHR logic models representin a linear flow diagramthe key activities, outputs, outcomes and impacts of each funding programme as a series of logical steps.

<b>MRC-NIHR Efficacy and Mechanism Evaluation (EME) Programme Logic Model</b><br /> <br /> Juliana Callaghan&sup1;, Robert Gray&sup1;, Louise Jones&sup2;, Adam Lockwood&sup1;, Danny McAuley&sup3;, John Norrie⁴, Danielle Preedy&sup1;, Sarah Thomas&sup1;, Insa Wemheuer&sup1;<br /> &sup1;National Institute for Health and Care Research (NIHR), School of Healthcare Enterprise and Innovation, University of Southampton, &sup2;UK Research and Innovation (UKRI) Medical Research Council (MRC), &sup3;Queen's University of Belfast, ⁴The University of Edinburgh<br /> February 2023<br /> <br /> The EME Programme is a partnership between the Medical Research Council (MRC) and the National Institute for Health and Care Research (NIHR). The aim of the programme is to improve the health and wealth of the nation by funding clinical efficacy studies that test if an intervention or technology which has shown early promise in patients works as expected in a well-defined group of patients. This may include using such studies to understand treatment mechanisms. The programme plays a key role in translational research by testing novel or repurposed interventions/technologies and determining whether their development should progress to later-phase clinical trials, or inform new earlier-stage research. <a href="https://www.nihr.ac.uk/explore-nihr/funding-programmes/efficacy-and-mechanism-evaluation.htm">More information can be found on the programme page on the NIHR website</a>.<br /> <br /> A logic model is a graphical way to show how an activity, programme or intervention is expected to work and bring about the benefits and changes it intends to achieve. By summarising the core elements, a logic model can then be used to support programme planning, implementation and evaluation. NIHR logic models represent in a linear flow diagram the key activities, outputs, outcomes and impacts of each funding programme as a series of logical steps.<br /> <br /> <br /> <br /> <b>Inputs</b><br /> The first step outlined in the logic model focuses on ‘inputs’, i.e., the resources needed to undertake programme activities. The inputs for the EME Programme are: <ul> <li>MRC and NIHR funding</li> <li>funding from the devolved nations</li> <li>NIHR coordinating centre resources</li> <li>stakeholder time</li> <li>the existing UK research infrastructure in terms of expertise, capacity and funding</li> </ul> <br /> <br /> <b>Activities&nbsp; </b><br /> Inputs feed into activities, the second stage of the logic model. Activities are the actions that NIHR and the funded research community undertake to help achieve the programme’s aims and objectives. Together, inputs and activities represent NIHR’s planned work.<br /> <br /> The initial focus for the programme is identification of key research questions, issues and programme priorities. A NIHR team develops targeted <a href="https://www.nihr.ac.uk/researchers/funding-opportunities/">funding opportunities</a> and activities through horizon scanning and collaboration with key stakeholders to stimulate activity or applications in an area of strategic priority. The programme also invites researcher-led proposals, which enables research into investigator-driven areas. All submitted project proposals are reviewed by harnessing detailed feedback from experts, including academics and other professional experts (for example, clinical staff and health care professionals) as well as patients, carers, service users, specific communities and/or members of the general public. A panel recommends high-quality research projects for funding according to set criteria.<br /> <br /> Funded projects are then actively monitored by a NIHR team that supports the project by providing advice and expertise regarding, for example, risks, appropriate methodologies, stakeholder management or patient and public involvement and engagement.<br /> <br /> NIHR support also includes guidance on the dissemination of research outputs. NIHR supports transparent research management and publication of knowledge, with information on and results of projects being openly accessible via the NIHR <a href="https://fundingawards.nihr.ac.uk/">website</a> and <a href="https://www.journalslibrary.nihr.ac.uk/#/">NIHR Journals Library</a> that hosts the <a href="https://www.journalslibrary.nihr.ac.uk/EME/#/">NIHR EME journal</a>.<br /> <br /> Further, the EME Programme’s application and funding process ensures that funded research projects test interventions/technologies independently and rigorously for efficacy, as well as mechanistic insight. The research process often includes collecting samples, for example in the form of biobanks. By funding projects that follow on from clinical studies supported by the NIHR or other funders, the programme also actively supports researchers in reusing data or samples.<br /> <br /> The EME Programme also builds research capacity through initiatives to broaden, strengthen and upskill the translational research community. &nbsp;For example, the programme provides tailored funding opportunities and activities to support the development of early-career clinical trialists and to stimulate cross-sector and international collaboration.<br /> <br /> <br /> <b>Outputs </b><br /> The next step of the flow diagram focuses on the range of ‘outputs’ that result directly from the undertaken activities. For the EME Programme, these include: <ul> <li>academic outputs such as articles in the <a href="https://www.journalslibrary.nihr.ac.uk/eme/#/">NIHR EME journal</a> and other peer-reviewed journals,</li> <li>communications tailored to key audiences (e.g. patient groups, industry, policy-makers and health-care professionals)</li> <li>study data from the testing of interventions/technologies</li> <li>samples collected as part of the research</li> <li>new intellectual property (IP) being registered as a result of the funded research</li> </ul> <br /> <br /> <br /> <b>Cross-cutting activities</b><br /> Some activities that enable the intended change cut across several steps of the logic model: <ul> <li>Stakeholder collaboration: the programme works closely with stakeholders such as other funders, industrial partners, patients, carers, service users, specific communities and the public to support translational research across the ecosystem</li> <li>Targeted knowledge exchange and dissemination takes place across the project lifecycle</li> <li>Activities, outputs and outcomes produced through research contribute to an increasing pool of knowledge which feeds into and influences both the identification of new questions and methods for answering those questions.</li> </ul> <br /> <br /> <b>Outcomes</b><br /> Outcomes are the changes or benefits the programme intends to produce through its activities and by funding a portfolio of research. Due to the programme’s position on the translational pathway and its role being to inform further research, outcomes are typically seen on a short- to medium-term.<br /> <br /> <b>Scientific advancements</b><br /> Research outputs document and disseminate the scientific advancements made by NIHR-funded projects. Scientific advancements include improved knowledge of the potential health benefits of interventions/ technologies and their mechanisms of action. They also include methodological advancements in the field of clinical trials and mechanistic studies. Improved knowledge can also stimulate further research. For research funded by the EME Programme, this can occur in both directions of the research and development pathway, with, for example, research teams continuing to study the tested interventions/ technologies in later-phase clinical trials or the results stimulating further earlier stage research. This all contributes to the UK’s world-leading reputation in delivering translational health research.<br /> <br /> <b>More efficient and effective health research</b><br /> Developing sample banks and establishing the effectiveness of interventions and technologies results in more efficient and effective health research. For example, trials showing ‘no effect’ of the tested intervention/ technology leads to researchers switching to other approaches, which reduces waste in UK scientific research and increases the efficiency of investments in Phase II and Phase III trials. Involving patients, carers, service users, specific communities and/or members of the general public in all steps of the research process results in increased relevance of research to patient and public need. Increased international and cross-sector collaboration in research enables aligned and complementary research aims to be addressed and optimises delivery of the translational research ecosystem.<br /> <br /> <b>De-risking future investment in research</b><br /> In the medium-term, research funded by the EME programme is expected to result in the de-risking of future investment in research by establishing which interventions and technologies are effective, how they work, and progressing those that are effective for practical use as measured on the Technology Readiness Level (TRL) scale. Increased knowledge around interventions/technologies and their mechanisms of action can also enable increased investment in associated development.<br /> <br /> <b>Enhanced research capacity </b><br /> Research projects funded by the EME Programme also contribute to enhancing research capacity in the form of training and skill-building of project team members through specialist skills and career progression, for example. Working on EME-funded projects is also expected to improve understanding of and interest in translational research for both researchers and trial sites. Collectively, this is expected to result in increased trial activity, capacity and networks, which in turn contributes to international recognition of the UK’s research capabilities.<br /> <br /> <br /> <b>Impacts</b><br /> Impacts, or long-term outcomes, are the anticipated broader (direct and indirect) changes or benefits for organisations, communities, systems and wider society expected to result from the programme's contribution via its activities and portfolio of funded research. These are expected to become apparent in approximately 10-25 years.&nbsp;<br /> For the EME Programme, the overarching long-term benefits are further research and the development of new and repurposed interventions and technologies. These contribute to health benefits through new or repurposed interventions and technologies; improved wealth of the nation through job creation; more effective and efficient use of healthcare resources through targeted investment into promising interventions and technologies; and ultimately, to improving the health and wealth of the nation.&nbsp;<br /> <br /> <br /> <b>Contributions and acknowledgements</b><br /> The NIHR supports the principles of open research, including full and appropriate recognition of the many varied contributions to the creation of knowledge. To support this, we use the<a href="https://credit.niso.org/"> CRediT taxonomy</a> to accurately reflect how each team member has brought their knowledge and skills to the development and delivery of this work. Those that have contributed to this work are listed alphabetically.&nbsp; <ul> <li>Juliana Callaghan:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Writing – review &amp; editing</li> <li>Robert Gray:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Conceptualization, Writing – review &amp; editing&nbsp;</li> <li>Louise Jones:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Conceptualization</li> <li>Adam Lockwood:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Conceptualization, Project administration, Funding acquisition, Methodology, Supervision, Writing – review &amp; editing</li> <li>Danny McAuley:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Conceptualization, Writing – review &amp; editing</li> <li>John Norrie:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Conceptualization, Writing – review &amp; editing</li> <li>Danielle Preedy: &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Conceptualization, Writing – review &amp; editing</li> <li>Sarah Thomas:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Conceptualization, Funding acquisition, Methodology, Supervision</li> <li>Insa Wemheuer:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Project administration, Visualization, Writing – original draft, Writing – review &amp; editing</li> </ul> <br /> In addition, we would specifically like to thank Rebecca Adler, Principal Consultant at NIRAS, and David Salisbury, Independent Consultant and NIRAS Associate, for facilitating the initial development of a Theory of Change for the EME Programme that formed the basis of developing the logic model presented in this document. We would also like to thank the Communications Team at the School of Healthcare Enterprise and Innovation, University of Southampton, for their advice and support in undertaking the visualisation of the model.&nbsp;<br /> <br /> The Logic Model presented in this document also builds on the following document:&nbsp;<br /> <br /> Rentel M C, Simpson K, Dav&eacute; A, Carter S, Blake M, Franke J, <i>et al.</i> A 10-year impact assessment of the Efficacy and Mechanism Evaluation (EME) programme: an independent mixed-method evaluation study. <i>Efficacy Mech Eval</i> 2021;8(20)<br /> <br /> <b>Competing interests&nbsp;</b><br /> This work has been undertaken as part of the delivery of the National Institute for Health and Care Research (NIHR), which is funded by the Department of Health and Social Care. The EME programme is a partnership between the Medical Research Council (MRC) and the NIHR. It is funded by the MRC and the NIHR, with contributions from the CSO in Scotland, Health and Care Research Wales and the HSC R&amp;D Division, Public Health Agency in Northern Ireland. All authors of this document have contributed to it as part of work paid for by the NIHR. No competing interests were disclosed.

The Evidence Synthesis Programme (ESP) is part of the National Institute for Health and Care Research (NIHR). As such, it aims to contribute to the NIHR's mission of improving the health and wealth of the nation by generating high-quality evidence syntheses (ES) to support evidence-informed health and care policy and practice. More information about the programme can be found on the NIHR website. A logic model is a graphical way to show how an activity, programme or intervention is expected to work and bring about the benefits and changes it intends to achieve. By summarising the core elements, a logic model can then be used to support programme planning, implementation and evaluation. NIHR logic models represent in a linear flow diagram the key activities, outputs, outcomes and impacts of each funding programme as a series of logical steps. This logic model sets out the essential elements of, and pathway to, impact for the NIHR ESP. Evidence syntheses are research projects that use formal techniques to bring together, evaluate and combine data from multiple studies to summarise and make sense of the existing body of research evidence on a particular topic.

Signifcant changes were brought about in health and social care in England in 2013, as a result of the Health and Social Care Act 2012. As part of the changes in 2013, a network of local Healthwatch organisations was set up to act as the people’s champion for health and social care in their local area. Healthwatch Shropshire is one of these local Healthwatch. It gathers experiences and opinions from patients, carers, service users and the wider public about publicly funded health and social care services and uses this information to infuence health and social care service delivery. Healthwatch Shropshire also recruits and trains volunteers to support its work, in particular, specially trained volunteers visit locations where health and social care services are provided and report on their fndings. Healthwatch Shropshire also has information and signposting services, provides volunteering opportunities, and has a statutory authority to visit locations where health and social care services are being delivered.Keywords: patient participation, consumer participation, public opinion

Improving access and quality for ethnic minority women— panel discussion

The Public Health Research (PHR) Programme is part of the National Institute for Health and Care Research (NIHR). As such, it aims to contribute to the NIHR's mission of improving the health and wealth of the nation by funding research that evaluates practical public health interventions and generates evidence that supports public health decisionmaking. It supports this decision-making by informing the delivery of non-NHS interventions through new knowledge on its benefits, costs, acceptability and wider impacts, and thus leads to sustainable population level change by improving the health of the public and reducing inequalities in health. More information can be found on the NIHR website. A logic model is a visual way of showing how an activity, programme or intervention is expected to work and bring about the benefits and changes it intends to achieve. By summarising the core elements, a logic model can be used to support programme planning, implementation and evaluation. NIHR logic models representin a linear flow diagramthe key activities, outputs, outcomes and impacts of each funding programme as a series of logical steps.

Background: Ireland has national strategies and policies setting out the importance of integrated care and coordination of care and support between health and social care services, to enable children to get timely and appropriate care and support. Despite Government commitment to a coordinated approach, delivery of care and support to children continues to be inconsistent and fragmented. While children with complex needs are more likely to experience significant gaps and delays in the care and support they need, evidence shows that any child in need of care and support from a health or social care service is at risk of gaps and delays. The Health Information and Quality Authority (HIQA) and the Mental Health Commission (MHC) are the regulatory bodies for health and social care services, and mental health services, in Ireland. To promote and support greater integration and collaboration between health and social care services, HIQA and the MHC worked together to develop national standards for all health and social care services working with children. Throughout the standards development process, we collaborated with children and families with lived experience, and advocates and staff working in health and social care services. Methods: These evidence-based standards cover all health and social care services working with children, including healthcare, disability, mental health and children’s social services. They provide a shared framework for all services and aim to support them to work together in a coordinated and collaborative way to improve the experience and outcomes of children and families. The standards were informed by a literature review, and extensive stakeholder involvement including focus groups with 217 children, young people and families with lived experience, advocates, staff, inspectors, and policy-makers; and 130 responses to two public consultations. An Advisory Group representing key stakeholders and a Children’s Reference Group informed the standards. The Children’s Reference Group comprised of young people and family members with experience of health and social care to ensure active people involvement and engagement in design and implementation of the standards. Their input helped ensure the standards authentically reflected what children should expect from a health and social care service committed to child-centred care. Initiative: This is the first time a set of Irish national standards has been developed focused on the needs of all children across health and social care services. The standards are underpinned by the principles of a children’s rights-based approach, safety and wellbeing, responsiveness, and accountability. Presented in the child’s voice, they articulate what outcomes a child should expect and what a service needs to do to achieve these outcomes. Impact: These standards will help to drive quality, safety, consistency and coordination across health and social care services working with children, as all organisations and services will be operating to one set of consistent national standards. Although an important lever for change, we recognise that services will need tools to support implementation of the standards and we will work with the sector to identify and collaboratively develop relevant tools to support implementation of the standards in day-to-day practice.

Gambling-related harms constitute a significant public health concern, with adverse effects ranging from financial difficulties to mental health disorders. Therefore, people experiencing gambling-related harm may need different kinds of services. While previous studies have examined the prevalence and impacts of problematic gambling, less is known how individuals who gamble use social and health care services. This study examines the social and health care usage between gambling severity groups: (1) non-gambling, (2) recreational, (3) at risk and (4) problem gambling. We aim to examine whether people with risk or problematic gambling use more social and health care services compared to non-gamblers, and what increases the probability to use social and health care services with individuals in different groups. The study used data from the population-based Healthy Finland survey (N = 28,154, 49.3%). Health and social care use were measured with separate questions by asking if participants had used services in the past 12 months (yes/no). Our results show that among individuals with problem gambling, 86% had utilized health care services, and 18% social care services during the past year, which was somewhat higher than among individuals who did not gamble. Among different gambling severity groups, it seemed, that the use of health care services is less common among men, younger individuals, people with excessive alcohol use and among those with higher income. Among individuals with problem gambling and low-risk gambling, the utilization of social services was more common among those with lower income, individuals experiencing psychological distress and long-standing illnesses. These results provide new knowledge on how people with different levels of risk for gambling harm use social and health services, and support to develop social and health services in responding to gambling problems.Key messages• People who experience different levels of risk or problem gambling are already patients in health care, and we need to make sure, that gambling is recognized behind the service use.• With these results we can understand who of those experiencing gambling problems are not in health care services, and develop practices to increase help-seeking.

PROTOCOL: Personal Budgeting Interventions to Improve Health and Social Care Outcomes for People with a Disability: A Systematic Review

BackgroundVast amounts of data are collected about patients and service users in the course of health and social care service delivery. Electronic data systems for patient records have the potential to revolutionise service delivery and research. But in order to achieve this, it is essential that the ability to link the data at the individual record level be retained whilst adhering to the principles of information governance. The SAIL (Secure Anonymised Information Linkage) databank has been established using disparate datasets, and over 500 million records from multiple health and social care service providers have been loaded to date, with further growth in progress.MethodsHaving established the infrastructure of the databank, the aim of this work was to develop and implement an accurate matching process to enable the assignment of a unique Anonymous Linking Field (ALF) to person-based records to make the databank ready for record-linkage research studies. An SQL-based matching algorithm (MACRAL, Matching Algorithm for Consistent Results in Anonymised Linkage) was developed for this purpose. Firstly the suitability of using a valid NHS number as the basis of a unique identifier was assessed using MACRAL. Secondly, MACRAL was applied in turn to match primary care, secondary care and social services datasets to the NHS Administrative Register (NHSAR), to assess the efficacy of this process, and the optimum matching technique.ResultsThe validation of using the NHS number yielded specificity values > 99.8% and sensitivity values > 94.6% using probabilistic record linkage (PRL) at the 50% threshold, and error rates were < 0.2%. A range of techniques for matching datasets to the NHSAR were applied and the optimum technique resulted in sensitivity values of: 99.9% for a GP dataset from primary care, 99.3% for a PEDW dataset from secondary care and 95.2% for the PARIS database from social care.ConclusionWith the infrastructure that has been put in place, the reliable matching process that has been developed enables an ALF to be consistently allocated to records in the databank. The SAIL databank represents a research-ready platform for record-linkage studies.

BackgroundThe COVID-19 pandemic has accelerated the digitalization of services, but at the same time, some user groups are excluded due to a lack of digital skills. One of the vulnerable groups is people with mental health problems. It has previously been found that self-efficacy beliefs explain the use of digital technology, but the role of social support is largely unexamined. Bandura’s concept of proxy agency provides a useful concept to investigate the role of social support in using digital services.ObjectiveThe study investigates sources of social support and the effect of proxy agency, Internet efficacy, and self-efficacy beliefs on the intention to use digital health and social care services.MethodsParticipants (N = 121) were users in community-based mental health services who were recruited through four organizations in southern Finland for a cross-sectional study. The scales for proxy agency and intention to use services were developed for purpose of the study. The questionnaire also comprised self-efficacy and Internet efficacy scales. Quantitative data were analyzed using descriptive statistics and linear regression analysis.ResultsBoth Internet self-efficacy and proxy efficacy (p < 0.001) predicted the intention to use digital health and social care services. Self-efficacy had an indirect positive effect on intention through Internet self-efficacy. Family members and friends were the main source of social support in using digital services.ConclusionInternet self-efficacy and proxy efficacy are important contributors to the intention to use digital health and social care services. Proxy agents may serve as facilitators to reduce the digital divide and promote the use of digital services by complementing individuals’ self-efficacy and Internet self-efficacy beliefs. It is important to develop different forms of social support, such as peer support, to enhance the quality of proxy agency. The limitations of proxy agency are discussed.

Population ageing and longevity are major trends that affect public health and social and health care systems. On average, the older people are, the more they have chronic conditions such as dementia, multimorbidity, and functional and cognitive decline, which require the use of different health care services. This workshop presents topical research findings on older people's health care service use, studied with different research methods and extensive datasets, and discusses the future challenges in providing adequate services for all. Our workshop highlights the diverse care needs and explores the use and the factors behind the use of health care among the older population. Even though the diverse care needs of older people are increasingly recognised, the attention often focuses on older people's services, i.e., the services whose main user groups consist of older people. These usually include home care services, auxiliary services, and long-term care facilities. However, the diverse care needs of older people include the need for different types of health care services, which are used by people in all age groups, such as hospital care, outpatient health care services, and emergency care. Services may not necessarily meet the diverse needs of the older population in a situation where both financial and human resources are limited. From the perspective of service providers, challenges arise when people have multiple or extensive service needs. Coordination and integration of services to promote the use of scarce resources according to multiple needs is challenging. From the perspective of individuals, the service system can appear fragmented, and it can be difficult to access the services that would be most beneficial. To promote adequate and effective health and social care use, we need more information about the factors contributing to different care use profiles. Our objective is to explore how ageing of population and increase in the number of people with chronic conditions is reflected in the use of various health care services and discuss how the needs and use as well as the organisation of health and social care services will develop in the future, as the number of very old people in Europe is estimated to more than double by 2050. We will focus on the use of health care services by different groups, such as people with dementia, people with multimorbidity, and cognitive decline. We will discuss how services should be developed and organised so that, as service needs grow and resources remain scarce, we can provide the older population with adequate services, which are a crucial part of the tasks of the welfare states. We add to the discussion on how different datasets, including registry-based data, could be utilised even more innovatively in research on health care services. The studies presented at the workshop utilise extensive Finnish and Swedish research data, analysed with different and novel statistical methods. Key messages • In terms of the adequacy of health and social care services, it is paramount to acknowledge that population ageing will increase the need for health care services, not only social and long-term care. • To better respond to future care needs with well-coordinated services, we need up-to-date and comprehensive research on the different older health care service user groups.

IntroductionTo assess how health care professionals outline the management of care and explore which health or social care professionals were involved in the patient's treatment.MethodsA survey with a patient vignette for general practitioners (n = 31) and registered nurses (n = 31) working daily in Finnish health centres located in four cities. Respondents answered structural questions and explained in detail the care process that they tailored for the patient. The care process was examined using content analysis.ResultsA physician–nurse working pair was declared to be in charge of the care process by 27% of respondents, a registered nurse by 9% and a general practitioner by 11%. However, 53% reported that no single person or working pair was in charge of the care process (response rate 72%). The concluding result of the analyses of the presented process was that both treatment practices and the professionals participating in the patient's treatment varied. Collaboration with social services was occasional, and few care processes included referrals to social services.ConclusionFor the patient who needs both health and social care services, the management of care is a challenge. To improve the chances of patients being actively involved in making treatment plans at least three factors need to be addressed. Firstly, a written treatment plan should explicate the care process. Second, collaboration and interaction between health and social care services should be strengthened, and third, a contact person should be named to avoid care gaps in primary health care. Next-step data from patients need to be collected to get their views on care management and compare these with those from general practitioners and registered nurses.

BackgroundHealth concerns, such as frailty and osteoporotic fractures decrease functional capacity and increase use of health and social care services in the aging population. The ability to continue living at home is dependent on functional capacity, which can be enhanced by rehabilitation.We study the effects of a 12-month home-based physiotherapy program with 12-month follow-up on duration of living at home, functional capacity, and the use of social and health care services among older persons with signs of frailty, or with a recently operated hip fracture.MethodsThis is a non-blinded, parallel group, randomized controlled trial performed in South Karelia Social and Health Care District, Finland (population 131,000). Three hundred community-dwelling older persons with signs of frailty (age ≥ 65) and 300 persons with a recent hip fracture (age ≥ 60) will be recruited. Frailty is screened by FRAIL questionnaire and verified by modified Fried’s frailty criteria. Both patient groups will be randomized separately to a physiotherapy and a usual care arm. Individualized, structured and progressive physiotherapy will be carried out for 60 min, twice a week for 12 months at the participant’s home. The primary outcome at 24 months is duration of living at home. Our hypothesis is that persons assigned to the physiotherapy arm will live at home for six months longer than those in the usual care arm. Secondary outcomes are functional capacity, frailty status, health-related quality-of-life, falls, use and costs of social and health care services, and mortality. Assessments, among others Short Physical Performance Battery, Functional Independence Measure, Mini Nutritional Assessment, and Mini-Mental State Examination will be performed at the participant’s home at baseline, 3, 6, and 12 months. Register data on the use and costs of social and health care services, and mortality will be monitored for 24 months.DiscussionOur trial will provide new knowledge on the potential of intensive, long-term home-based physiotherapy among older persons at risk for disabilities, to enhance functional capacity and thereby to postpone the need for institutional care, and diminish the use of social and health care services.Trial registrationClinicalTrials.gov Identifier: NCT02305433, Registered Nov 28, 2014.

This research explores service providers’ views on the barriers that prevent women in the sex work industry in Ireland from accessing co-ordinated health services. A purposive sample of eight service providers in the field of women’s health and social care in the West of Ireland were selected and interviewed for this study. The service providers were asked about their perception of the barriers of sex workers accessing health and social care services. Using thematic analysis, three key themes were identified: (1) lack of knowledge of women’s involvement in sex work; (2) identified barriers to health services; and (3) legislative and policy barriers to providing supportive services. While the service providers acknowledged that they do not knowingly provide services for sex workers, they all recognise that some of their service users are at risk of, and potentially are, involved in sex work. Yet, they were able to identify some of the barriers sex workers face when accessing their services. All these barriers were the result to the services’ limited capacity to support women engaging in sex work. At the time of data collection, the legislative context meant that selling sex under certain conditions was outside the law. This study highlights the consequences that criminalisation can have on the health of sex workers and the need for a paradigm shift in existing health and social care services. In this paper, we propose that a social justice rather than a criminal justice approach has the potential to address sex workers’ right to access appropriate health care. This paper gives due recognition to marginalised women, and advocates for better provision of services for women in the sex industry, while considering the new legislation of 2017.