Care Planning Research Articles

Local authority variation in special educational needs provision at the start of primary school: observational study of preterm children born in England, 2003-2013

Objective and ApproachWe explored variation in special educational needs (SEN) provision between local authorities (LAs) in England by focussing on children born preterm (24-<37 weeks gestation). We used linked individual-level state-funded hospital and school records from the ECHILD database, alongside publicly available school-level records. LA of child’s residential address (n=150) and recording of SEN provision (split into SEN support and education, health and care plans, EHCPs) were captured at the January school census in year one, when pupils were five/six years old. We fitted multi-level logistic regression models to the child-level records that included a-priori selected child- and LA-level characteristics. ResultsOur population included 226,419 children (45.4% female ; 10.6% with a congenital anomaly) born between 2003-2013 and attending a state-funded primary school. Across LAs, the median prevalence of SEN support and EHCPs recorded in year one was 18.4% (interquartile range 16.4%-20.4%) and 4.2% (3.5%-4.8%), respectively. In the SEN support vs. no SEN provision model, there was very low correlation among children from the same LA (intraclass correlation coefficient (ICC)=0.006 )). There was higher correlation in the EHCP vs. no SEN provision model (ICC=0.032). Of the LA-level characteristics, the percentage of children eligible for free school meals had the greatest impact on the ICC values (reduction of 26.7% in the EHCP model). ConclusionsLess than 1% of the variation in SEN support and approximately 3% of the variation in EHCPs was explained at the LA level. We will extend these models to consider variation at the school level.

Disabilities in children receiving care and support in Wales and risk factors associated with being placed in care: A population-based data linkage study

ObjectiveTo determine the prevalence of functional impairments in children with disabilities receiving care and support in Wales between 2016 and 2022, and to investigate risk factors associated with being placed in care amongst these children. MethodThis study used Children Receiving Care and Support (CRCS) Census records held in the Secure Anonymised Information Linkage Databank. We examined the proportion of children with specific impairments by their looked-after status, using bar charts and Upset plots. CRCS records were linked to demographic datasets to obtain information on area-level deprivation, and we conducted multivariable logistic regression analyses to model risk factors associated with being placed in care for children with disabilities. ResultsOf 38,165 children receiving care and support, 10,075 (26%) had a disability, and 3,360 (33%) of these children were placed in care. Older children were less likely to be placed in care than infants (e.g. for age group 1‒4: OR 0.37 (95% CI 0.24‒0.56)). Children of mixed ethnicity were more likely to be placed in care compared to White children (2.17 (1.65‒2.85)). Child mental health problems were associated with being placed in care (1.82 (1.60‒2.07)) as were parental mental health problems (1.44 (1.29‒1.60)), parental substance/alcohol misuse (3.16 (2.81‒3.56)), parental learning disability (2.92 (2.51‒3.38)), and domestic abuse (1.48 (1.31‒1.66)). ConclusionsThis new evidence may assist in the planning and provision of appropriate ongoing care and support for these children and their families to help prevent entry into the care system.

CLOUD SECURITY POSTURE MANAGEMENT AUTOMATING RISK IDENTIFICATION AND RESPONSE IN CLOUD INFRASTRUCTURES

Cloud Security Posture Management (CSPM) tools have become essential in addressing the growing security challenges faced by organizations as they migrate to cloud environments. This study explores the effectiveness of CSPM tools in automating the identification and response to security risks within cloud infrastructures, highlighting their role in reducing misconfigurations, improving compliance, and enhancing overall security posture. Through a mixed-method approach, combining a comprehensive literature review, a survey of IT security professionals, and detailed case study analyses, this research provides a robust evaluation of CSPM tools' capabilities and the challenges associated with their implementation. The findings reveal that organizations utilizing CSPM tools experience significant reductions in security incidents and operational inefficiencies, with automation playing a crucial role in enabling real-time threat detection and response. However, the study also identifies critical barriers to CSPM adoption, including integration complexities, cost concerns, and organizational resistance to automated security solutions. These challenges suggest that while CSPM tools offer substantial benefits, their successful deployment requires careful planning, adequate resource allocation, and strategic change management to address both technical and human factors. This study contributes to the existing literature by providing detailed insights into the practical applications and limitations of CSPM tools, offering valuable guidance for organizations seeking to enhance their cloud security strategies through automation.

Hospital admissions among adolescents in out-of-home care or special educational needs in England: insights from the ECHILD database of linked health, education and social care records

ObjectiveWe quantified planned and unplanned hospital admissions during adolescence for children with special educational needs (SEN) or placed into the care of the local authority (child looked after in out-of-home care; CLA). ApproachWe analysed linked hospital, education and social care records with whole nation coverage of England (ECHILD). Our cohort comprised pupils who started secondary school between 2007/8 and 2011/12 (aged 11), with follow-up until 2018/19 (up to 17-22 years old). Hospital admission rates were examined by sex across distinct groups with varying levels of support: i) no support, ii) school-based SEN only, iii) higher SEN (an Education and Health Care Plan) only, iv) CLA only, v) SEN and CLA, and vi) higher SEN and CLA. Negative binomial regression models were used to estimate rate ratios (RR) for each group relative to no support. Results The study population totalled 2,827,464 children; 65% (1,835,404) had no support, 30% (848,620) SEN only, 3% (93,620) higher SEN only, 1% (30,880) SEN and CLA, with the remaining groups accounting for <1%. Planned and unplanned hospital admission rates were higher for girls than boys. Planned admission rates were highest among younger children in both higher SEN groups. CLA groups had the highest rates of unplanned hospital admissions, especially girls aged 13-15 years with higher SEN (RR: 7.69, 95% CI: 6.86-8.65). A significant proportion of all unplanned admissions in adolescence were mental health-related. ImplicationsOur findings highlight significant unmet health needs, particularly in mental health, among care-experienced adolescent girls with SEN in their mid-teens.

Communication processes in an advance care planning initiative: A socio-ecological perspective for service evaluation.

Advance care planning initiatives are becoming more widespread, increasing expectations for providers to engage in goals of care conversations. However, less is known about how providers communicate advance care planning within and throughout a health care system. To explore perspectives of communication processes in the rollout of an advance care planning initiative. Theoretically informed secondary analysis of 31 semi-structured interviews. Key partners in a Veterans Health Administration goals of care initiative. Using the constant comparative approach followed by qualitative mapping of themes to the layers of the Socio-Ecological Model, four themes and corresponding Socio-Ecological layers were identified: Goals of Care Communication Training (Policy, Community, and Institutional) requires more resources across sites and better messaging to reduce provider misconceptions and promote an institutional culture invested in advance care planning; Interprofessional Communication (Interpersonal) suggests care team coordination is needed to facilitate continuity in goals of care messaging; Communication in Documentation (Institutional, Interpersonal, and Intrapersonal) highlights the need for capturing the context for goals of care preferences; and Patient/Family Communication (Interpersonal and Intrapersonal) encourages offering materials and informational resources early to facilitate rapport building and readiness to determine goals of care. Findings support the need for initiatives to incorporate an evaluation of how goals of care are discussed beyond the interpersonal exchange between patient and provider and signal opportunities for applying the Socio-Ecological Model to better understand goals of care communication processes, including opportunities to improve initiation and documentation of goals of care.

Improving risk models for patients having emergency bowel cancer surgery using linked electronic health records: a national cohort study

ObjectiveTo investigate whether accuracy of a risk model for colorectal cancer (CRC) patients undergoing emergency surgery, including patient and tumour characteristics from disease-specific data, was improved by inclusion of physiological and surgical measures from linked treatment-specific data. ApproachLinked, routinely-collected data on patients undergoing emergency CRC surgery in England between December 2016 and November 2019 were used to develop a risk model for 90-day mortality. Backwards selection identified a 'selected model' of physiological and surgical measures in addition to patient and tumour characteristics. Model performance was assessed compared to a 'basic model' including only patient and tumour characteristics. Missing data was multiply imputed. Results846 of 10,578 (8.0%) patients died within 90 days of surgery. The selected model included seven pre-operative physiological and surgical measures (pulse rate, systolic blood pressure, breathlessness, sodium, urea, albumin, and predicted peritoneal soiling), in addition to the ten patient and tumour characteristics in the basic model (year of surgery, age, sex, ASA grade, cancer site, number of comorbidities, emergency admission, TNM T stage, N stage and M stage). The selected model had considerably better discrimination than the basic model (C-statistic: 0.824 versus 0.783, respectively). ConclusionLinkage of disease-specific and treatment-specific datasets allowed the inclusion of physiological and surgical measures in a risk model alongside patient and tumour characteristics, which improved the accuracy of predictions. ImplicationsOur new accurate and relatively simple risk prediction model for patients undergoing emergency CRC surgery will allow more accurate performance monitoring of healthcare providers and enhance clinical care planning.

The congruence between the preferred and actual places of death among terminal cancer patients in China

BackgroundDying in a preferred place is important for a good death. Currently, no study has evaluated the extent to which the preferences for the place of death (PoD) are met among terminal cancer patients in China. This study examined the congruence between the preferred and actual PoD and its predictors among terminal cancer patients in China.MethodsBetween 2015 and 2023, 845 terminal cancer patients from four tertiary hospitals in Wuhan, China, were enrolled and followed till death. Face-to-face surveys at baseline and telephone-based interviews in the last month of patients’ lives were combined to learn patients’ preferred PoD. Data on patients’ actual PoD were collected from families within 1 month after patients’ death.ResultsOf the 410 patients who died, 62.7% of them died in hospitals. The agreement between patients’ preferred and actual PoD was fair (κ = 0.221). The congruence between patients’ preferred and actual PoD was 63.0, 36.6%, and 0 for hospital death, home death, and hospice facility/nursing home death separately. Patients were more likely to die in their preferred places if their preferred place and family caregivers’ belief of patients’ preferred PoD was congruent (odds ratio [OR] = 6.464, p = 0.001), or if caregivers had a medically related occupation (OR = 4.577, p = 0.003); if patients were hospitalized at least twice in the last month of life (OR = 0.422, p = 0.000), or the quality of care received by patients in the last 48 h was rated good by the families (OR = 0.373, p = 0.011), patients were less likely to die in their preferred places.ConclusionThe congruence between patients’ preferred and actual PoD was fair. Advance care planning (ACP) needs to be popularized in China, and the quality of care in hospice facilities and nursing homes should be improved. The necessary policy support for hospice care should be made to respect cancer patients’ end-of-life (EoL) care preferences in China.

Palliative care in terminally ill advanced chronic liver disease patients.

While mortality rates from advanced chronic liver disease (ACLD) are rapidly increasing, patients with an advanced disease stage have acomparable or even higher symptom burden than those with other life-limiting diseases. Although evidence is limited there is increasing recognition of the need to improve care for patients with ACLD; however, there are many limiting factors to providing good palliative care for these patients, including unpredictable disease progression, the misconception of palliative care and end of life care as being equivalent, alack of confidence in prescribing medication and alack of time and resources. Health professionals working with these patients need to develop the skills to ensure effective palliative care, while referral to specialized palliative care centers should be reserved for patients with complex needs. Basic palliative care, along with active disease management, is best delivered by the treating hepatologists. This includes discussions about disease progression and advance care planning, alongside the active management of disease complications. Liver disease is closely associated with significant social, psychological, and financial burdens for patients and their caregivers. Strategies to engage the discussion in multidisciplinary teams early in disease progression help to ensure addressing these issues proactively. This review summarizes the evidence on palliative care for patients with ACLD, provides examples of current best practice and offers suggestions on how disease-modifying and palliative care can coexist, to ensure that patients do not miss opportunities for quality of life improving interventions.

Effect of Hospital-to-Home Transitional Care for COPD on Patient-Centered Outcomes.

Appropriate hospital-to-home transitional care has been recognized for its positive impact on health care usage and health outcomes in patients with COPD. However, there is limited research assessing its effects on patient-centered outcomes, focusing on patient symptoms and experiences. This single-blind randomized controlled trial included subjects diagnosed with COPD at one of 2 university hospitals in South Korea. The study included 179 subjects (transitional care group [transitional care], 87; usual care group [usual care], 92). The transitional care received transitional care comprising post-discharge care planning, personalized education, breathing exercises, telephone counseling, home visits, and referral to social services. We analyzed the effects of these interventions by comparing breathing symptoms and various patient-centered outcomes between the 2 groups. The Modified Medical Research Council scores (mean [SD], transitional care 1.3 [1.06], usual care 1.82 [1.1], P = .002) and COPD Assessment Test scores (transitional care 6.32 [5.5], usual care 9.43 [7.16], P = .001) in the intervention group demonstrated more significant improvement than did those in the usual care. Following intervention, the subjects exhibited enhanced awareness of their disease, an increased frequency of inhaler use (transitional care 49.69 [1.67], usual care 46.86 [7.92], P = .002), and lower depression and anxiety scores. Additionally, the transitional care outperformed the usual care in the domain of subject experience during hospitalization (transitional care 39.34 [6.14], usual care 37.5 [5.61], P = .036), preparedness before discharge (transitional care 34.54 [4.96], usual care 32.3 [5.09], P = .003), and post-discharge management (transitional care 34.72 [4.36], usual care 30.29 [4.26], P = .003). Evidence-based transitional care services can exert positive effects on patient-centered indices. Our findings can be used as evidence of the need to establish patient-centered transitional care as a form of universal care for patients with COPD.

The Influence of Pulmonary Arterial Hypertension In Pregnancy: A Review.

Pulmonary arterial hypertension (PAH) is a severe condition characterized by increased pulmonary vascular resistance and right ventricular failure. This review examines the intersection of PAH and pregnancy, highlighting the significant physiological, hemodynamic, and hormonal changes that exacerbate PAH during gestation. Pregnancy is contraindicated in PAH patients due to high maternal and fetal morbidity and mortality rates. However, some patients choose to continue their pregnancies, necessitating a comprehensive understanding of the implications and management strategies. Effective management of PAH in pregnant patients involves individualized treatment plans. Prepartum management focuses on optimizing therapy and monitoring hemodynamic status. Prostacyclin analogs and phosphodiesterase inhibitors are commonly used, though their safety profiles require further investigation. Intrapartum management prioritizes preventing right ventricular failure, utilizing therapies such as intravenous epoprostenol, inhaled iloprost, and inhaled nitric oxide. Managing PAH in pregnancy requires careful planning, continuous monitoring, and tailored therapeutic strategies to navigate the complex interplay of physiological changes and mitigate risks. Future research should focus on elucidating the pathophysiology of PAH during pregnancy and developing safer, more effective treatments to improve maternal and fetal outcomes.

Preferences for coordinated care for rare diseases: discrete choice experiment

BackgroundEvidence suggests that coordination of care for people affected by rare diseases is poor. In order to improve the way that care is coordinated it is necessary to understand the preferences of people affected by these conditions, and providers. The aim of this study was to examine patient, parent and carer, and health care professional preferences for different attributes of care coordination for people affected by rare diseases. We conducted a discrete choice experiment using online surveys. There were no restrictions on participants in terms of rare conditions, demographic factors other than age, or geographical location within the UK. Choice scenarios were based on the following attributes: annual cost of attending appointments; access to health records; access to clinical expertise; support of a care coordinator; access to a specialist centre; and, the existence of a documented plan for emergency care. Data were analysed using alternative-specific conditional logit regression models.ResultsValid responses were obtained from 996 individuals (528 patients, 280 carers, 188 health care professionals) between August and December 2019. All attributes significantly influenced the type of service respondents preferred. Patients, carers and health professionals’ preferences for care coordination were influenced by: the cost of attending appointments; access to health records; clinical expertise; role of care coordinators; access to specialist centres; and the existence of plan for emergency care. There were no statistically significant differences in the preferences between patients and carers. Preferences of health professionals differed to those of patients and carers. Both patients and carers selected responses which granted them a greater degree of autonomy in relation to the role of care coordinators, whereas health professionals preferred services where care coordinators had more autonomy. Health care professionals also expressed a stronger preference for a documented formal emergency plan to be in place.ConclusionsThe findings highlight that people value better coordinated care, in line with policy documents emphasising commitments to coordinated care for people affected by rare diseases. This study highlights the factors that could be included in service provision as ways of improving the coordination of care for people affected by rare diseases.

SP4.12 - A single centre experience of managing patients admitted for elective Nissen’s Fundoplication as a day case procedure

Abstract Aims Laparoscopic Nissen’s fundoplication (LNF) is an elective procedure used to treat gastro-oesophgeal reflux which cannot be managed effectively with medical and conservative methods. LNF is the most common surgical procedure used to treat reflux in the UK and optimising the discharge process for these patients can therefore prevent excessive admission times for many patients. This study aimed to analyse the success of LNF as a day case procedure in a tertiary centre. Methods The notes from patients who underwent LNF between January 2020 and December 2023 were retrospectively reviewed. The demographics, co-morbidities and the rates of readmission and complications of the patients included were noted. All patients were managed following local and national surgical, anaesthetic and nursing guidelines. Results 67 patients underwent LNF within the time frame studied, each of which were initially planned to be kept in hospital overnight. 41 (61.2%) cases however, were considered to be medically safe for discharge as a day case operation. None of the patients studied required readmission or suffered any complications despite this change in their care plan. Conclusions This single centre experience showed that patient safety was not compromised by encouraging LNF as a day case procedure in selected patients. Day-case protocols should therefore be considered for patients undergoing LNF who have no/few major co-morbidities and can be looked after at home post-operatively in order to reduce healthcare costs and maximise bed space availability.

FP1.14 - A Re-audit of the prevalence of faecal incontinence in hospital inpatients

Abstract Introduction Faecal incontinence (FI) is a common and under-reported problem, with many patients too embarrassed to seek help. Patients often do not receive optimal care due to lack of identification. In-hospital identification when they are admitted for other reasons may be one method of improving the care of such patients. Aims & Methods We had assessed the identification of continence problems in our hospital inpatients via a simple ‘spot check’ audit of the different wards in 2015; we used the case notes for checking the documentation by both nursing and medical staff. We looked at care plans, stool charts, follow up plans etc. We repeated this audit in 2023 to check for any improvement. Results Overall,132 (163 in 2015) patient case notes were examined. 94%(previously 90) had nursing documentation about bowels documented in comparison to 47% (48) for medical documentation. 5.3% (10.8) were found to have FI. Only 28% (31) of these patients would have been identified by medical documentation. Most of the patients identified with FI were elderly, as expected; surprisingly, 28.57% were on general surgical wards. All patients (100%) in 2015 were then referred appropriately for further management. In 2023, though some action for FI was taken in 71.42 % patients, no referral was apparently arranged in any. Conclusion It is important to identify patients with FI, establish cause and initiate appropriate management. The impact on the individual patient’s QOL needs assessment prior to planning management/specialist referral etc. We found that our nursing documentation was still better than medical documentation which needs to be improved; however, onward referral/management needs improving significantly.

Management of a Radicular Cyst Encroaching the Maxillary Sinus in a Thrombocytopenic Patient: the Crucial Role of Oral Physicians in Careful Planning and Intervention

Management of a Radicular Cyst Encroaching the Maxillary Sinus in a Thrombocytopenic Patient: the Crucial Role of Oral Physicians in Careful Planning and Intervention

Pregnant Women Presenting to Psychiatric Emergency Services: A Retrospective Chart Review from India

Background: Managing psychiatric emergencies during pregnancy is often challenging, as the safety of both the mother and the unborn fetus needs to be considered. This study aimed to examine the nature of psychiatric emergencies in pregnancy, their management, and clinical outcomes in women presenting to a psychiatry emergency room (ER). Methods: Charts of perinatal women consulting psychiatry ER between January 2016 and June 2021 were reviewed for the nature of the psychiatric emergency, pregnancy details, psychiatric symptoms, sociodemographic information, medical comorbidities, clinical diagnosis, and care plan. Results: Among 286 perinatal women who attended psychiatry ER, 57 (19.9%) patients were pregnant. Over half ( n = 30, 52.6%) women were multiparous and in their second trimester ( n = 29, 50.9%). Bipolar disorder ( n = 22, 38.6%) was the most common diagnosis. Agitation/aggression ( n = 34, 59.6%) was the most common reason for visiting ER, with risk of self-harm ( n = 14, 24.6%) and risk of harm to the fetus ( n = 7, 12.3%) being other reasons. Emergency psychotropic medications were used in 32 (56.1%) women, with the use of haloperidol in combination with promethazine ( n = 12, 37.5%) or lorazepam ( n = 8, 25%) being the most common. Conclusion: One-fifth of women in the perinatal period presenting to the ER were pregnant. Agitation and aggression were the most common reasons. Parenteral medications were commonly used, and more than a fifth required inpatient care, emphasizing the seriousness of risk.

Case Report: Unveiling an anomalous diaphragmatic paraganglioma mimicking a hepatic tumor

Abstract Paragangliomas are rare neuroendocrine tumors, often associated with catecholamine secretion. These tumors can arise in various locations, with the majority found in the abdomen and pelvis, while a smaller percentage occurs in the thorax and head and neck regions. Diaphragmatic paragangliomas are exceedingly rare, with only two documented cases in the literature. This report details a case of a primary diaphragmatic paraganglioma in a 59-year-old patient presenting with unexplained weight loss, tremors, and diaphoresis. Imaging studies revealed a mass in the right lobe of the liver, later identified as a diaphragmatic paraganglioma during surgery. The case underscores the importance of preoperative catecholamine assessment and careful surgical planning due to the risks associated with tumor manipulation. Complete surgical resection, although challenging, remains the definitive treatment, especially in hypervascular tumors located near major vascular structures.

The physical and mental health of home care recipients: A quantitative secondary data analysis

The physical and mental health of home care recipients: A quantitative secondary data analysis Abstract: Background: Although more and more people are being supported by home care services, there is a lack of information regarding the health limitations and needs of this group. Aim: The objective of this study was to examine the health status of people with home care needs in Switzerland. Method: A secondary data analysis based on the HomeCareData database, which contains routine data on people with home care requirements in Switzerland, was conducted. All cases with a fully completed Resident Assessment Instrument (RAI-HC) were included. Data on various items of the RAI-HC and other standardized scale scores with reference to physical or mental health were analyzed using descriptive statistics. Results: In total, 74,674 data records were evaluated. Physical limitations most frequently manifested in the form of fatigue (40.6%), pain (29.7%) or within the scope of impaired hearing (21.9%). Around a third of individuals sampled had experienced a fall in the last 90 days. With regard to mental health, the most frequent signs were fear of falling (33.5%), loneliness (13.9%), depression (12.8%) and anxiety (4%). Approximately one third showed signs of impaired cognition and polypharmacy was detected in almost 68% of those evaluated. Conclusion: Considering the comparatively high prevalence of mental health problems among people with home care requirements, there is a need to develop appropriate skills of employees in home care services and for adequate care planning.

Preferences for Advance Care Planning in Patients with End-stage Kidney Disease: A Cross-sectional survey amongst Nephrology healthcare providers in a Tertiary Care Center in India.

Introduction: Advance care planning (ACP) is essential in managing patients with end-stage kidney disease (ESKD), yet its integration into clinical practice remains limited, particularly in low- and middle-income countries. This study explores the preferences, attitudes and perceived barriers of nephrology healthcare providers towards ACP for patients with ESKD in a tertiary care centre in India. Methods: A cross-sectional survey was conducted among nephrology healthcare providers at a tertiary care centre in India. The survey, developed from literature reviews and pretested, covered demographics, ACP knowledge and attitudes, current practices, and perceived barriers and facilitators. Data collection occurred from September 2022 to March 2023. Quantitative data were analyzed descriptively, and qualitative data through thematic analysis. Results: A total of 50 healthcare providers participated. While 36% acknowledged the importance of ACP, only 8% routinely engaged in ACP discussions. Major barriers included inadequate training (22%), lack of awareness about the importance of discussing ACP amongst stakeholders (20%), cultural barriers (18%), lack of time (14%), and the absence of institutional protocols for discussion on ACP (14%). Additional barriers included instances where families withhold health information from patients due to fear of losing hope (16%) and patient/family discomfort in discussing ACP (12%). Providers expressed a need for structured ACP protocols and educational programs. Conclusion: Despite recognizing its importance, ACP is underutilized in the care of patients with ESKD in India. Addressing the identified barriers through targeted interventions may enhance ACP practices and improve patient outcomes.

Research Into Digital Health Intervention for Mental Health: 25-Year Retrospective on the Ethical and Legal Challenges

Digital mental health interventions are routinely integrated into mental health services internationally and can contribute to reducing the global mental health treatment gap identified by the World Health Organization. Research teams designing and delivering evaluations frequently invest substantial effort in deliberating on ethical and legal challenges around digital mental health interventions. In this article, we reflect on our own research experience with digital mental health intervention design and evaluation to identify 8 of the most critical challenges that we or others have faced, and that have ethical or legal consequences. These include: (1) harm caused by online recruitment work; (2) monitoring of intervention safety; (3) exclusion of specific demographic or clinical groups; (4) inadequate robustness of effectiveness and cost-effectiveness findings; (5) adequately conceptualizing and supporting engagement and adherence; (6) structural barriers to implementation; (7) data protection and intellectual property; and (8) regulatory ambiguity relating to digital mental health interventions that are medical devices. As we describe these challenges, we have highlighted serious consequences that can or have occurred, such as substantial delays to studies if regulations around Software as a Medical Device (SaMD) are not fully understood, or if regulations change substantially during the study lifecycle. Collectively, the challenges we have identified highlight a substantial body of required knowledge and expertise, either within the team or through access to external experts. Ensuring access to knowledge requires careful planning and adequate financial resources (for example, paying public contributors to engage in debate on critical ethical issues or paying for legal opinions on regulatory issues). Access to such resources can be planned for on a per-study basis and enabled through funding proposals. However, organizations regularly engaged in the development and evaluation of digital mental health interventions should consider creating or supporting structures such as advisory groups that can retain necessary competencies, such as in medical device regulation.

SP5.9 - A cost-benefit analysis of a digital post-operative integrated care plan app for surgical patients

Abstract Aims To study the cost-benefit analysis of a digital post-operative integrated care plan app for surgical patients. Methods 1. Preliminary data from patient survey - we designed a questionnaire to assess patients’ views of the Post Op app. 2. Estimates for NHS services cost - derived from the King’s Fund latest report (2023) and the NHS Digital National schedule of reference costs (2017, 2021-22). 3.Estimates for travel-associated costs - We assumed a total cost per mile of 16p, and also assumed the patients would need to pay an average cost of £1.6/h for hospital parking for an average of 3h per visit. We assumed a carbon emission of 221.4 grams per mile (Department for Transport data). 4.Modelling approach - We used a conservative modelling approach simulating different patient groups with varying levels of postoperative anxiety/complications. Results Taking into account avoidable presentations to ED, costs borne by the patients, lost productivity, environmental costs, avoidable re-operations and the costs related to antibiotic tolerance/resistance, the lower boundary of total savings from a digital post-operative follow-up tool equates to £58,739 per 100 patients and the upper boundary is £79,949 per 100 patients. Conclusion Post Op application provides excellent support for most patients in the immediate postoperative period and is likely to result in a significant reduction in the number of contacts patients make with the GP or hospital, and with the Emergency Department resulting in significant cost saving for both the service and the patients. Furthermore, earlier recognition, monitoring and appropriate treatment of SSIs provides further savings whose magnitude is likely underestimated.