National Health Service Specialist Research Articles

Navigating challenges and workarounds: A qualitative study of healthcare and support workers' perceptions on providing care to people seeking sanctuary.

Healthcare and support workers play a pivotal role in delivering quality services and support to people seeking sanctuary who have experienced poor physical and mental health linked to previous trauma, relocation and loss of freedoms. However, they often encounter various challenges in their daily work, ranging from communication barriers to resource constraints. This qualitative study seeks to delve into the perspectives of healthcare and support workers' experience of workarounds, employed to overcome barriers to providing care. This study aims to describe healthcare providers', practitioners' and health and third sector support workers' views on barriers and workarounds to providing care for people seeking sanctuary, to inform policy and practice. A qualitative study was carried out using semi-structured telephone interviews. This study focused on primary, secondary, community and specialist National Health Service (NHS) support services for people seeking sanctuary in Wales, United Kingdom (2018). We interviewed 32 healthcare providers, practitioners and support workers employed by primary care and third sector organisations. Our approach involved obtaining verbal informed consent before digitally recording and transcribing all interviews. To analyse the data, we used the Four Levels of Change for Improving Quality model as a guiding framework for interpretation. Our study findings reveal that certain respondents expressed challenges in meeting the needs of people seeking sanctuary; notably, their experience of delivering care differed by care settings. Specifically, those involved in providing specialist NHS care believed that there was room for improvement. Mainstream primary, secondary and community health practitioners faced limitations due to resource constraints and lacked tailored information to address the unique circumstances and needs of sanctuary seekers. To address these gaps, workarounds emerged at both individual and local levels (team/departmental and organisational level). These included establishing informal communication channels between providers, fostering cross service collaboration to fill gaps and adapting existing services to enhance accessibility. Understanding healthcare providers', practitioners' and support workers' perspectives offers invaluable insights into ways to enhance healthcare delivery to sanctuary seekers. Acknowledging challenges and harnessing innovative workarounds can foster a more effective and compassionate service for this vulnerable population. The HEAR study actively involved public contributors in the design, delivery and dissemination of the research. Two public contributors (S. M. and G. R.) who had personal experience of seeking asylum served as study co-applicants. They played pivotal roles in shaping the research by participating in its development and securing funding. Alongside other co-applicants, S. M. and G. R. formed the Research Management Group, overseeing study delivery. Their contributions extended to strategic decision-making and specific feedback at critical junctures, including participant recruitment, data collection, analysis and reporting. Additionally, S. M. and G. R. were instrumental in recruiting and supporting a team of peer researchers, enhancing respondent participation among people seeking sanctuary. To facilitate effective public involvement, we provided named contacts for support (A. K. and R. F.), research training, honoraria, reimbursement of expenses and accessible information in line with best practice.

“It’s a Lot Deeper than the Way It Looks”: An Interpretative Phenomenological Analysis of Body Image for Men With Eating Disorders

Men represent a proportion of those with eating disorders yet are neglected in the existing literature. One area with limited research is how men with eating disorders experience body image. This study investigated how men with eating disorders make sense of their experience of body image. Ten male participants with diagnosed eating disorders were recruited from four National Health Service specialist adult eating disorder services. Semi-structured interviews were conducted, and data analysed with Interpretative Phenomenological Analysis. Analysis identified three themes: ‘Focus on Self’, ‘Focus on Others’ and ‘Systemic Influences and Pressures’. Findings indicated that body image was experienced intrapersonally, interpersonally, and systemically. This study adds to the limited accounts of body image among men with eating disorders. It is recommended that future research explore body image in underrepresented gender and sexuality groups and that clinicians incorporate the nuances of men’s experiences of body image into clinical assessment and treatment.

Lived experience of recurrent miscarriage: women and their partners’ experience of subsequent pregnancy and support within an NHS specialist clinic – a qualitative study

ObjectiveThis study aims to describe the lived experiences of couples with a history of recurrent miscarriage in subsequent pregnancies and their perception of clinic support and cytogenetic investigations.DesignA qualitative interview...

Management of medically assisted withdrawal from alcohol in acute adult mental health and specialist addictions in-patient services: UK clinical audit findings.

Medically assisted alcohol withdrawal (MAAW) is increasingly undertaken on acute adult psychiatric wards. Comparison of the quality of MAAW between acute adult wards and specialist addictions units in mental health services. Clinical audit conducted by the Prescribing Observatory for Mental Health (POMH). Information on MAAW was collected from clinical records using a bespoke data collection tool. Forty-five National Health Service (NHS) mental health trusts/healthcare organisations submitted data relating to the treatment of 908 patients undergoing MAAW on an acute adult ward or psychiatric intensive care unit (PICU) and 347 admitted to a specialist NHS addictions unit. MAAW had been overseen by an addiction specialist in 33 (4%) of the patients on an acute adult ward/PICU. A comprehensive alcohol history, measurement of breath alcohol, full screening for Wernicke's encephalopathy, use of parenteral thiamine, prescription of medications for relapse prevention (such as acamprosate) and referral for specialist continuing care of alcohol-related problems following discharge were all more commonly documented when care was provided on a specialist unit or when there was specialist addictions management on an acute ward. The findings suggest that the quality of care provided for medically assisted withdrawal from alcohol, including the use of evidence-based interventions, is better when clinicians with specialist addictions training are involved. This has implications for future quality improvement in the provision of MAAW in acute adult mental health settings.

Does registered nurse involvement in improving healthcare services, influence registered nurse retention?

Registered nurses are 'critical' to population health, international responses to emergencies, epidemics and disasters. Retention of registered nurses (RNs) is an international nursing priority. In England, RNs are encouraged to be involved in improving healthcare services. This benefits quality of care, operational and financial performance. However, RN involvement in improvement may reduce RN retention. It is important to understand this relationship when developing effective RN retention strategies. The purpose of this research is to describe possible relationships between RN involvement in improving healthcare services and RN retention, using published 2018 data for National Health Service (NHS) Trusts in England. The relationship between RN involvement in improving healthcare services and RN retention was explored using a correlational design, involving secondary data from the annual NHS Staff Survey and Model Hospital. In mental health NHS Trusts in England, a statistically significant, positive correlation of 0.24 was found between RN 'ab(ility) to make suggestions for improvement' and RN retention. In mental health NHS Trusts, a statistically significant correlation of 0.278 was found between RNs 'making improvements happen' and RN retention. In acute NHS Trusts in England, a statistically significant, negative correlation of -0.15 was identified between RNs 'mak(ing) improvements happen' and RN retention. The findings suggest that RN retention factors in mental health and acute NHS Trusts differ from community and specialist NHS Trusts in England. This is an important consideration for national RN retention programmes as a single approach to RN retention may not be effective across all healthcare settings.

University students with attention deficit hyperactivity disorder (ADHD): a consensus statement from the UK Adult ADHD Network (UKAAN)

BackgroundAttention deficit hyperactivity disorder (ADHD) is associated with poor educational outcomes that can have long-term negative effects on the mental health, wellbeing, and socio-economic outcomes of university students. Mental health provision for university students with ADHD is often inadequate due to long waiting times for access to diagnosis and treatment in specialist National Health Service (NHS) clinics. ADHD is a hidden and marginalised disability, and within higher education in the UK, the categorisation of ADHD as a specific learning difference (or difficulty) may be contributing to this.AimsThis consensus aims to provide an informed understanding of the impact of ADHD on the educational (or academic) outcomes of university students and highlight an urgent need for timely access to treatment and management.MethodsThe UK Adult ADHD Network (UKAAN) convened a meeting of practitioners and experts from England, Wales, and Scotland, to discuss issues that university students with ADHD can experience or present with during their programme of studies and how best to address them. A report on the collective analysis, evaluation, and opinions of the expert panel and published literature about the impact of ADHD on the educational outcomes of university students is presented.ResultsA consensus was reached that offers expert advice, practical guidance, and recommendations to support the medical, education, and disability practitioners working with university students with ADHD.ConclusionsPractical advice, guidance, and recommendations based on expert consensus can inform the identification of ADHD in university students, personalised interventions, and educational support, as well as contribute to existing research in this topic area. There is a need to move away from prevailing notions within higher education about ADHD being a specific learning difference (or difficulty) and attend to the urgent need for university students with ADHD to have timely access to treatment and support. A multimodal approach can be adapted to support university students with ADHD. This approach would view timely access to treatment, including reasonable adjustments and educational support, as having a positive impact on the academic performance and achievement of university students with ADHD.

Clinical studies on parent–infant psychotherapy pre- and post-COVID-19 pandemic ‘Making the best of a bad job’ (1)

ABSTRACT In his last writing in 1979, Bion, aged 81, described how ‘when two personalities meet, an emotional storm is created’ and the way that psychotherapy can only ever aim to ‘make the best of a bad job’ by turning that storm between the two people in the room to good account. This paper, whose title refers to Bion’s famous statement, complements a publication by Micotti and Pozzi, on a literature review regarding this topic. The paper describes clinical vignettes from psychoanalytic psychotherapy with parents, infants and children underfive seen in person, then online, in a Specialist National Health Service. Some technical issues in the move from in-person to online work as well as its impact on families and therapists are highlighted here.

Disparate healthcare experiences of people living with overweight or obesity in England.

BackgroundEnsuring that patients have high quality, equitable experiences in healthcare is a high priority in the UK. As such, identifying and addressing areas where patient experiences are unsatisfactory and inequitable is of high priority, and has been included as part of the National Health Service (NHS) England equity objectives.MethodsThe healthcare experiences of people who identified as living with overweight or obesity were gathered from freely available websites using the Patient Experience Platform (PEP). PEP was used to gather and analyse all comments from NHS UK, Google, Facebook and Twitter that related to care experiences of people who identified as living with overweight or obesity across all NHS Acute and Specialist Trusts and all general practitioners (GPs) in England from 01/01/2018 to 31/12/2020. These healthcare experiences were analysed to provide care quality metrics, a comparison of care across regions of England, and to explore associations between behavioural clusters of personality attributes, values and sentiment with care quality metrics.FindingsPerceptions of the quality of care were significantly lower for people who identified as living with overweight or obesity compared to people who didn't identify as living with overweight or obesity across all regions for ‘Effective Treatment’ and ‘Emotional Support’. The perceived quality of care metrics can be predicted by the behavioral clusters, where for instance, the experiences of people who identified as living with overweight or obesity in the negative behavioral cluster have a lower overall perceived quality of care score. Themes arising from the data also highlighted that barriers quality care experienced by people who identified as living with obesity include the speed of access, effective treatment, and emotional support, with stigmatising healthcare experiences are reported.InterpretationThe findings of this study provide insights into the experiences reported via freely available websites, of people who self-identified as living with overweight or obesity in healthcare in England. These insights demonstrate that the perceived quality of care was lower for people who identified as living with overweight or obesity compared to the general population, and that there is regional variation in care quality. The study has also shown that patient experiences differ based on personality attributes, values and sentiment, highlighting the need for patient-centred care and personalised approaches. These findings hold important considerations for healthcare and policy makers aiming to address healthcare inequity.

An exploration of specialist clinicians’ experiences and beliefs about inpatient amputee rehabilitation as a pathway option for adult primary amputees

Purpose To explore specialist amputee physiotherapists’ experiences and subsequent views about specialist inpatient rehabilitation (IPR) as a National Health Service (NHS) pathway option for adult primary amputees and their perceptions and beliefs about the effects of inpatient amputee rehabilitation. Materials and methods A qualitative study using a phenomenological approach. Semi-structured interviews were completed with seven physiotherapists experienced in working in both specialist amputee inpatient and outpatient rehabilitation settings. Interviews were audio-recorded and fully transcribed. Data were analysed using thematic analyses; inductive coding was completed; emerging themes are shown and a conceptual framework was developed. To promote rigour, this study was peer reviewed and coding was done by two people. Results Clinicians believed inpatient amputee rehabilitation to be the preferred model of rehabilitation for the majority of adult primary amputees. A central theme of healthcare inequality within primary amputee rehabilitation provision emerged with four sub-themes: IPR, outpatient rehabilitation, barriers, the ideal world. Geographical variation was described in: type of rehabilitation provided, timescales of prosthetic rehabilitation provision, fitting a prosthesis with wounds, and the availability of community rehabilitation services. Conclusions Healthcare inequality is a central concern identified by clinicians who work within amputee rehabilitation in the UK. Clinicians interviewed believe NHS specialist amputee inpatient rehabilitation should be a more accessible pathway. Implications for rehabilitation Clinicians believe healthcare inequality exists within primary amputee rehabilitation provision in the UK National Health Service (NHS). Geographical variation in type of care provision, fitting a prosthesis with wounds, timescales in prosthetic rehabilitation provision and community rehabilitation services were described. Clinicians believe inpatient amputee rehabilitation to be the preferred model of care for the majority of adult primary amputees and should be a more accessible pathway within the NHS. Inpatient rehabilitation facilities may be a way of compensating for amputee rehabilitation inequalities.

Impact of nasal polyps on endotype and phenotype in patients with moderate to severe asthma

BackgroundNasal polyps (NPs) are a common comorbidity of asthma. Differences in disease endotype and phenotype may have treatment implications for these concomitant conditions, including biologic therapies. ObjectiveTo determine putative differences in type 2 biomarkers, lung function, and asthma control in patients with asthma with NPs (AwNPs) and those with asthma alone (A). MethodsA total of 140 consecutive patients with moderate to severe asthma with or without endoscopic NPs taking a daily inhaled corticosteroid dose of greater than or equal to 800 µg and at least 1 second-line controller were identified from our National Health Service specialist respiratory and rhinology clinics. Data were collected before starting on biologics, including peripheral blood eosinophils (PBEs), fractional exhaled nitric oxide (FeNO), allergy status, spirometry, impulse oscillometry, Asthma Control Questionnaire, oral corticosteroid requiring asthma exacerbations, NP score, and Lund-Mackay score. ResultsThe PBE count and FeNO levels were significantly higher (P < .01), whereas specific and total immunoglobulin E levels (P < .05) were significantly lower in AwNPs vs A. In addition, FeNO had sensitivity of 81% and specificity of 67% for detecting NPs (area under the curve = 0.76; P = .001). Patients with AwNPs had less severe asthma than those with asthma without NPs (A), as reflected by fewer exacerbations (P < .001), lower inhaled corticosteroid dose (P < .001), and less impairment of impulse oscillometry (P < .05). ConclusionPatients with moderate to severe asthma with NPs have higher levels of PBE and FeNO despite better asthma control and lower total and specific allergy than those without NPs.

Retrospective analysis of referrals to the North East of England intermediate oral surgery service

AbstractIntroductionThe intermediate oral surgery service in North East England was introduced in 2009 following changes in the primary care contract in 2005 allowing primary care organisations to locally commission services to meet population need. The aim of this service introduction was to reduce pressures on secondary care and improve efficiency and costs of oral surgery service provision. Where there are geographical variations in the number of referrals received to intermediate oral surgery services in North East England, this study aimed to identify the reasons for these.Materials and methodsA retrospective analysis of referrals to the National Health Service (NHS) Intermediate North East of England Oral Surgery Service was completed. Analysis of 48,286 referrals from 2009 to 2019 was assessed from two NHS specialist oral surgery providers. Primary care practice referrals were located to practice postcode; the sum of referrals from each postcode accumulated over this period. Referral variations were compared with NHS primary care contract sizes, distance to specialist provider and Index of Multiple Deprivation of provider location to identify correlations.ResultsData indicate a significant range in primary care referral frequency over the 10‐year period. Referrals from primary care providers ranged from 1 to 2334 over the 10‐year period. No correlation is seen between distance to provider (r2 = 0.058), contract size (r2 = 0.087), deprivation levels (r2 = 0.01) and the referral rate.ConclusionThe large variation in referral rate provides data for commissioners of dental services including managed clinical networks (MCNs) to outline high referring primary care practices and plan for future service development.

Pharmacy professionals’ views regarding the future of NHS patient medicines helpline services: A multimethod qualitative study

Abstract Introduction Patient medicines helpline services (PMHS) have been established at some National Health Service (NHS) hospitals in England, to provide medicines-related support to recently discharged hospital patients and carers. However, findings suggest that, due to a lack of resources, considerable variation exists in the operation of PMHS, and that their access, availability, and promotion do not meet national standards regarding helpline provision (1, 2). To develop recommendations for service improvement, this qualitative study sought to examine pharmacy professionals’ views regarding the future of PMHS. Aim To examine pharmacy professionals’ perceptions of the future of PMHS, and develop recommendations for service improvement. Methods University ethics and Health Research Authority approval were obtained before commencement. Participants comprised pharmacy professionals from acute, mental health, specialist, and community NHS Trusts that provided a PMHS. Invitations to participate in an online qualitative survey and subsequent semi-structured telephone interview were sent via email to pharmacy services at all Trusts that provided a PMHS. Within the survey and the interview schedule was one question “How do you see patient medicines helplines at NHS Trusts developing in the future?” and only the data generated from this open-ended question were analysed for this study. Survey data were collected via SurveyMonkey (n=100). Individuals interested in participating in an interview contacted the research team, resulting in 34 interviews. Interviews were conducted from May-October 2018, and ranged from 16 to 53 minutes. Braun and Clarke’s inductive reflexive thematic analysis was used to analyse the data. Guidelines for enhancing the validity and trustworthiness of qualitative research were used. Results Two themes were generated from the survey and interviews. Enhancing value for service users identifies suggestions for improving the value of PMHS for service users. These include providing access methods beyond the telephone, and providing patients/carers with post-discharge follow-up calls from a pharmacist. Improving efficiency identifies that, in the future, and in line with NHS plans for efficiency and shared resources, PMHS may become centralised or provided by community pharmacies. Centralised services were considered to likely have more resources available to provide a patient medicines information service compared to hospital pharmacies. Participants often referred to the Carter report and sustainability and transformation plans, which promote the sharing of resources within regions. However, such a change was perceived to only increase efficiency if patient information can be shared between relevant healthcare settings. Conclusion PMHS are perceived by pharmacy professionals as likely to become centralised in the future (i.e., provided regionally or nationally) or provided by community pharmacies. This is dependent upon patients’ information being shared between hospitals and the centralised PMHS or pharmacies. To enhance the value of PMHS for service users, providers could establish other methods of access, such as email and video consultation. A limitation of this study is that it did not seek the perspectives of pharmacy professionals who do not provide a PMHS, other healthcare professionals, nor patients and carers. Considering the uncertainty around the future of PMHS, research should establish the best way to support all patients and carers regarding medicines following hospital discharge.

Drug Use in Street Sex worKers (DUSSK) study: results of a mixed methods feasibility study of a complex intervention to reduce illicit drug use in drug dependent female sex workers.

ObjectivesThe majority of female street-based sex workers (SSWs) are dependent on illicit drugs and sell sex to fund their drug use. They typically face multiple traumatic experiences, starting at a young age, which continue through sex work involvement. Their trauma-related symptoms tend to increase when drug use is reduced, hindering sustained reduction. Providing specialist trauma care to address post-traumatic stress disorder (PTSD) alongside drug treatment may therefore improve treatment outcomes. Aims to (1) evaluate recruitment and retention of participants; (2) examine intervention experiences and acceptability; and (3) explore intervention costs using a mixed methods feasibility study.SettingFemale SSW charity premises in a large UK inner city.ParticipantsFemales aged 18 years or older, who have sold sex on the street and used heroin and/or crack cocaine at least once a week in the last calendar month.InterventionFemale SSW-only drug treatment groups in a female SSW-only setting delivered by female staff. Targeted PTSD screening then treatment of positive diagnoses with eye movement desensitisation and reprocessing (EMDR) therapy by female staff from a specialist National Health Service trauma service.Results(1) Of 125 contacts, 11 met inclusion criteria and provided informed consent, 4 reached the intervention final stage, (2) service providers said working in collaboration with other services was valuable, the intervention was worthwhile and had a positive influence on participants. Participants viewed recruitment as acceptable and experienced the intervention positively. The unsettled nature of participant’s lives was a key attendance barrier. (3) The total cost of the intervention was £11 710, with staff costs dominating.ConclusionsRecruitment and retention rates reflected study inclusion criteria targeting women with the most complex needs. Two participants received EMDR demonstrating that the three agencies working together was feasible. Staff heavy costs highlight the importance of supporting participant attendance to minimise per participant costs in a future trial.

Monitoring treatment harm in myalgic encephalomyelitis/chronic fatigue syndrome: A freedom-of-information study of National Health Service specialist centres in England.

The use of graded exercise therapy and cognitive behavioural therapy for myalgic encephalomyelitis/chronic fatigue syndrome has attracted considerable controversy. This controversy relates not only to the disputed evidence for treatment efficacy but also to widespread reports from patients that graded exercise therapy, in particular, has caused them harm. We surveyed the National Health Service-affiliated myalgic encephalomyelitis/chronic fatigue syndrome specialist clinics in England to assess how harms following treatment are detected and to examine how patients are warned about the potential for harms. We sent 57 clinics standardised information requests under the United Kingdom's Freedom of Information Act. Data were received from 38 clinics. Clinics were highly inconsistent in their approaches to the issue of treatment-related harm. They placed little or no focus on the potential for treatment-related harm in their written information for patients and for staff. Furthermore, no clinic reported any cases of treatment-related harm, despite acknowledging that many patients dropped out of treatment. In light of these findings, we recommend that clinics develop standardised protocols for anticipating, recording, and remedying harms, and that these protocols allow for therapies to be discontinued immediately whenever harm is identified.

More Harm than Good? A Pilot of a Motivational Interviewing Based Intervention for Increasing Readiness to Improve Nutrition in Young People Experiencing a First Episode of Psychosis

The relationship between nutrition and mental health, as well as physical health, is well known. Mental Health Services in the UK and worldwide are recognising the need for nutritional care, however eliciting a change in eating habits in patients/service users is a challenge. The effects of a ‘Psych-Nutritional Intervention’ (PNI) using Motivational Interviewing (n = 30) was compared with a ‘Treatment as Usual’ (TAU) involving standard nutritional advice (n = 21) and a control group (no nutritional support) (n = 22). The sample consisted of young people aged 18–35 years old with a diagnosis of psychosis, who were currently under the care of a UK specialist National Health Service (NHS) Mental Health team (Early Intervention for Psychosis Team). Nutritional knowledge was assessed at baseline across the groups. Readiness to Change eating habits was measured at baseline and a further two time points post intervention. Although there were no significant between group differences, the PNI group elicited both the most progression in terms of readiness to change eating habits, but also the most regression. The use of MI may be anti-therapeutic for those who are not ready to consider make changes to their eating habits, and this requires further investigation. Greater emphasis on the importance of assessing and selecting who is most likely to benefit from interventions is necessary.

Evaluation of Weigh Forward: A group intervention delivered by dietitians and psychologists within a National Health Service specialist weight management service.

There is limited evidence of the effectiveness of non-surgical interventions for severe obesity. Our aim was to evaluate a group intervention delivered by a National Health Service (NHS) specialist weight management service to contribute to the evidence base and inform the development of future services. Participants in this prospective cohort study were patients attending NHS Grampian Specialist Weight Management Services. The intervention was an interactive 12-session group programme based on evidence-based psychological model, with combined dietetic and psychological knowledge and support provided. The primary outcome was mean weight change at the end of the intervention and for 12-mo follow-up (including programme completers, baseline observation carried forward [BOCF], last observation carried forward). Secondary outcome measures included mood, anxiety, binge eating and quality of life. A total of 166 patients accepted a place on the group programme, mean body mass index was 48.9 kg/m2 . Mean weight loss at 6 mo was 5.6 kg and 35.2% of those who completed the group (n = 88) lost ≥5%. Using BOCF, 18.7% lost ≥5% at 6 mo. Those who remained in the programme maintained their weight loss 12 and 18 mo after the start of the intervention. Significant improvements were also found in psychological variables, including reduced depression, anxiety, binge eating and improved emotion regulation. This real-world evaluation of an NHS intervention for patients with severe obesity suggests that individuals who engage achieve a moderate weight loss, which most maintain a year later, although further research is needed to strengthen this conclusion.

Operating a patient medicines helpline: a survey study exploring current practice in England using the RE-AIM evaluation framework

BackgroundPatient medicines helplines provide a means of accessing medicines-related support following hospital discharge. However, it is unknown how many National Health Service (NHS) Trusts currently provide a helpline, nor how they are operated. Using the RE-AIM evaluation framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance), we sought to obtain key data concerning the provision and use of patient medicines helplines in NHS Trusts in England. This included the extent to which the delivery of helplines meet with national standards that are endorsed by the Royal Pharmaceutical Society (standards pertaining to helpline access, availability, and promotion).MethodsAn online survey was sent to Medicines Information Pharmacists and Chief Pharmacists at all 226 acute, mental health, specialist, and community NHS Trusts in England in 2017.ResultsAdoption: Fifty-two percent of Trusts reported providing a patient medicines helpline (acute: 67%; specialist: 41%; mental health: 29%; community: 18%). Reach: Helplines were predominantly available for discharged inpatients, outpatients, and carers (98%, 95% and 93% of Trusts, respectively), and to a lesser extent, the local public (22% of Trusts). The median number of enquiries received per week was five. Implementation: For helpline access, 54% of Trusts reported complying with all ‘satisfactory’ standards, and 26% reported complying with all ‘commendable’ standards. For helpline availability, the percentages were 86% and 5%, respectively. For helpline promotion, these percentages were 3% and 40%. One Trust reported complying with all standards. Maintenance: The median number of years that helplines had been operating was six. Effectiveness: main perceived benefits included patients avoiding harm, and improving patients’ medication adherence.ConclusionsPatient medicines helplines are provided by just over half of NHS Trusts in England. However, the proportion of mental health and community Trusts that operate a helpline is less than half of that of the acute Trusts, and there are regional variations in helpline provision. Adherence to the national standards could generally be improved, although the lowest adherence was regarding helpline promotion. Recommendations to increase the use of helplines include increasing the number of promotional methods used, the number of ways to contact the service, and the number of hours that the service is available.

Treatment outcomes in individuals diagnosed with chlamydia in SH:24, an online sexual health service: a retrospective audit

BackgroundSH:24 is the UK's only fully integrated online sexual health service, developed between public health and National Health Service specialist services and providing testing for sexually transmitted infections, online chlamydia treatment, clinical support, and contraception. Users self-sample for chlamydia and gonorrhoea using a vulvovaginal swab (female users) or a urine sample (male), with or without pharyngeal or rectal swabs. At the time of audit SH:24 provided chlamydia home treatment in 66% SH:24 areas; 90% of users in these areas choose this option. 75% of users diagnosed with chlamydia receive home treatment; 25% are ineligible because of patient choice, unavailability of online treatment, or complex infection. We aimed to evaluate treatment outcomes in SH:24 users diagnosed with chlamydia. MethodsClinical records of users with a positive chlamydia result in January, 2018, were reviewed. Treatment was categorised as confirmed if home treatment was dispatched or if clinic attendance was confirmed by partner clinics via the shared clinical record. Individuals whose treatment was unconfirmed were sent a follow-up SMS requesting treatment status. Analysis was carried out in Microsoft Excel 2016. FindingsOf 7079 tests, 415 (5·9%, 95% CI 5·3–6·4), were chlamydia positive; 260 (62·7%) were in female users and 155 (37·3%) in male users. The median age of users with positive tests was 23 years (IQR 20–27). Treatment status was confirmed in 331 of 415 users (79·8%, 95% CI 75·5–83·5) and unconfirmed in 84 (20·2%, 16·5–24·5), but after follow-up SMS a further 30 users confirmed receiving treatment (361 [87·0%, 83·3–90·0]), and 54 (13·0%, 10·0–16·7) had treatment unconfirmed. InterpretationReceipt of treatment was confirmed in 87% of SH:24 users with chlamydia; this proportion is similar to results in genitourinary medicine settings but higher than those in primary care. A major advantage of the SH:24 model is rapid turnaround: 98% of users receive results within 72 h of the sample reaching the laboratory, and home treatment is received within 24 h. By comparison, results can take 1–2 weeks in traditional services. Rapid treatment reduces the infectious period and can decrease onward transmission. Our results also indicate that home chlamydia treatment is highly acceptable to service users. Follow-up SMS can support ascertainment of treatment status in users of an online service. FundingNone.

Drug use in street sex workers (DUSSK) study protocol: a feasibility and acceptability study of a complex intervention to reduce illicit drug use in drug-dependent female street sex workers

IntroductionPoor health of sex workers continues to be a source of international concern. Sex work is frequently linked with problematic drug use and drug-dependent sex workers typically work on the...

Eliciting the Impact of Digital Consulting for Young People Living With Long-Term Conditions (LYNC Study): Cognitive Interviews to Assess the Face and Content Validity of Two Patient-Reported Outcome Measures.

BackgroundDigital consulting, using email, text, and Skype, is increasingly offered to young people accessing specialist care for long-term conditions. No patient-reported outcome measures (PROMs) have been evaluated for assessing outcomes of digital consulting. Systematic and scoping reviews, alongside patient involvement, revealed 2 candidate PROMs for this purpose: the patient activation measure (PAM) and the physician’s humanistic behaviors questionnaire (PHBQ). PAM measures knowledge, beliefs, and skills that enable people to manage their long-term conditions. PHBQ assesses the presence of behaviors that are important to patients in their physician-patient interactions.ObjectiveThis study aimed to assess the face and content validity of PAM and PHBQ to explore whether they elicit important outcomes of digital consulting and whether the PROMs can isolate the digital consultation component of care.MethodsParticipants were drawn from 5 clinics providing specialist National Health Service care to 16- to 24-year-olds with long-term health conditions participating in the wider LYNC (Long-Term Conditions, Young People, Networked Communications) study. Overall, 14 people undertook a cognitive interview in this substudy. Of these, 7 participants were young people with either inflammatory bowel disease, cystic fibrosis, or cancer. The remaining 7 participants were clinicians who were convenience sampled. These included a clinical psychologist, 2 nurses, 3 consultant physicians, and a community youth worker practicing in cancer, diabetes, cystic fibrosis, and liver disease. Cognitive interviews were transcribed and analyzed, and a spreadsheet recorded the participants’ PROM item appraisals. Illustrative quotes were extracted verbatim from the interviews for all participants.ResultsYoung people found 11 of the PAM 13 items and 7 of the additional 8 PAM 22 items to be relevant to digital consulting. They were only able to provide spontaneous examples of digital consulting for 50% (11/22) of the items. Of the 7 clinicians, 4 appraised all PAM 13 items and 20 of the PAM 22 items to be relevant to evaluating digital consulting and articulated operationalization of the items with reference to their own digital consulting practice with greater ease than the young people. Appraising the PHBQ, in 14 of the 25 items, two-thirds of the young people’s appraisals offered digital consulting examples with ease, suggesting that young people can detect and discern humanistic clinician behaviors via digital as well as face-to-face communication channels. Moreover, 17 of the 25 items were appraised as relevant by the young people. This finding was mirrored in the clinician appraisals. Both young people and the clinicians found the research task complex. Young participants required considerably more researcher prompting to elicit examples related to digital consulting rather than their face-to-face care.ConclusionsPAM and PHBQ have satisfactory face and content validity for evaluating digital consulting to warrant proceeding to psychometric evaluation. Completion instructions require revision to differentiate between digital and face-to-face consultations.