Strategic Health Authority Research Articles

Residential and healthcare mobility during pregnancy among women living with HIV in the UK, 2009-2019.

The extent to which individuals living with HIV experience residential and healthcare mobility during pregnancy in the UK is unknown. We aimed to determine a minimum estimate of residential and healthcare mobility during pregnancy in people living with HIV in the UK in 2009-2019 to explore patterns of and factors associated with mobility and to assess whether mobility was associated with specific HIV outcomes. We analyzed data from the Integrated Screening Outcomes Surveillance Service to assess pregnancies with HIV in the UK and included livebirths and stillbirths with estimated delivery in 2009-2019. Residential mobility was defined as changing residential postcode between notification and delivery, and healthcare mobility was defined as changing NHS Trust or Strategic Health Authority (SHA) in that same timeframe. We used logistic regression to determine factors associated with residential and healthcare mobility and with detectable delivery viral load. Among 10 305 pregnancies, 19.6% experienced residential mobility, 8.1% changed NHS Trust, and 4.5% changed SHA during pregnancy. Mobility was more likely to be experienced by younger women, migrants, and those with new antenatal diagnosis; residential but not healthcare mobility declined over time. In a fully adjusted model, mobility was not associated with having a detectable viral load at delivery. Higher proportions of infants were lost to follow-up after mobile pregnancies than after non-mobile pregnancies. This analysis provides new knowledge on mobility during pregnancy in the context of HIV, but further research is needed to understand its broader impacts and its utility as a marker to help identify families requiring additional follow-up and support.

Ten minutes with Mr Peter Lees, CEO, Faculty of Medical Leadership and Management (FMLM)

![Graphic][1] ### Biography Peter Lees is the Chief Executive of the UK Faculty of Medical Leadership and Management (FMLM). In 2011, he led the establishment of FMLM which became an...

Understanding perceptions and expectations of studying radiotherapy: mature students compared to school-leavers

Introduction: Recruitment and retention for pre-registration radiotherapy courses in the U.K. has posed a difficulty for workforce planning within cancer care for many years 1, 2, 3, 4, 5, 6, 7, 8 ,9 ,10. Mature students have traditionally made up a high proportion of students, but there has been a large decline in them starting the course since 2017 11,. There is a broad understanding of the market for mature students in general 12, 13, 14, but little research on why mature students choose radiotherapy specifically. This study explores mature students’ views on radiotherapy as a course and a career, in comparison to the views of students who had joined the course straight from school. Method: A focus group of mature students and one of school-leavers all from one institution were conducted with semi-structured questions. Focus groups were recorded, transcribed verbatim and coded by one researcher. Ethical approval was obtained via Sheffield Hallam University. Results: Both groups were attracted by hands-on learning, close patient care of cancer patients and secure job opportunities, but were concerned by the physics content. School-leaver students expected a traditional University experience, where mature students were expecting a more structured training course. Mature students required more detail on the practicalities of placement living and location as they were more limited. Both groups felt disappointed in the job opportunities from before the course compared to starting it, but it was a more of a concern for mature students due to their settled lives. Mature students were more anxious about their choice to study radiotherapy and were more interested in the ability to plan, as they had made an active choice to return to education, where school-leavers were going to go to University at this point anyway. Conclusion: More detailed information on the course and the job prospects may help mature student recruitment and retention. Similarly, policies which allowed for more job security earlier in the course should be looked at. These ideas should then be put back to prospective mature students in further research. Numerical References 1 Department of Health (DoH) (2000) Meeting the Challenge: A Strategy for the Allied Health Professions. The Stationary Office. London. 2 Department of Health (DoH) (2017) Smaller and Specialist Allied Health Professions Final Report. The Stationary Office. London. Retrieved from https://www.healthcareers.nhs.uk/sites/default/files/documents/Smaller%20and%20Specialist%20Allied%20Health%20Professions%20Final%20Report%20-%20June%202017.pdf 3 Higher Education Funding Council for England (HEFCE) (2018) Strategic Interventions in Health Education Disciplines. Retrieved from http://www.hefce.ac.uk/media/HEFCE,2014/Content/Pubs/2018/201802/HEFCE2018_02.pdf 4 Hutton, & Eddy. (2012). How was it for you? What factors influence job satisfaction for band 5 and 6 therapeutic radiographers. Radiography, Radiography. 5 McNamara, J. (2010). The recruitment and retention of therapy radiographers. International Journal of Therapy and Rehabilitation, 17(5), 225. 6 Probst, H., & Griffiths, S. (2007). Retaining therapy radiographers: What’s so special about us? Journal of Radiotherapy in Practice, 6(1), 21-32. 7 Society of Radiographers (2009). Improving Student Retention: Guidelines and Good Practice. Retrieved from https://www.sor.org/printpdf/book/export/html/5971 8 Society of Radiographers (2017). The College of Radiographers Research Priorities for the Radiographic Profession. Retrieved from: https://www.sor.org/learning/document-library/college-radiographers-research-priorities-radiographic-profession 9 South West London Strategic Health Authority (SWLSHA) (2006) Student Recruitment and Retention Guide for Diagnostic and Therapeutic Radiography. Retrieved from https://www.sharedsolutions.net/app/download/5779480454/Student+Recruit.++Ret.+Guide+2006-02-09.pdf 10 Wharton D, Green D. Therapeutic Radiography Students—Why Become One? An Investigation of Motives Behind the Choice to Become a Therapeutic Radiography Student and Some Implications of These Motives for the Profession. Research Report. Leeds: Cookridge Hospital, 2000. 11 University and Colleges Admission System (UCAS) (2017) End of Cycle Report. UCAS. London 12 MillionPlus and National Union of Students (2012). Never Too Late To Learn. MillionPlus. London. Retrieved from http://www.millionplus.ac.uk/documents/Never_Too_Late_To_Learn_-_FINAL_REPORT.pdf 13 MillionPlus (2018). Forgotten Learners: building a system that works for mature students. MillionPlus. London. Retrieved from http://www.millionplus.ac.uk/documents/Forgotten_learners_building_a_system_that_works_for_mature_students.pdf 14 Office For Fair Access (2017). Topic briefing: mature and part-time students. Retrieved from https://www.offa.org.uk/universities-and-colleges/guidance/topic-briefings/offa-topic-briefing-mature-learners/

Demographic and geographical variability in physiotherapy provision following hip and knee replacement. An analysis from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man

BackgroundTotal hip (THR) and knee replacement (TKR) are two of the most common elective orthopaedic procedures worldwide. Physiotherapy is core to the recovery of people following joint replacement. However, there remains uncertainty as to physiotherapy provision at a national level. ObjectivesTo examine the relationship between patient impairment and geographical variation on the provision of physiotherapy among patients who undergo primary total hip or knee replacement (THR/TKR). DesignPopulation-based observational cohort study. MethodsPatients undergoing THR (n=17,338) or TKR (n=20,260) recorded in the National Joint Registry for England (NJR) between 2009 and 2010 and completed Patient Reported Outcome Measures (PROMs) questionnaires at Baseline and 12 months postoperatively. Data were analysed on the frequency of physiotherapy over the first postoperative year across England’s Strategic Health Authorities (SHAs). Logistic regression analyses examined the relationship between a range of patient and geographical characteristics and physiotherapy provision. ResultsFollowing THR, patients were less likely to receive physiotherapy than following TKR patients (‘some’ treatment by a physiotherapist within 1st post operative year: 53% vs 79%). People with worse functional outcomes 12 months postoperatively, received more physiotherapy after THR and TKR. There was substantial variation in provision of physiotherapy according to age (younger people received more physiotherapy), gender (females received more physiotherapy) ethnicity (non-whites received more physiotherapy) and geographical location (40% of patients from South West received some physiotherapy compared to 40 73% in London after THR). ConclusionsThere is substantial variation in the provision of physiotherapy nationally. This variation is not explained by differences in the patient’s clinical presentation.

Clinical commissioning groups

When the Health and Social Care Act (2012) was passed, it was one of one of the most extensive NHS reforms ever seen in England. It gave rise to Clinical Commissioning Groups, which replaced Primary Care Trusts and larger strategic health authorities in April 2013. Commissioners identify the needs of the local population, set clinical priorities and purchase services on behalf of their community from a provider. Hospital trusts, community health groups, general practices, charities and private healthcare providers can ‘sell' services to the ‘buying' commissioner. This article will outline how services are commissioned in England, and explains how services are decommissioned when no longer required.

Randomised controlled trial with economic and process evaluations of domiciliary welfare rights advice for socioeconomically disadvantaged older people recruited via primary health care (the Do-Well study)

BackgroundWelfare rights advice services are effective at maximising previously unclaimed welfare benefits, but their impact on health has not been evaluated.ObjectiveTo establish the acceptability, cost-effectiveness and effect on health of a domiciliary welfare rights advice service targeting older people, compared with usual practice.DesignA pragmatic, individually randomised, parallel-group, single-blinded, wait-list controlled trial, with economic and process evaluations. Data were collected by interview at baseline and 24 months, and by self-completion questionnaire at 12 months. Qualitative interviews were undertaken with purposive samples of 50 trial participants and 17 professionals to explore the intervention’s acceptability and its perceived impacts.SettingParticipants’ homes in North East England, UK.ParticipantsA total of 755 volunteers aged ≥ 60 years, living in their own homes, fluent in English and not terminally ill, recruited from the registers of 17 general practices with an Index of Multiple Deprivation within the most deprived two-fifths of the distribution for England, and with no previous access to welfare rights advice services.InterventionsWelfare rights advice, comprising face-to-face consultations, active assistance with benefit claims and follow-up as required until no longer needed, delivered in participants’ own homes by a qualified welfare rights advisor. Control group participants received usual care until the 24-month follow-up, after which they received the intervention.Main outcome measuresThe primary outcome was health-related quality of life (HRQoL), assessed using the CASP-19 (Control, Autonomy, Self-realisation and Pleasure) score. The secondary outcomes included general health status, health behaviours, independence and hours per week of care, mortality and changes in financial status.ResultsA total of 755 out of 3912 (19%) general practice patients agreed to participate and were randomised (intervention,n = 381; control,n = 374). In the intervention group, 335 participants (88%) received the intervention. A total of 605 (80%) participants completed the 12-month follow-up and 562 (75%) completed the 24-month follow-up. Only 84 (22%) intervention group participants were awarded additional benefits. There was no significant difference in CASP-19 score between the intervention and control groups at 24 months [adjusted mean difference 0.3, 95% confidence interval (CI) –0.8 to 1.5], but a significant increase in hours of home care per week in the intervention group (adjusted difference 26.3 hours/week, 95% CI 0.8 to 56.1 hours/week). Exploratory analyses found a weak positive correlation between CASP-19 score and the amount of time since receipt of the benefit (0.39, 95% CI 0.16 to 0.58). The qualitative data suggest that the intervention was acceptable and that receipt of additional benefits was perceived by participants and professionals as having had a positive impact on health and quality of life. The mean cost was £44 per participant, the incremental mean health gain was 0.009 quality-adjusted life-years (QALYs) (95% CI –0.038 to 0.055 QALYs) and the incremental cost-effectiveness ratio was £1914 per QALY gained.ConclusionsThe trial did not provide sufficient evidence to support domiciliary welfare rights advice as a means of promoting health among older people, but it yielded qualitative findings that suggest important impacts on HRQoL. The intervention needs to be better targeted to those most likely to benefit.Future workFurther follow-up of the trial could identify whether or not outcomes diverge among intervention and control groups over time. Research is needed to better understand how to target welfare rights advice to those most in need.Trial registrationCurrent Controlled Trials ISRCTN37380518.FundingThis project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full inPublic Health Research; Vol. 7, No. 3. See the NIHR Journals Library website for further project information. The authors also received a grant of £28,000 from the North East Strategic Health Authority in 2012 to cover the costs of intervention delivery and training as well as other non-research costs of the study.

The Impact of Sociodemographic Factors and Emergency Admissions on the Place of Death of Gynecological Cancer Patients in England: An Analysis of a National Mortality-Hospital Episode Statistics-Linked Data Set.

The aim of this study was to develop a predictive model for risk of death in hospital for gynecological cancer patients specifically examining the impact of sociodemographic factors and emergency admissions to inform patient choice in place of death. The model was based on data from 71,269 women with gynecological cancer as underlying cause of death in England, January 1, 2000, to July 1, 2012, in a national Hospital Episode Statistics-Office for National Statistics database. Two thousand eight hundred eight deaths were used for validation of the model. Logistic regression identified independent predictors of a hospital death: adjusting for year of death, age group, income deprivation quintile, Strategic Health Authority, gynecological cancer site, and number of elective and emergency hospital admissions and respective total durations of stay. Forty-three percent of deaths from gynecological cancer occurred in hospital. The variables significantly predicting death in hospital were less recent year of death (odds ratio [OR], 0.93; P < 0.001), increasing age (OR, 1.17; P < 0.001), increasing deprivation (OR, 1.06; P < 0. 001), increasing frequency and length of elective and emergency admissions (P < 0.001). The model correctly identified 73% of hospital deaths with a sensitivity of 75% and a specificity of 72%. The areas under the receiver operating curve were 0.78 for the predictive model and 0.71 for the validation data set. Each subsequent emergency admission in the last month of life increased the odds of death in hospital by 2.4 times (OR, 2.38; P < 0.001). Hospital deaths were significantly lower in all other regions compared with London. The model predicted a 16% reduction of deaths in hospital if 50% of emergency hospital admissions in the last month of life could be avoided by better community care. Our findings could enable identification of patients at risk of dying in hospital to ensure greater patient choice for place of death.

Linkage of national soil quality measurements to primary care medical records in England and Wales: a new resource for investigating environmental impacts on human health

BackgroundLong-term, low-level exposure to toxic elements in soil may be harmful to human health but large longitudinal cohort studies with sufficient follow-up time to study these effects are cost-prohibitive and impractical. Linkage of routinely collected medical outcome data to systematic surveys of soil quality may offer a viable alternative.MethodsWe used the Geochemical Baseline Survey of the Environment (G-BASE), a systematic X-ray fluorescence survey of soil inorganic chemistry throughout England and Wales to obtain estimates of the concentrations of 15 elements in the soil contained within each English and Welsh postcode area. We linked these data to the residential postcodes of individuals enrolled in The Health Improvement Network (THIN), a large database of UK primary care medical records, to provide estimates of exposure. Observed exposure levels among the THIN population were compared with expectations based on UK population estimates to assess representativeness.ResultsThree hundred seventy-seven of three hundred ninety-five English and Welsh THIN practices agreed to participate in the linkage, providing complete residential soil metal estimates for 6,243,363 individuals (92% of all current and former patients) with a mean period of prospective computerised medical data collection (follow-up) of 6.75 years. Overall agreement between the THIN population and expectations was excellent; however, the number of participating practices in the Yorkshire & Humber strategic health authority was low, leading to restricted ranges of measurements for some elements relative to the known variations in geochemical concentrations in this area.ConclusionsThe linked database provides unprecedented population size and statistical power to study the effects of elements in soil on human health. With appropriate adjustment, results should be generalizable to and representative of the wider English and Welsh population.

Incidence, Prevalence, and Survival of Patients with Idiopathic Pulmonary Fibrosis in the UK.

IntroductionRecent developments in the care of patients with idiopathic pulmonary fibrosis have the potential to improve survival rates. Population-based estimates of the current disease burden are needed to evaluate the future impact of newly approved therapies. The objective of this study is to describe incidence, prevalence, and survival of idiopathic pulmonary fibrosis patients in the UK.MethodsBetween 2000 and 2012, a patient cohort (N = 9,748,108), identified from Clinical Practice Research Datalink primary care data, was used to identify incident and prevalent cases of idiopathic pulmonary fibrosis–clinical syndrome. Incident cases were followed up to identify deaths. Poisson and Cox regressions were used to calculate incidence rate ratios (IRR) and hazard ratios for mortality, respectively. Adjustments were made for age, gender, and strategic health authority. Survival from diagnosis was estimated using Kaplan–Meier analysis.ResultsIn total 1491 and 4527 incident cases were identified using narrow and broad idiopathic pulmonary fibrosis–clinical syndrome definitions, respectively. Incidence and prevalence increased during the study. Compared with 2000, a near 80% increase in incidence was observed by 2012 [IRR 1.78 (95% CI 1.50–2.11; broad definition)], despite an observed decrease using the narrow definition [0.50 (0.38–0.65)]. Median survival was 3.0 years (95% CI 2.8–3.1) and 2.7 years (95% CI 2.5–3.0) in broad (n = 2168) and narrow case sets (n = 996), respectively. No significant changes in survival were observed.ConclusionsIdiopathic pulmonary fibrosis incidence rates have increased since 2000 and survival remains poor. These results provide a benchmark against which the effects of future treatment changes can be measured.FundingInterMune UK and Ireland (now part of F. Hoffman La Roche).Electronic supplementary materialThe online version of this article (10.1007/s12325-018-0693-1) contains supplementary material, which is available to authorized users.

A standard liaison psychiatry service structure

AIMS AND METHOD We surveyed all psychiatric services in the six northeast strategic health authorities to determine how the provision of liaison psychiatry services related to College recommendations and the size of the general hospital trusts served. RESULTS Thirty-six (100%) services provided usable data, 8% of general hospital trusts had no liaison psychiatry service, 41% of teams were not multidisciplinary with their only staff being nurses, only 38% of services had dedicated consultant psychiatry time and only a quarter met the recommended minimum standard of 0.5 whole-time equivalents. No teams contained clinical psychologists. Disorder-specific out-patient clinic provision was idiosyncratic. CLINICAL IMPLICATIONS There is a lack of rational planning of liaison psychiatry services and as a result, many services are not needs-based and do not comply with College recommendations. One indication of this is the lack of multidisciplinary teams.

Rethinking priorities: experience of an educational initiative to change attitudes, behaviours and clinical practice in end-of-life care

To implement the National End of Life Care strategy and enable more people to express and achieve their preferences about care at the end of life, senior clinicians outside palliative...

Partnerships from the seeds of collaboration

Purpose This paper aims to review the latest management developments across the globe and pinpoint practical implications from cutting-edge research and case studies. Design/methodology/approach This briefing is prepared by an independent writer who adds their own impartial comments and places the articles in context. Findings In 2007, Birmingham City University (UK) and the West Midlands National Health Service (NHS) Strategic Health Authority developed and implemented the leadership, education and partnership project. The project aimed to develop genuine partnership and collaborative working among health and social care education providers from a range of higher education and NHS organizations in the West Midlands region of the UK. Neither the partnership label nor the most robust of partnership contracts will make a partnership succeed. That is something only the people within the partnership can do. This project demonstrated that partners who are already collaborating, or are predisposed to do so, are more likely to build and sustain a partnership that really delivers. Practical implications The paper provides strategic insights and practical thinking that have influenced some of the world’s leading organizations. Originality/value The briefing saves busy executives and researchers hours of reading time by selecting only the very best, most pertinent information and presenting it in a condensed and easy-to-digest format.

Clinical effectiveness and cost-effectiveness of physiotherapy and occupational therapy versus no therapy in mild to moderate Parkinson's disease: a large pragmatic randomised controlled trial (PD REHAB).

Cochrane reviews of physiotherapy (PT) and occupational therapy (OT) for Parkinson's disease found insufficient evidence of effectiveness, but previous trials were methodologically flawed with small sample size and short-term follow-up. To evaluate the clinical effectiveness and cost-effectiveness of individualised PT and OT in Parkinson's disease. Large pragmatic randomised controlled trial. Thirty-eight neurology and geriatric medicine outpatient clinics in the UK. Seven hundred and sixty-two patients with mild to moderate Parkinson's disease reporting limitations in activities of daily living (ADL). Patients were randomised online to either both PT and OT NHS services (n = 381) or no therapy (n = 381). Therapy incorporated a patient-centred approach with individual assessment and goal setting. The primary outcome was instrumental ADL measured by the patient-completed Nottingham Extended Activities of Daily Living (NEADL) scale at 3 months after randomisation. Secondary outcomes were health-related quality of life [Parkinson's Disease Questionnaire-39 (PDQ-39); European Quality of Life-5 Dimensions (EQ-5D)], adverse events, resource use and carer quality of life (Short Form questionnaire-12 items). Outcomes were assessed before randomisation and at 3, 9 and 15 months after randomisation. Data from 92% of the participants in each group were available at the primary time point of 3 months, but there was no difference in NEADL total score [difference 0.5 points, 95% confidence interval (CI) -0.7 to 1.7; p = 0.4] or PDQ-39 summary index (0.007 points, 95% CI -1.5 to 1.5; p = 1.0) between groups. The EQ-5D quotient was of borderline significance in favour of therapy (-0.03, 95% CI -0.07 to -0.002; p = 0.04). Contact time with therapists was for a median of four visits of 58 minutes each over 8 weeks (mean dose 232 minutes). Repeated measures analysis including all time points showed no difference in NEADL total score, but PDQ-39 summary index (curves diverging at 1.6 points per annum, 95% CI 0.47 to 2.62; p = 0.005) and EQ-5D quotient (0.02, 95% CI 0.00007 to 0.03; p = 0.04) showed significant but small differences in favour of the therapy arm. Cost-effective analysis showed that therapy was associated with a slight but not significant gain in quality-adjusted life-years (0.027, 95% CI -0.010 to 0.065) at a small incremental cost (£164, 95% CI -£141 to £468), resulting in an incremental cost-effectiveness ratio of under £4000 (£3493, 95% -£169,371 to £176,358). There was no difference in adverse events or serious adverse events. NHS PT and OT did not produce immediate or long-term clinically meaningful improvements in ADL or quality of life in patients with mild to moderate Parkinson's disease. This evidence does not support the use of low-dose, patient-centred, goal-directed PT and OT in patients in the early stages of Parkinson's disease. Future research should include the development and testing of more structured and intensive PT and OT programmes in patients with all stages of Parkinson's disease. Current Controlled Trials ISRCTN17452402. This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 63. See the NIHR Journals Library website for further project information. The Birmingham Clinical Trials Unit, University of Birmingham, received support from the UK Department of Health up to March 2012. Catherine Sackley was supported by a NIHR senior investigator award, Collaboration for Leadership in Applied Health Research and Care East of England and West Midlands Strategic Health Authority Clinical Academic Training award.

Ethnic and geographic variations in the epidemiology of childhood fractures in the United Kingdom

BackgroundFractures are common in childhood, and there is considerable variation in the reported incidence across European countries, but few data relating to ethnic and geographic differences within a single country. We therefore aimed to determine the incidence of childhood fractures in the United Kingdom (UK), and to describe age-, ethnicity- and region- specific variations. MethodsThe Clinical Practice Research Datalink (CPRD) contains anonymised electronic health records for approximately 7% of the UK population. The occurrence of a fracture between 1988 and 2012 was determined from the CPRD for all individuals <18years of age, and used to calculate fracture incidence rates for age, sex and ethnicity. Regional fracture incidence rates were also calculated based on general practitioner location within 14 Strategic Health Authorities (SHA) within the UK. ResultsThe overall fracture incidence rate was 137 per 10,000 person-years (py). This was higher in boys (169 per 10,000 py) than girls (103 per 10,000 py) and white children (150 per 10,000 py) compared to those of black (64 per 10,000 py) and South Asian (81 per 10,000 py) ethnicity. Marked geographic variation in incidence was observed. The highest fracture rates were observed in Wales, where boys and girls had 1.82 and 1.97 times greater incidence, respectively, than those residing in Greater London. ConclusionIn the period 1988–2012, there was marked geographic and ethnic variation in childhood fracture incidence across the UK. These findings also implicate lifestyle and socio-economic differences associated with location and ethnicity, and are relevant to policy makers in the UK and internationally.

Implications of case managers' perceptions and attitude on safety of home-delivered care.

Perceptions on safety in community care have been relatively unexplored. A project that sought to understand the multiple perspectives on safety in the NHS case-management programme was carried out in relation to the structure, process, and outcome of care. This article presents a component of the nursing perspective that highlights an important element in the structure of nursing care that could potentially impede the nurses' ability to be fully effective and safe. A single case study of the case-management programme was undertaken. Three primary care organisations from three strategic health authorities participated, and three focus groups were conducted (one within each organisation). In total, 17 case management nurses participated. Data were audiotaped and transcribed verbatim and subjected to framework analysis. Nursing staff attitudes were identified as a structure of care that influence safety outcomes, particularly their perceptions of the care setting and the implications it has on their role and patient behaviour. Greater understanding of the expected role of the community nurse is necessary, and relevant training is required for nurses to be successful in empowering patients to perform more safely. In addition, efforts need to be made to improve patients' trust in the health-care system to prevent harm and promote more effective utilisation of resources.

Shaping district diabetes services: a novel performance index scoring system to successfully negotiate with Clinical Commissioning Groups

Aims: To establish whether a recently reported performance index scoring system developed in two diverse populations (Medway and Guildford, UK) could be used to successfully negotiate with a Clinical Commissioning Group (CCG) to shape diabetes services and set priorities.Methods: We collated demographic details for the area’s population with diabetes with diabetes scores from local primary care Quality and Outcomes Framework (QOF) records, together with exception reporting. Data from Hospital Episode Statistics and Dr Foster were used to record the Standardised Admission Rate (SAR) for a first/new referral to a secondary-care diabetes outpatient appointment or for emergency admission to hospital for diabetes. Hospital notes for patients from one GP practice were reviewed to clarify why patients were seen in secondary rather than primary care.Results: The prevalence of diabetes was low (4%) compared with figures from the Strategic Health Authority (SHA) (4.5%) and nationally (5.6%). Total diabetes QOF points achieved (99.3) were higher than for the SHA (97.8) and nationally (95.3); 61.1% achieved HbA1c &lt;7%, which was much higher than the SHA (57.2%) or national average (54.3%). The exception-reporting rate (9.8%) was lower than the SHA (10.5%) or national average (14%). The SAR was lower than the Surrey average for a first outpatient visit (87.8 vs. 128.9) or emergency admissions (85 vs. 106.7).Conclusions: The performance index scoring system enabled an assessment of diabetes care that transcended primary and secondary care. A successful negotiation took place between the local diabetes stakeholders and the CCG with a plan for improving and developing the current model of care. The scoring system is applicable to any district in the UK and may be of interest to clinicians and commissioners.

Sustainable Methods of Funding Health Care in Primary and Secondary Care for the Elderly

Clinical commissioning is a current health care management model for primary, secondary, and long term health care needs n United Kingdom nowadays. Form on 1 April 2013, Primary care trusts (PCTs) and strategic health authorities (SHAs) have been abolished. Clinical Commissioning Groups (CCGs) work with local authorities to address the wider determinants of health that is used to help people make positive changes to their lifestyle. NHS England (formerly the NHS Commissioning Board) and CCGs are currently responsible for commissioning the wide majority of NHS services. Local authorities take place on new public health commissioning responsibilities. England’s 211 CCGs will take over from 303 PCTs. CCGs are responsible for £65bn of the £95bn NHS commissioning budget. CCGs are planning and commissioning hospital care, community care as well as elderly care and mental health services. All GP practices have to be members of a CCG, and every CCG board will include at least one hospital doctor, nurse and member of the public. This process has continuing healthcare funding for managing elderly care, but personal health budgets also needed for providing huge benefits for these individuals. The aim of CCGs in managing a health budget is to provide elderly people more choice and control over the money spent on meeting their health care and well-being needs. That is, clinical commissioning groups select services that meet the elderly people’s needs in a flexibly and appropriately.

An investigation into the content validity of the Antimicrobial Self-Assessment Toolkit for NHS Trusts (ASAT v15a) using cognitive interviews with antimicrobial pharmacists.

The Antimicrobial Self-Assessment Toolkit for NHS Trusts (ASAT) was developed to evaluate the organizational strategies used to implement hospital-based antimicrobial stewardship programmes. An iterative approach was used to develop ASAT v15a, which has been previously investigated for face validity; however, further investigation into other types of validity was required. Therefore, the aim of this study was to investigate the content validity of ASAT v15a and hence modify and improve the content validity of the toolkit. A purposive sample of eight antimicrobial pharmacists was interviewed using cognitive interviewing techniques from within the former North-west Strategic Health Authority in England. Respondents were asked to 'think aloud' and to verbally express their thought processes as they generated responses to each question with the ASAT. There were no cognitive difficulties reported by respondents in response to 26/83 (31·3%) questions within the ASAT. However, cognitive difficulties were reported by respondents at each stage of the cognitive processing pathway in response to 57/83 (68·7%) questions. These difficulties were comprehension/interpretation in 27/83 (32·5%) questions, information retrieval in 10/83 (12%) questions, judgment/decision in 6/83 (7·2%) questions and response generation/formatting in 13/83 (15·7%) questions. Other findings included disagreement with the weightings applied to 13/83 (15·7%) questions. Respondents recommended that these questions should be modified to reflect their impact on hospital-based antimicrobial stewardship programmes (ASPs). Based on these findings, modifications were made to ASAT v15a to produce the next iteration (ASAT v16). Furthermore, respondents indicated that the role of clinical microbiologists was underrepresented in the current version of the toolkit; therefore, seven proposed questions were drafted, based on a literature review. Cognitive interviews were effectively able to detect problems encountered by respondents along the cognitive processing pathway by identifying words and/or phrases that required further modifications. Also, this method highlighted that there was a disparity between the respondents' interpretation and the ASAT developers' intent within some questions. Although respondents indicated that the toolkit evaluated the most pertinent components of ASPs, further modifications and testing would be required to improve its validity. These results highlight the importance of the inclusion of end-users in the development of reporting and/or evaluation tools or questionnaires.

Factors Affecting the Implementation of the National Programme for Information Technology in the National Health Services: The Case of Lorenzo in the North, Midlands and East of England Region

This study is concerned with the aspect of revealing the factors that affect the adoption of IT programs in the health sector in the NHS in UK. It focuses on the identification of the factors that influence significantly the adoption of LORENZO, the Electronic Health Record system that is being implemented in the Strategic Health Authorities (SHAs) in the North, Midlands and East of England (NME) region as part of the National Program for Information Technology (NPfIT) in the NHS. This study is based on the Technology Acceptance Model (TAM). A qualitative research methodology was used to approach this area unlike the quantitative approach usually associated with the TAM. The data was obtained by conducting face-to-face semi-structured interviews with people who represented the end users in the NHS and the designing company (the LSP). By contrast with most academic studies, the research, therefore, studied the NPfIT from the bottom up (i.e., the end user perspective). The main tool used to aid the analysis of the interview data is NVivo. This analysis was used to develop an extended TAM model and to suggest a theoretical model of the relationship between LORENZO development methodology and users’ acceptance. The study suggests some factors, apart from usefulness, which LORENZO’s designers, the NHS should take into account when it comes to enhance users’ usage of IT adoption. These factors are clinical safety, security, integration and information sharing.

The impact of chronic venous leg ulcers: a systematic review.

Chronic venous leg ulcers are common, intractable and often recurrent, but care tends to be wound focused, potentially overlooking the significant impact the condition has on patients' lives. A systematic review was undertaken to explore the factors that impact on the quality of life of patients with chronic venous leg ulceration. Eligible articles published between 1990 and 2013 were identified via electronic searches of research databases (MEDLINE, CINAHL, BNI, EMBASE, PsycINFO, AMED and HMIC, Cochrane Collaboration database and Google Scholar). There were 23 studies (11 qualitative and 12 quantitative) that met the inclusion criteria. There were then the subject of a full review. The qualitative studies were collapsed into four core themes: physical, psychological, social implications and the nurse-patient relationship. The quantitative studies were grouped according to the tool applied. The review demonstrated that chronic venous leg ulcers impact negatively upon all areas of daily living. Pain, exudate, odour and the impact on mobility were daily challenges. The ability to engage with everyday functioning was restricted either owing to the ulcer, the dressing or to a self-imposed isolation in response to the impact of symptoms. Depression and low mood were common and yet, despite this, some studies reported that participants remained hopeful. Studies suggest that chronic venous leg ulceration negatively affects the quality of life of the patient and that such issues receive inadequate attention during current consultations. If such negative implications are to be effectively addressed, key issues need to be considered during every consultation. This study was funded by West Midlands Strategic Health Authority. The authors have no conflicts of interest to declare.