Care Commissioners Research Articles

Types and aspects of support that young carers need and value, and barriers and enablers to access: the REBIAS-YC qualitative study.

Many children and young people in England provide support to family members who are disabled, have mental or physical ill health, or misuse drugs or alcohol. Providing care can negatively impact children and young people's education, employment, health and social participation, with associated costs. Support is needed to prevent and reduce these negative impacts. The study sought to provide new knowledge and address prior research gaps regarding how best to support young carers from their perspective and that of the people they care for. To address the following questions: What types, components or features of services and other support are seen as helpful, valued, and acceptable to young people who look after someone at home and the people they support? Conversely, what is found to be less or unhelpful? What additional support is perceived as needed? What are the barriers experienced by young and young adult carers in seeking and accessing services for themselves or the person they support? What are the barriers and facilitators for practitioners in providing support and services perceived as valued, helpful and needed by young and young adult carers and the people they support? In-depth qualitative methodology using focus groups, in-depth semistructured interviews and workshops in four localities in England. One hundred and thirty-three carers aged 9-25 years with a range of caring and life circumstances and sociodemographic characteristics. Seventeen adult care recipients (parents) with a range of physical and/or mental healthcare and support needs. Nineteen practitioners from schools, colleges, young carers organisations, voluntary sector services, mental health services, the National Health Service, adult social care and local authority adult and children's social care commissioners. The types and aspects of support that young carers and their families need, and value when received, include: support that reduces or removes their practical and emotional caring responsibilities; support to mitigate the negative impacts of care and help with other life issues; information and advice about services and wider resources and support; someone trusted available to talk to; greater awareness, recognition and understanding; and choice, flexibility, and co-development of plans and solutions. We found a great deal of unmet need for support, and variation in type and quality of support received, including geographically. Potential limitations are that we were not able to engage with, or recruit, young carers from some intended subgroups, meaning some perspectives are missing. Partly because of COVID-19 measures during the study, we mainly recruited through young carers organisations and their family projects, although this was balanced by recruitment through schools and extensive outreach and engagement by the collaborating organisations prior to the project starting. Action is now needed to consistently and sustainably implement the types of support that young carers and the people they care for say they need and value. Future work should include more research from the perspectives of young carers and the people they care for, especially from particularly marginalised groups; and research to understand what works and how to improve implementation of the support needed and valued. This study is registered as Current Controlled Trials ISRCTN13478876. https://doi.org/10.1186/ISRCTN13478876. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR129645) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 36. See the NIHR Funding and Awards website for further award information.

Systematic review of types of safety incidents and the processes and systems used for safety incident reporting in care homes.

To identify the safety incident reporting systems and processes used within care homes to capture staff reports of safety incidents, and the types and characteristics of safety incidents captured by safety incident reporting systems. Systematic review following PRISMA reporting guidelines. Databases were searched January 2023 for studies published after year 2000, written in English, focus on care homes and incident reporting systems. Data were extracted using a bespoke data extraction tool, and quality was assessed. Data were analysed descriptively and using narrative synthesis, with types and characteristics of incidents analysed using the International Classification for Patient Safety. Databases were CINAHL, MEDLINE, PsycINFO, EMBASE, HMIC, ASSISA, Nursing and Allied Health Database, MedNar and OpenGrey. We identified 8150 papers with 106 studies eligible for inclusion, all conducted in high-income countries. Numerous incident reporting processes and systems were identified. Using modalities, typical incident reporting systems captured all types of incidents via electronic computerized reporting, with reports made by nursing staff and captured information about patient demographics, the incident and post-incident actions, whilst some reporting systems included medication- and falls-specific information. Reports were most often used to summarize data and identify trends. Incidents categories most often were patient behaviour, clinical process/procedure, documentation, medication/intravenous fluids and falls. Various contributing and mitigating factors and actions to reduce risk were identified. The most reported action to reduce risk was to improve safety culture. Individual outcomes were often reported, but social/economic impact of incidents and organizational outcomes were rarely reported. This review has demonstrated a complex picture of incident reporting in care homes with evidence limited to high-income countries, highlighting a significant knowledge gap. The findings emphasize the central role of nursing staff in reporting safety incidents and the lack of standardized reporting systems and processes. The findings from this study can inform the development or adaptation of safety incident reporting systems in care home settings, which is of relevance for nurses, care home managers, commissioners and regulators. This can help to improve patient care by identifying common safety issues across various types of care home and inform learning responses, which require further research. This study addresses a gap in the literature on the systems and processes used to report safety incidents in care homes across many countries, and provides a comprehensive overview of safety issues identified via incident reporting. PRISMA. A member of the research team is a patient and public representative, involved from study conception.

Reimagined day care for older people - supporting older people and caregivers to age in place.

There is a widespread view amongst policy makers, as well as some senior managers and commissioners in local authorities, that collective forms of day care for older people are outdated and not aligned with wider policy ambitions. However, there is also growing recognition, amongst advocacy organisations such as Carers UK and Age UK, that many older people and their caregivers would welcome the opportunity to attend collective day care services, as well as growing interest amongst providers of services and older people themselves about the need to transform provision. 
 As health and social care commissioners in England develop Integrated Care Systems, there is potential for reimagined day care for older people to play an important role in delivering person-centred, preventative and place-based care for older people and their caregivers, including enabling older people to live at home for longer as well as addressing wellbeing, loneliness and social isolation. 
 The presentation will outline findings from case studies visited as part of a National Institute for Health Research, School for Social Care Research study exploring the experiences of and aspirations for collective day care in England, from the perspectives of older people, their carers, those who work in or manage services, as well as local stakeholders from the health and care system. For this research, day care is defined as community building-based services that provide care and/or health related services and/or clubs and activities specifically for older people (65+) with care and support needs. 
 Case studies visited included a range of models of day care for older people including day centres for people living with dementia, small-scale day care based in a hosts home, to large-scale preventative provision for older people. The study explored: peoples experiences of attending; impact on wellbeing and health of older people and their caregivers; what an ideal model of day care would look like; experiences of day care through the COVID-19 pandemic; and relationships with local health and community partners. 
 Our findings highlight the role day care can play in providing opportunities for connection and friendship for older people who attend, supporting caregivers to sustain their caring role, and supporting physical and mental wellbeing and health of older people and their caregivers. Highlighting the importance of personal connections, joy and purposeful activity, design of the physical space and connections with local place, the presentation will discuss innovations in practice that may support a ‘reimagining of day care’, ensuring it meets the aspirations of older people and their caregivers, as well as supporting wider policy ambitions including how social care services can contribute to the wider preventative health agenda. 

The usage of data in NHS primary care commissioning: a realist evaluation

BackgroundTo improve health outcomes and address mounting costs pressures, policy-makers have encouraged primary care commissioners in the British National Health Service (NHS) to increase the usage of data in decision-making. However, there exists limited research on this topic. In this study, we aimed to understand how and why primary care commissioners use data (i.e. quantitative, statistical information) to inform commissioning, and what outcomes this leads to.MethodsA realist evaluation was completed to create context-mechanism-outcome configurations (CMOs) relating to the contexts influencing the usage of data in primary care commissioning. Using a realist logic of analysis and drawing on substantive theories, we analysed qualitative content from 30 interviews and 51 meetings (51 recordings and 19 accompanying meeting minutes) to develop CMOs. Purposive sampling was used to recruit interviewees from diverse backgrounds.ResultsThirty-five CMOs were formed, resulting in an overarching realist programme theory. Thirteen CMOs were identical and 3 were truncated versions of those formed in an existing realist synthesis on the same topic. Seven entirely new CMOs, and 12 refined and enhanced CMOs vis-à-vis the synthesis were created. The findings included CMOs containing contexts which facilitated the usage of data, including the presence of a data champion and commissioners’ perceptions that external providers offered new skillsets and types of data. Other CMOs included contexts presenting barriers to using data, such as data not being presented in an interoperable way with consistent definitions, or financial pressures inhibiting commissioners’ abilities to make evidence-based decisions.ConclusionsCommissioners are enthusiastic about using data as a source of information, a tool to stimulate improvements, and a warrant for decision-making. However, they also face considerable challenges when using them. There are replicable contexts available to facilitate commissioners’ usage of data, which we used to inform policy recommendations. The findings of this study and our recommendations are pertinent in light of governments’ increasing commitment to data-driven commissioning and health policy-making.

AHP P01 A Survey To Explore The Use Of Nutritional Outcome Measures In Clinical Practice By Dietitians In Oesophago-Gastric Cancer Care In The British Isles

Abstract Background Dietitians in clinical practice face the challenge of providing high quality care whilst demonstrating clinical effectiveness and continuous improvement. Assessing the effectiveness of dietetic intervention is vital in ensuring the provision of clinically effective dietetic services. Nutritional outcome measures are key in identifying the impact of dietetic interventions; enabling dietitians to objectively measure the effectiveness of their care as well as providing patients, other health care professionals and commissioners with data around the value of care provision. Currently there are no specific nutritional outcomes associated with oesophago-gastric cancer care in the UK. Methods A survey was disseminated through direct personal emails to 93 Dietitians known to be working in UGI, a list derived from NOGCA audit sites of 2021, with the aim of assessing the current use of nutritional outcome measures by Dietitians working in oesophago-gastric cancer acute care in the British Isles. Further promotion was directed through a UGI Dietitians Forum and through social media posts. A YouTube video was produced and distributed alongside the survey, with the aim of providing education around identifying nutritional outcomes. The video also aimed to connect personally with people, with a visual presentation from the researcher. Results 54 responses represented the entire patient journey. Whilst 72% of respondents reported identifying and documenting dietetic outcomes, the quality of these assessments was low, mainly focusing on weight, weight changes and hand grip strength. Other common themes related to nutritional intake, quality of life and symptom impact. Less common outcomes measured included standardised nutritional assessment (PG-SGA), gastro-intestinal symptom evaluation, optimised prehabilitation, biochemical parameters and patient experience. There was little standardisation in how outcomes are used and when they were taken. There is no national database available to collate OG nutritional outcome data, representing a missed opportunity to support national benchmarking. Conclusions This study has presented not only the inconsistencies in nutritional outcome data collection (definition, timing and tools) and the need for standardisation of outcomes use in this speciality, it has also demonstrated the challenges around the promotion of outcomes measures and application/roll out into clinical practice. Novel ways of obtaining and evaluating nutritional outcomes will need to be considered. This will form the basis of a further research study, exploring barriers to completion of nutritional outcomes.

The usage of data in NHS primary care commissioning: a realist review

BackgroundPrimary care has been described as the ‘bedrock’ of the National Health Service (NHS) accounting for approximately 90% of patient contacts but is facing significant challenges. Against a backdrop of a rapidly ageing population with increasingly complex health challenges, policy-makers have encouraged primary care commissioners to increase the usage of data when making commissioning decisions. Purported benefits include cost savings and improved population health. However, research on evidence-based commissioning has concluded that commissioners work in complex environments and that closer attention should be paid to the interplay of contextual factors and evidence use. The aim of this review was to understand how and why primary care commissioners use data to inform their decision making, what outcomes this leads to, and understand what factors or contexts promote and inhibit their usage of data.MethodsWe developed initial programme theory by identifying barriers and facilitators to using data to inform primary care commissioning based on the findings of an exploratory literature search and discussions with programme implementers. We then located a range of diverse studies by searching seven databases as well as grey literature. Using a realist approach, which has an explanatory rather than a judgemental focus, we identified recurrent patterns of outcomes and their associated contexts and mechanisms related to data usage in primary care commissioning to form context-mechanism-outcome (CMO) configurations. We then developed a revised and refined programme theory.ResultsNinety-two studies met the inclusion criteria, informing the development of 30 CMOs. Primary care commissioners work in complex and demanding environments, and the usage of data are promoted and inhibited by a wide range of contexts including specific commissioning activities, commissioners’ perceptions and skillsets, their relationships with external providers of data (analysis), and the characteristics of data themselves. Data are used by commissioners not only as a source of evidence but also as a tool for stimulating commissioning improvements and as a warrant for convincing others about decisions commissioners wish to make. Despite being well-intentioned users of data, commissioners face considerable challenges when trying to use them, and have developed a range of strategies to deal with ‘imperfect’ data.ConclusionsThere are still considerable barriers to using data in certain contexts. Understanding and addressing these will be key in light of the government’s ongoing commitments to using data to inform policy-making, as well as increasing integrated commissioning.

Non-pharmacological interventions for the management of perinatal anxiety in primary care: a meta-review of systematic reviews.

Perinatal anxiety (PNA), anxiety that occurs during pregnancy and/or up to 12 months postpartum, is estimated to affect up to 21% of women, and may impact negatively on mothers, children, and their families. The National Institute for Health and Care Excellence (NICE) has called for further research around non-pharmacological interventions in primary care for PNA. To summarise the available international evidence on non-pharmacological interventions for women with PNA in a primary care population. A meta-review of systematic reviews (SRs) with narrative synthesis was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance. Systematic literature searches were conducted in 11 health-related databases up to June 2022. Titles, abstracts, and full-text articles were dual-screened against pre-defined eligibility criteria. A variety of study designs were included. Data were extracted about study participants, intervention design, and context. Quality appraisal was performed using the AMSTAR 2 tool (A MeaSurement Tool to Assess systematic Reviews). A patient and public involvement group informed and contributed towards this meta-review. Twenty-four SRs were included in the meta-review. Interventions were grouped into the following six categories for analysis purposes: psychological therapies; mind-body activities; emotional support from healthcare professionals (HCPs); peer support; educational activities; and alternative or complementary therapies. In addition to pharmacological and psychological therapies, this meta-review has demonstrated that there are many more options available for women to choose from that might be effective to manage their PNA. Evidence gaps are present in several intervention categories. Primary care clinicians and commissioners should endeavour to provide patients with a choice of these management options, promoting individual choice and patient-centred care.

Spiritual, religious, and existential concerns of children and young people with life-limiting and life-threatening conditions: A qualitative interview study

Background: Despite being a core domain of palliative care, primary data on spiritual and existential concerns has rarely been collected among children with life-limiting and life-threatening conditions and their families. Existing evidence has tended to focus on the religious aspects among children with cancer. Aim: To identify the spiritual needs of children with life-limiting and life-threatening conditions. Design: Cross-sectional semi-structured, qualitative interview study with children, families and health and social care professionals. Verbatim transcripts were analysed using Framework analysis Setting/participants: Purposively sampled children with life-limiting and life-threatening conditions, their parents and siblings, health and social care professionals recruited from six hospitals and three children’s hospices in the UK, and commissioners of paediatric palliative care services recruited through networks and a national charity. Results: One hundred six participants were interviewed: 26 children (5–17 years), 53 family members (parents/carers of children 0–17 years and siblings (5–17 years)), 27 professionals (health and social care professionals and commissioners of paediatric palliative care). Themes included: living life to the fullest, meaning of life and leaving a legacy, uncertainty about the future, determination to survive, accepting or fighting the future and role of religion. Children as young as 5 years old identified needs or concerns in the spiritual domain of care. Conclusions: Addressing spiritual concerns is essential to providing child- and family-centred palliative care. Eliciting spiritual concerns may enable health and social care professionals to identify the things that can support and enhance a meaningful life and legacy for children and their families.

Piloting of a minimum data set for older people living in care homes in England: protocol for a longitudinal, mixed-methods study

IntroductionHealth and care data are routinely collected about care home residents in England, yet there is no way to collate these data to inform benchmarking and improvement. The Developing research...

Mapping and characterising electronic palliative care coordination systems and their intended impact: A national survey of end-of-life care commissioners.

In England, Electronic Palliative Care Coordination Systems (EPaCCS) were introduced in 2008 to support care coordination and delivery in accordance with patient preferences. Despite policy supporting their implementation, there has been a lack of rigorous evaluation of EPaCCS and it is not clear how they have been translated into practice. This study sought to examine the current national implementation of EPaCCS, including their intended impact on patient and service outcomes, and barriers and facilitators for implementation. We conducted a national cross-sectional online survey of end-of-life care commissioning leads for Clinical Commissioning Groups (CCGs) in England. We enquired about the current implementation status of EPaCCS, their role in information sharing and intended impact, and requested routine patient-level data relating to EPaCCS. Out of 135 CCGs, 85 (63.0%) responded, with 57 (67.1%) having operational EPaCCS. Use of EPaCCS were confined to healthcare providers with most systems (67%) not supporting information sharing with care homes and social care providers. Most systems (68%) sought to facilitate goal concordant care, although there was inconsonance between intended impacts and monitoring measures used. Common challenges to implementation included healthcare professionals' limited engagement. Only one-third of patients had an EPaCCS record at death with limited recording of patient preferences. Critical gaps exist in engagement with EPaCCS and their ability to facilitate information sharing across care providers. The limited alignment between stated goals of EPaCCS and their monitoring impedes efforts to understand which characteristics of systems can best support care delivery.

The provision of person-centred care for care home residents with stroke: An ethnographic study.

Care home residents with stroke have higher levels of disability and poorer access to health services than those living in their own homes. We undertook observations and semi-structured interviews (n= 28 participants) with managers, staff, residents who had experienced a stroke and their relatives in four homes in London, England, in 2018/2019. Thematic analysis revealed that residents' needs regarding valued activity and stroke-specific care and rehabilitation were not always being met. This resulted from an interplay of factors: staff's lack of recognition of stroke and its effects; gaps in skills; time pressures; and the prioritisation of residents' safety. To improve residential care provision and residents' quality of life, care commissioners, regulators and providers may need to re-examine how care homes balance safety and limits on staff time against residents' valued activity, alongside improving access to specialist healthcare treatment and support.

What do the NICE updates mean for people with type 1 diabetes?

NICE has recently updated its guidelines on the diagnosis and management of type 1 diabetes in adults. Dr Anne Kilvert and Dr Emma Wilmot here summarise the new recommendations and consider the implications for people with diabetes, health care professionals and commissioners.

Reflection on modern methods: constructing directed acyclic graphs (DAGs) with domain experts for health services research

Directed acyclic graphs (DAGs) are a useful tool to represent, in a graphical format, researchers’ assumptions about the causal structure among variables while providing a rationale for the choice of confounding variables to adjust for. With origins in the field of probabilistic graphical modelling, DAGs are yet to be widely adopted in applied health research, where causal assumptions are frequently made for the purpose of evaluating health services initiatives. In this context, there is still limited practical guidance on how to construct and use DAGs. Some progress has recently been made in terms of building DAGs based on studies from the literature, but an area that has received less attention is how to create DAGs from information provided by domain experts, an approach of particular importance when there is limited published information about the intervention under study. This approach offers the opportunity for findings to be more robust and relevant to patients, carers and the public, and more likely to inform policy and clinical practice. This article draws lessons from a stakeholder workshop involving patients, health care professionals, researchers, commissioners and representatives from industry, whose objective was to draw DAGs for a complex intervention—online consultation, i.e. written exchange between the patient and health care professional using an online system—in the context of the English National Health Service. We provide some initial, practical guidance to those interested in engaging with domain experts to develop DAGs.

Barriers and facilitators of use of analytics for strategic health and care decision-making: a qualitative study of senior health and care leaders’ perspectives

ObjectiveThis study investigated the barriers and facilitators that senior leaders’ experience when using knowledge generated from the analysis of administrative health or care records (‘analytics’) to inform strategic health and...

Developing a social prescribing research school using translational research: Learning from Wales

Abstract The Wales School for Social Prescribing Research (WSSPR) was launched in April 2020. Central to its functioning, WSSPR uses a translational research model (Cooksey, 2007; Weeks et al 2013) to describe, order and organise a multi-phase programme of applied research, development and evaluation. It promotes an equal and mutually supporting relationship between theory-building, knowledge acquisition and practice, without privileging any one activity. Within WSSPR sits the Wales Social Prescribing Research Network. The network has a membership of over 300 individuals interested in social prescribing research across Wales, this includes academics, social prescribers, policy makers, health and social care professionals and commissioners. The school is also linked to three communities of practice in the North, West & Mid, and South East of Wales, which collectively reach over 1000 social prescribing practitioners. Through the translational research model, issues and questions are raised by practice or members of the public through the network to WSSPR. These inform thinking and development of research projects and proposals. The network is then used to disseminate findings, receive feedback on findings and implement evidence-based changes in practice. This presentation will discuss the development of WSSPR and our networks & communities of practice using a translational model of research to develop programmes of research for Wales. It will discuss the challenges and provide step by step developmental guidance about setting up a research organisation for SP. It will demonstrate the impact of the social prescribing research and its contribution to the evidence base to date.

Outsourced austerity or improved services? A systematic review and thematic synthesis of the experiences of social care providers and commissioners in quasi-markets.

Social care services are commonly delivered by a combination of for-profit, public, and non-profit sector providers. These services are often commissioned in quasi-markets, in which providers from all sectors compete for public service contracts. The outsourcing of social services to private providers has resulted in a predominantly for-profit provision. Despite the rationale that open bidding facilitates better services and improved consumer choice, the outsourcing of social care has been criticized for prioritising cost-efficiency above service quality and effectiveness. However, the experiences and perspectives of those operating within quasi-markets (providers and commissioners) are poorly understood. To address this gap, we systematically identified, appraised, and thematically synthesised existing qualitative research on social care commissioners and providers (for-profit, public, and non-profit) published in the last 20 years (2000-2020). Twenty-six studies examining the perspectives of social care providers and commissioners relating to the quasi-market provision of social care were included. The synthesis demonstrates consistent concern among non-profit and public providers with regard to spending cuts in the care sector, whereas for-profit providers were primarily concerned with creating a profitable market strategy by carefully analysing opportunities in the commissioning system. All provider types described flaws in the commissioning process, especially with regards to the contracting conditions, which were reported to force providers into deteriorating employment conditions, and also to negatively impact quality of care. These findings suggest that in a commissioning environment characterised by austerity and public budget cuts, it is insufficient to assume that increasing the market share of non-profits will alleviate issues grounded in insufficient funding and flawed contracting criteria. In other words, no ownership type can compensate for inadequate funding of social care services.

Implementation of digital technology for connected resilient communities, enhancing access to public services

Digital technology has been presented as part of the solution to revolutionise public services, such as social care with its rising costs and demand. Here we present the outcome of an ongoing trial of CareTeam, a digital platform used during the redesign of the commission of domiciliary care for Portsmouth City Council, UK. CareTeam comprises a mobile app and sensors developed to support independent living, enabling communication and coordination of the wider care network. Qualitative interviews with care workers and commissioners were conducted to understand the impact on the commissioning and administration of care for clients and care workers/management. Responses indicate that technology can enhance care provision through increased transparency and collaboration. CareTeam provided (a) assurances to formal and informal carers that the care was actually being delivered and (b) improved adherence and adaptability to the care schedule delivering a more cost effective and robust service. While previous research has shown digital technologies perceived as being in competition with traditional service provision, CareTeam was found to support human interactions. Results show that connected services can be deployed to support assisted living through providing person centric, efficient and cost-effective support in the budget-restrained social services reality.

Influences on NHS Health Check behaviours: a systematic review

BackgroundNational Health Service Health Checks were introduced in 2009 to reduce cardiovascular disease (CVD) risks and events. Since then, national evaluations have highlighted the need to maximise the programme’s impact by improving coverage and outputs. To address these challenges it is important to understand the extent to which positive behaviours are influenced across the NHS Health Check pathway and encourage the promotion or minimisation of behavioural facilitators and barriers respectively. This study applied behavioural science frameworks to: i) identify behaviours and actors relevant to uptake, delivery and follow up of NHS Health Checks and influences on these behaviours and; ii) signpost to example intervention content.MethodsA systematic review of studies reporting behaviours related to NHS Health Check-related behaviours of patients, health care professionals (HCPs) and commissioners. Influences on behaviours were coded using theory-based models: COM-B and Theoretical Domains Framework (TDF). Potential intervention types and behaviour change techniques (BCTs) were suggested to target key influences.ResultsWe identified 37 studies reporting nine behaviours and influences for eight of these. The most frequently identified influences were physical opportunity including HCPs having space and time to deliver NHS Health Checks and patients having money to adhere to recommendations to change diet and physical activity. Other key influences were motivational, such as beliefs about consequences about the value of NHS Health Checks and behaviour change, and social, such as influences of others on behaviour change. The following techniques are suggested for websites or smartphone apps: Adding objects to the environment, e.g. provide HCPs with electronic schedules to guide timely delivery of Health Checks to target physical opportunity, Social support (unspecified), e.g. include text suggesting patients to ask a colleague to agree in advance to join them in taking the ‘healthy option’ lunch at work; Information about health consequences, e.g. quotes and/or videos from patients talking about the health benefits of changes they have made.ConclusionsThrough the application of behavioural science we identified key behaviours and their influences which informed recommendations for intervention content. To ascertain the extent to which this reflects existing interventions we recommend a review of relevant evidence.

Morbidity Prevalence Estimate at 6 Months Following a Stroke: Protocol for a Cohort Study.

BackgroundKnowledge of the prevalence of morbidity secondary to stroke is important for health care professionals, health care commissioners, third sector organizations, and stroke survivors to understand the likely progress of poststroke sequelae and to aid in commissioning decisions, planning care, and adjusting to life after stroke.ObjectiveThe primary aim of the Morbidity PRevalence Estimate In StrokE (MORe PREcISE) study is to determine the prevalence of morbidity secondary to a stroke, predictors of morbidity, and trends in quality of life and functional status using patient-reported outcomes, cognitive and functional assessments.MethodsA total of 500 participants will be recruited across Wales and England within 14 days following an admission to a stroke unit for either an ischemic or hemorrhagic stroke as part of a multicenter cohort study. Participants are assessed at baseline ≤14 days poststroke and subsequently at 90 (± 14) days and 180 (± 14) days poststroke. At each time point, data will be collected relating to the following domains: participant demographics, routine clinical, patient reported, cognitive status, emotional well-being, and functional ability.ResultsRecruitment commenced in October 2018 with 20 sites opened as of September 2019 and was closed on October 31, 2019.ConclusionsThe primary outcome is the prevalence of morbidity at 6 months secondary to a stroke. Further analysis will consider temporal changes in the health-related domains to describe trends among baseline, 3-, and 6-month time points.Trial RegistrationClinicalTrials.gov NCT03605381; https://clinicaltrials.gov/ct2/show/NCT03605381International Registered Report Identifier (IRRID)DERR1-10.2196/15851

Emergency Admission Risk Prediction (EARP) tools in primary care to reduce emergency admissions to hospital: clash of evidence and practice.

Policy initiatives have incentivised use of EARP tools in primary care to reduce emergency admissions. A recently published trial in South Wales found that EARP increased emergency admissions and emergency department attendances without clear benefits. This cost the NHS an additional £76 per patient per year. But the use of EARP in primary care across the UK was unknown. To assess implementation and facilitators use of EARP tools in primary care across the UK. Structured email survey of 235 UK primary care commissioners across the UK. There were 148 (87%) of 171 responders (73%) who reported that EARP tools were available in their areas. We identified 39 different EARP tools in use. Access to EARP tools varied widely by country: Northern Ireland (100%), Scotland (91%), England (76%) and Wales (14%). Promotion by NHS commissioners, and engagement of clinical leaders and practice managers were identified as the most important factors in encouraging use of EARP tools. Research evidence was seen as less important. Nearly 40% of areas using EARP reported that they had revised services as a result, but few reported use of EARP for service evaluation. Though EARP tools are widely available in primary care, new evidence shows that they are counter-productive. We estimate that by delaying the dissemination of EARP for evaluation NHS Wales saved >£200 million per year. We encourage further research and discussion about next steps in use of EARP tools in emergency admission prevention in the UK.