Demonstrating the search strategy for CINAHL (EBSCOhost). The advanced search techniques were adj... more Demonstrating the search strategy for CINAHL (EBSCOhost). The advanced search techniques were adjusted to meet the different requirements of the included electronic databases. (DOCX 80Â kb)
Background Social prescribing initiatives are widely implemented in the UK National Health Servic... more Background Social prescribing initiatives are widely implemented in the UK National Health Service to integrate health and social care. Social prescribing is a service in primary care that links patients with non-medical needs to sources of support provided by the community and voluntary sector to help improve their health and wellbeing. Such programmes usually include navigators, who work with referred patients and issue onward referrals to sources of non-medical support. This systematic review aimed to assess the evidence of service user outcomes of social prescribing programmes based on primary care and involving navigators. Methods We searched 11 databases, the grey literature, and the reference lists of relevant studies to identify the available evidence on the impact of social prescribing on service users. Searches were limited to literature written in English. No date restrictions were applied, and searches were conducted to June 2018. Findings were synthesized narratively, e...
International Journal of Technology Assessment in Health Care, 2017
Objectives: Exoskeletons are electromechanical devices that are worn by a human operator to incre... more Objectives: Exoskeletons are electromechanical devices that are worn by a human operator to increase their physical performance. Several exoskeletons have been developed to restore functional movements, such as walking, for those with paralysis due to neurological impairment. However, existing exoskeletons have limitations with respect to affordability, size, weight, speed, and efficiency, which may reduce their functional application. Therefore, the aim of this scoping review is to collect and narratively synthesize the perspectives of users of exoskeleton technology. Methods: A systematic literature search was conducted across several healthcare related online databases. Results: A total of 4,619 articles were identified, of which 51 were selected for full review. Only three studies were identified that met the inclusion criteria. Of these, one showed an incongruence between users’ expectations and experiences of device use; another reported perspectives on potential rather than a...
This article reports aspects of a systematic literature review commissioned by the UK Council of ... more This article reports aspects of a systematic literature review commissioned by the UK Council of Deans of Health. The review collated and analysed UK and international literature on pre-registration healthcare students raising concerns with poor quality care. The research found in that review is summarised here. To review research on healthcare students raising concerns with regard to the quality of practice published from 2009 to the present. In addition to grey literature and Google Scholar a search was completed of the CINAHL, Medline, ERIC, BEI, ASSIA, PsychInfo, British Nursing Index, Education Research Complete databases. Sandelowski and Barroso's (2007) method of metasynthesis was used to screen and analyse the research literature. The review covered students from nursing, midwifery, health visiting, paramedic science, operating department practice, physiotherapy, chiropody, podiatry, speech and language therapy, orthoptist, occupational therapy, orthotist, prosthetist, r...
Introduction: Despite the importance of continuity of care and patient engagement, few studies ha... more Introduction: Despite the importance of continuity of care and patient engagement, few studies have captured patients' views on integrated care. This study assesses patient experience in the Integrated Care Pilot in North West London with the aim to help clinicians and policymakers understand patients' acceptability of integrated care and design future initiatives. Methods: A survey was developed, validated and distributed to 2029 randomly selected practice patients identified as having a care plan. Results: A total of 405 questionnaires were included for analysis. Respondents identified a number of benefits associated with the pilot, including increased patient involvement in decision-making, improved patient-provider relationship, better organisation and access to care, and enhanced inter-professional communication. However, only 22.4% were aware of having a care plan, and of these only 37.9% had a copy of the care plan. Knowledge of care plans was significantly associated with a more positive experience. Conclusions: This study reinforces the view that integrated care can improve quality of care and patient experience. However, care planning was a complex and technically challenging process that occurred more slowly than planned with wide variation in quality and time of recruitment to the pilot, making it difficult to assess the sustainability of benefits.
The literature on integrated care is limited with respect to practical learning and experience. A... more The literature on integrated care is limited with respect to practical learning and experience. Although some attention has been paid to organizational processes and structures, not enough is paid to people, relationships, and the importance of these in bringing about integration. Little is known, for example, about provider engagement in the organizational change process, how to obtain and maintain it, and how it is demonstrated in the delivery of integrated care. Based on qualitative data from the evaluation of a large-scale integrated care initiative in London, United Kingdom, we explored the role of provider engagement in effective integration of services. Using thematic analysis, we identified an evolving engagement narrative with three distinct phases: enthusiasm, antipathy, and ambivalence, and argue that health care managers need to be aware of the impact of professional engagement to succeed in advancing the integrated care agenda.
BackgroundPerson-centered care emphasizes a holistic, humanistic approach that puts patients firs... more BackgroundPerson-centered care emphasizes a holistic, humanistic approach that puts patients first, at the center of medical care. Person-centeredness is also considered a core element of integrated care. Yet typologies of integrated care mainly describe how patients fit within integrated services, rather than how services fit into the patient¿s world. Patient-centeredness has been commonly defined through physician¿s behaviors aimed at delivering patient-centered care. Yet, it is unclear how `person-centeredness¿ is realized in integrated care through the patient voice. We aimed to explore patient narratives of person-centeredness in the integrated care context.MethodsWe conducted a phenomenological, qualitative study, including semi-structured interviews with 22 patients registered in the Northwest London Integrated Care Pilot. We incorporated Grounded Theory approach principles, including substantive open and selective coding, development of concepts and categories, and constant ...
Background: There is considerable international interest in exploiting the potential of digital s... more Background: There is considerable international interest in exploiting the potential of digital solutions to enhance the quality and safety of health care. Implementations of transformative eHealth technologies are underway globally, often at very considerable cost. In order to assess the impact of eHealth solutions on the quality and safety of health care, and to inform policy decisions on eHealth deployments, we undertook a systematic review of systematic reviews assessing the effectiveness and consequences of various eHealth technologies on the quality and safety of care. Methods and Findings: We developed novel search strategies, conceptual maps of health care quality, safety, and eHealth interventions, and then systematically identified, scrutinised, and synthesised the systematic review literature. Major biomedical databases were searched to identify systematic reviews published between 1997 and 2010. Related theoretical, methodological, and technical material was also reviewed. We identified 53 systematic reviews that focused on assessing the impact of eHealth interventions on the quality and/or safety of health care and 55 supplementary systematic reviews providing relevant supportive information. This systematic review literature was found to be generally of substandard quality with regards to methodology, reporting, and utility. We thematically categorised eHealth technologies into three main areas: (1) storing, managing, and transmission of data; (2) clinical decision support; and (3) facilitating care from a distance. We found that despite support from policymakers, there was relatively little empirical evidence to substantiate many of the claims made in relation to these technologies. Whether the success of those relatively few solutions identified to improve quality and safety would continue if these were deployed beyond the contexts in which they were originally developed, has yet to be established. Importantly, best practice guidelines in effective development and deployment strategies are lacking. Conclusions: There is a large gap between the postulated and empirically demonstrated benefits of eHealth technologies. In addition, there is a lack of robust research on the risks of implementing these technologies and their cost-effectiveness has yet to be demonstrated, despite being frequently promoted by policymakers and ''techno-enthusiasts'' as if this was a given. In the light of the paucity of evidence in relation to improvements in patient outcomes, as well as the lack of evidence on their cost-effectiveness, it is vital that future eHealth technologies are evaluated against a comprehensive set of measures, ideally throughout all stages of the technology's life cycle. Such evaluation should be characterised by careful attention to socio-technical factors to maximise the likelihood of successful implementation and adoption.
ABSTRACT Background In the context of integrated care, multidisciplinary group (MDG) meetings inv... more ABSTRACT Background In the context of integrated care, multidisciplinary group (MDG) meetings involve participants who are not only from different professional groups but also from different organisational backgrounds within a complex local health economy. Such meetings therefore provide opportunities for participants to discuss complex care of individual patients, as well as ways to improve working within that local health economy—ie, working in a more integrative manner. We used an innovative coding scheme and method to explore the communication patterns within MDGs of a large-scale integrated care pilot (the North-West London Integrated Care Pilot). We investigated the extent to which case discussions foster an integrative way of working between MDG participants.Methods Case discussions in four MDG meetings were audio recorded and transcribed. Scripts were divided into utterances, or units of meaning, of about equal length representing a complete phrase or sentence. A second researcher then checked these utterances, and disagreements were resolved through consensus. Two coders independently coded utterances according to their integrative potential, which was defined against three independent domains: the level (ie, individual, collective, and systems); the valence (problem, information, and solution); and the focus (concrete and abstract). Utterances were coded first with respect to level, then valence, and then focus, to avoid any bias to code preferentially towards one permutation of the three codes. Inter-rater and intra-rater reliability was tested with kappa scores on one randomly selected case discussion. Intra-rater scores were taken 2 weeks apart to avoid possible code recall. We developed an ordinal scale based on mathematical weights for the 18 permutations of level, valence, and focus. Standardised mean integration scores were calculated for case discussions across utterance deciles, corresponding roughly to time deciles, indicating how integrative intensity changed during the conversation.FindingsWe transcribed and coded 23 case discussions in four different MDG groups. Inter-rater and intra-rater reliability was good, as shown by the prevalence and bias-adjusted kappa scores for one randomly selected case discussion. We coded 4209 utterances. The proportion of utterances differed according to participant type (consultant 14·6%; presenting general practitioner 38·8%; chair 7·8%; non-presenting general practitioner 2·3%; allied health professional 4·8%). Utterances were predominantly coded at low levels of integrative intensity. Allied health professionals accounted for a fairly low proportion of utterances; however, they tended to speak at higher integrative levels. We noted evidence for a gradual increase (R2 0·66) in integrative intensity during the case discussions, but on the basis of analysis of the minutes and action points arising from these discussions, this evidence did not translate into future actions.InterpretationWe characterise the MDGs as having consultative characteristics with some trend towards collaboration, but best resemble community-based ward rounds. The increase in integration scores did not tend to translate into actions for the groups to take forward. The role of the chair and the improved participation of non-presenting general practitioners and allied health professionals seem important, especially because allied health professionals contribute greatly to higher integrative scores. Traditional communication patterns of medical dominance are being perpetuated in the MDGs, suggesting that more could be done to sensitise participants to the value of full participation from all members of the group. Case discussions in integrated care MDGs are opportunities for health professionals to learn from each other's cases and explore how services could work together better to improve care generally. Our characterisation of these MDGs shows that more could be done in this regard. Reviews of decision making and communication in primary and community care show a dearth of empirical research examining real-time dynamics. Our method enables researchers to detect evolutionary changes in the integrative intensity of the group over time and make comparisons between MDGs.FundingImperial College Healthcare Charity.
Partners rather than just providers…" : a qualitative study on health care professionals' views o... more Partners rather than just providers…" : a qualitative study on health care professionals' views on implementation of multidisciplinary group meetings in the North West London integrated care pilot. International Journal of Integrated Care, 15. e032.
International Journal of Environmental Research and Public Health
Obesity is a complex public health issue with multiple contributing factors. The emphasis on join... more Obesity is a complex public health issue with multiple contributing factors. The emphasis on joined care has led to the development and implementation of a number of integrated care interventions targeting obesity and mental health. The purpose of this study was to examine user experience in an integrated care programme for obesity and mental health in Luton, UK. Semi-structured interviews were conducted with a purposeful sample of service users (N = 14). Interview transcripts were analysed using thematic analysis. Analysis of the interviews identified six main themes for understanding service users’ experiences of integrated care: (1) ‘A user-centered system’, (2) ‘Supports behaviour change’, (3) ‘Valued social support’, (4) ‘Communication is key’, (5) ‘Flexible referral process’, and (6) ‘Positive impact on life’. These themes describe how the service is operated, evidence perceived value service users place on social support in behavior change intervention, and address which serv...
Protocol: A systematic scoping review of the impact of mutual care on individuals with learning d... more Protocol: A systematic scoping review of the impact of mutual care on individuals with learning disabilities and their ageing carers in the United Kingdom. Journal Item How to cite: Mahon, Aoife; Vseteckova, Jitka; Tilley, Elizabeth; Pappas, Yannis and Randhawa, Gurch (2019). Protocol: A systematic scoping review of the impact of mutual care on individuals with learning disabilities and their ageing carers in the United Kingdom. Biomedical Journal of Scientific and Technical Research, article no. BJSTR-CAR-19-RW-153.
The aim is to is to provide a greater understanding of the existing crisis interventions and prev... more The aim is to is to provide a greater understanding of the existing crisis interventions and preventative support available for individuals with learning disabilities (LD) who are cared for by an ageing carer within the UK. This will include evaluating the outcomes and effectiveness of available interventions, including cost-efficiency (where this information is provided).The current review aimed to synthesize all available evidence on the availability and effectiveness of the interventions available to support people with LD who are being cared for by older carers in times of crisis. This includes a review of the financial implications of such crises and interventions.
Introduction: Social prescription promotes the use of the community and voluntary sector within p... more Introduction: Social prescription promotes the use of the community and voluntary sector within primary healthcare. It provides healthcare professionals with a non-medical referral option, which can operate alongside medical treatments, to address the non-clinical needs of patients. Social deprivation or psychosocial problems are often the source of health problems, poor wellbeing, and may lead to frequent primary and secondary care visits. To address the non-clinical needs of people, social prescribing links patients with sources of support within the third sector. There is evidence that social prescribing interventions have the potential to improve service user outcomes, however, most evaluations are small scale and limited by poor design and reporting. This study aimed to assess and explore the service user outcomes for the patients who participated in a social prescription intervention in the East of England Luton. Methods: A mixed-methods study was conducted including ten semi-...
Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy
The aim of this study is to investigate the relationship between childhood maternal level of educ... more The aim of this study is to investigate the relationship between childhood maternal level of education (CMLE) and changes in anthropometric and laboratory risk markers of metabolic syndrome (MetS) in mid-adulthood using results from the 1958 British Birth Cohort Study. Design: Cohort study. Participants: A total of 9376 study samples consisting of subjects that participated in the biomedical survey of the national child development study (NCDS) carried out between 2002 and 2004 were used for the analysis. Main Outcome Measures: Five risk markers of MetS: (i) HDL-cholesterol (ii) triglyceride (iii) blood pressure (BP) including systolic (SBP) and diastolic (DBP) (iv) waist circumference (WC) and (v) glycated haemoglobin (HbA1c). Methods: The NCDS or the 1958 British birth cohort data deposited in the UK data service by the centre for longitudinal studies were used for analyses. Ordinary least squares regression was used to determine unit changes in the outcome variables given CMLE. Results: The estimates for unadjusted regression analysis of individual risk markers indicated a significant relationship between CMLE and alterations in the five risk markers of MetS (HDL-cholesterol, triglyceride, WC, HbA1c, and BP) in midlife. After adjustment for birth and lifestyle characteristics/health behaviours, the relationship between CMLE and the risk markers was attenuated for HDL-cholesterol, triglycerides, and HbA1c but remained significant for WC 0.70 (95% confidence interval (CI) 0.065-1.30, p<0.001) and SBP 1.48 (95% CI 0.48-2.47 p<0.001). Conclusion: There was a positive association between lower CMLE and the risk of MetS using the NCDS data. Lifestyle characteristics may be influential determinants of MetS risk in mid-adulthood.
Demonstrating the search strategy for CINAHL (EBSCOhost). The advanced search techniques were adj... more Demonstrating the search strategy for CINAHL (EBSCOhost). The advanced search techniques were adjusted to meet the different requirements of the included electronic databases. (DOCX 80Â kb)
Background Social prescribing initiatives are widely implemented in the UK National Health Servic... more Background Social prescribing initiatives are widely implemented in the UK National Health Service to integrate health and social care. Social prescribing is a service in primary care that links patients with non-medical needs to sources of support provided by the community and voluntary sector to help improve their health and wellbeing. Such programmes usually include navigators, who work with referred patients and issue onward referrals to sources of non-medical support. This systematic review aimed to assess the evidence of service user outcomes of social prescribing programmes based on primary care and involving navigators. Methods We searched 11 databases, the grey literature, and the reference lists of relevant studies to identify the available evidence on the impact of social prescribing on service users. Searches were limited to literature written in English. No date restrictions were applied, and searches were conducted to June 2018. Findings were synthesized narratively, e...
International Journal of Technology Assessment in Health Care, 2017
Objectives: Exoskeletons are electromechanical devices that are worn by a human operator to incre... more Objectives: Exoskeletons are electromechanical devices that are worn by a human operator to increase their physical performance. Several exoskeletons have been developed to restore functional movements, such as walking, for those with paralysis due to neurological impairment. However, existing exoskeletons have limitations with respect to affordability, size, weight, speed, and efficiency, which may reduce their functional application. Therefore, the aim of this scoping review is to collect and narratively synthesize the perspectives of users of exoskeleton technology. Methods: A systematic literature search was conducted across several healthcare related online databases. Results: A total of 4,619 articles were identified, of which 51 were selected for full review. Only three studies were identified that met the inclusion criteria. Of these, one showed an incongruence between users’ expectations and experiences of device use; another reported perspectives on potential rather than a...
This article reports aspects of a systematic literature review commissioned by the UK Council of ... more This article reports aspects of a systematic literature review commissioned by the UK Council of Deans of Health. The review collated and analysed UK and international literature on pre-registration healthcare students raising concerns with poor quality care. The research found in that review is summarised here. To review research on healthcare students raising concerns with regard to the quality of practice published from 2009 to the present. In addition to grey literature and Google Scholar a search was completed of the CINAHL, Medline, ERIC, BEI, ASSIA, PsychInfo, British Nursing Index, Education Research Complete databases. Sandelowski and Barroso's (2007) method of metasynthesis was used to screen and analyse the research literature. The review covered students from nursing, midwifery, health visiting, paramedic science, operating department practice, physiotherapy, chiropody, podiatry, speech and language therapy, orthoptist, occupational therapy, orthotist, prosthetist, r...
Introduction: Despite the importance of continuity of care and patient engagement, few studies ha... more Introduction: Despite the importance of continuity of care and patient engagement, few studies have captured patients' views on integrated care. This study assesses patient experience in the Integrated Care Pilot in North West London with the aim to help clinicians and policymakers understand patients' acceptability of integrated care and design future initiatives. Methods: A survey was developed, validated and distributed to 2029 randomly selected practice patients identified as having a care plan. Results: A total of 405 questionnaires were included for analysis. Respondents identified a number of benefits associated with the pilot, including increased patient involvement in decision-making, improved patient-provider relationship, better organisation and access to care, and enhanced inter-professional communication. However, only 22.4% were aware of having a care plan, and of these only 37.9% had a copy of the care plan. Knowledge of care plans was significantly associated with a more positive experience. Conclusions: This study reinforces the view that integrated care can improve quality of care and patient experience. However, care planning was a complex and technically challenging process that occurred more slowly than planned with wide variation in quality and time of recruitment to the pilot, making it difficult to assess the sustainability of benefits.
The literature on integrated care is limited with respect to practical learning and experience. A... more The literature on integrated care is limited with respect to practical learning and experience. Although some attention has been paid to organizational processes and structures, not enough is paid to people, relationships, and the importance of these in bringing about integration. Little is known, for example, about provider engagement in the organizational change process, how to obtain and maintain it, and how it is demonstrated in the delivery of integrated care. Based on qualitative data from the evaluation of a large-scale integrated care initiative in London, United Kingdom, we explored the role of provider engagement in effective integration of services. Using thematic analysis, we identified an evolving engagement narrative with three distinct phases: enthusiasm, antipathy, and ambivalence, and argue that health care managers need to be aware of the impact of professional engagement to succeed in advancing the integrated care agenda.
BackgroundPerson-centered care emphasizes a holistic, humanistic approach that puts patients firs... more BackgroundPerson-centered care emphasizes a holistic, humanistic approach that puts patients first, at the center of medical care. Person-centeredness is also considered a core element of integrated care. Yet typologies of integrated care mainly describe how patients fit within integrated services, rather than how services fit into the patient¿s world. Patient-centeredness has been commonly defined through physician¿s behaviors aimed at delivering patient-centered care. Yet, it is unclear how `person-centeredness¿ is realized in integrated care through the patient voice. We aimed to explore patient narratives of person-centeredness in the integrated care context.MethodsWe conducted a phenomenological, qualitative study, including semi-structured interviews with 22 patients registered in the Northwest London Integrated Care Pilot. We incorporated Grounded Theory approach principles, including substantive open and selective coding, development of concepts and categories, and constant ...
Background: There is considerable international interest in exploiting the potential of digital s... more Background: There is considerable international interest in exploiting the potential of digital solutions to enhance the quality and safety of health care. Implementations of transformative eHealth technologies are underway globally, often at very considerable cost. In order to assess the impact of eHealth solutions on the quality and safety of health care, and to inform policy decisions on eHealth deployments, we undertook a systematic review of systematic reviews assessing the effectiveness and consequences of various eHealth technologies on the quality and safety of care. Methods and Findings: We developed novel search strategies, conceptual maps of health care quality, safety, and eHealth interventions, and then systematically identified, scrutinised, and synthesised the systematic review literature. Major biomedical databases were searched to identify systematic reviews published between 1997 and 2010. Related theoretical, methodological, and technical material was also reviewed. We identified 53 systematic reviews that focused on assessing the impact of eHealth interventions on the quality and/or safety of health care and 55 supplementary systematic reviews providing relevant supportive information. This systematic review literature was found to be generally of substandard quality with regards to methodology, reporting, and utility. We thematically categorised eHealth technologies into three main areas: (1) storing, managing, and transmission of data; (2) clinical decision support; and (3) facilitating care from a distance. We found that despite support from policymakers, there was relatively little empirical evidence to substantiate many of the claims made in relation to these technologies. Whether the success of those relatively few solutions identified to improve quality and safety would continue if these were deployed beyond the contexts in which they were originally developed, has yet to be established. Importantly, best practice guidelines in effective development and deployment strategies are lacking. Conclusions: There is a large gap between the postulated and empirically demonstrated benefits of eHealth technologies. In addition, there is a lack of robust research on the risks of implementing these technologies and their cost-effectiveness has yet to be demonstrated, despite being frequently promoted by policymakers and ''techno-enthusiasts'' as if this was a given. In the light of the paucity of evidence in relation to improvements in patient outcomes, as well as the lack of evidence on their cost-effectiveness, it is vital that future eHealth technologies are evaluated against a comprehensive set of measures, ideally throughout all stages of the technology's life cycle. Such evaluation should be characterised by careful attention to socio-technical factors to maximise the likelihood of successful implementation and adoption.
ABSTRACT Background In the context of integrated care, multidisciplinary group (MDG) meetings inv... more ABSTRACT Background In the context of integrated care, multidisciplinary group (MDG) meetings involve participants who are not only from different professional groups but also from different organisational backgrounds within a complex local health economy. Such meetings therefore provide opportunities for participants to discuss complex care of individual patients, as well as ways to improve working within that local health economy—ie, working in a more integrative manner. We used an innovative coding scheme and method to explore the communication patterns within MDGs of a large-scale integrated care pilot (the North-West London Integrated Care Pilot). We investigated the extent to which case discussions foster an integrative way of working between MDG participants.Methods Case discussions in four MDG meetings were audio recorded and transcribed. Scripts were divided into utterances, or units of meaning, of about equal length representing a complete phrase or sentence. A second researcher then checked these utterances, and disagreements were resolved through consensus. Two coders independently coded utterances according to their integrative potential, which was defined against three independent domains: the level (ie, individual, collective, and systems); the valence (problem, information, and solution); and the focus (concrete and abstract). Utterances were coded first with respect to level, then valence, and then focus, to avoid any bias to code preferentially towards one permutation of the three codes. Inter-rater and intra-rater reliability was tested with kappa scores on one randomly selected case discussion. Intra-rater scores were taken 2 weeks apart to avoid possible code recall. We developed an ordinal scale based on mathematical weights for the 18 permutations of level, valence, and focus. Standardised mean integration scores were calculated for case discussions across utterance deciles, corresponding roughly to time deciles, indicating how integrative intensity changed during the conversation.FindingsWe transcribed and coded 23 case discussions in four different MDG groups. Inter-rater and intra-rater reliability was good, as shown by the prevalence and bias-adjusted kappa scores for one randomly selected case discussion. We coded 4209 utterances. The proportion of utterances differed according to participant type (consultant 14·6%; presenting general practitioner 38·8%; chair 7·8%; non-presenting general practitioner 2·3%; allied health professional 4·8%). Utterances were predominantly coded at low levels of integrative intensity. Allied health professionals accounted for a fairly low proportion of utterances; however, they tended to speak at higher integrative levels. We noted evidence for a gradual increase (R2 0·66) in integrative intensity during the case discussions, but on the basis of analysis of the minutes and action points arising from these discussions, this evidence did not translate into future actions.InterpretationWe characterise the MDGs as having consultative characteristics with some trend towards collaboration, but best resemble community-based ward rounds. The increase in integration scores did not tend to translate into actions for the groups to take forward. The role of the chair and the improved participation of non-presenting general practitioners and allied health professionals seem important, especially because allied health professionals contribute greatly to higher integrative scores. Traditional communication patterns of medical dominance are being perpetuated in the MDGs, suggesting that more could be done to sensitise participants to the value of full participation from all members of the group. Case discussions in integrated care MDGs are opportunities for health professionals to learn from each other&#39;s cases and explore how services could work together better to improve care generally. Our characterisation of these MDGs shows that more could be done in this regard. Reviews of decision making and communication in primary and community care show a dearth of empirical research examining real-time dynamics. Our method enables researchers to detect evolutionary changes in the integrative intensity of the group over time and make comparisons between MDGs.FundingImperial College Healthcare Charity.
Partners rather than just providers…" : a qualitative study on health care professionals' views o... more Partners rather than just providers…" : a qualitative study on health care professionals' views on implementation of multidisciplinary group meetings in the North West London integrated care pilot. International Journal of Integrated Care, 15. e032.
International Journal of Environmental Research and Public Health
Obesity is a complex public health issue with multiple contributing factors. The emphasis on join... more Obesity is a complex public health issue with multiple contributing factors. The emphasis on joined care has led to the development and implementation of a number of integrated care interventions targeting obesity and mental health. The purpose of this study was to examine user experience in an integrated care programme for obesity and mental health in Luton, UK. Semi-structured interviews were conducted with a purposeful sample of service users (N = 14). Interview transcripts were analysed using thematic analysis. Analysis of the interviews identified six main themes for understanding service users’ experiences of integrated care: (1) ‘A user-centered system’, (2) ‘Supports behaviour change’, (3) ‘Valued social support’, (4) ‘Communication is key’, (5) ‘Flexible referral process’, and (6) ‘Positive impact on life’. These themes describe how the service is operated, evidence perceived value service users place on social support in behavior change intervention, and address which serv...
Protocol: A systematic scoping review of the impact of mutual care on individuals with learning d... more Protocol: A systematic scoping review of the impact of mutual care on individuals with learning disabilities and their ageing carers in the United Kingdom. Journal Item How to cite: Mahon, Aoife; Vseteckova, Jitka; Tilley, Elizabeth; Pappas, Yannis and Randhawa, Gurch (2019). Protocol: A systematic scoping review of the impact of mutual care on individuals with learning disabilities and their ageing carers in the United Kingdom. Biomedical Journal of Scientific and Technical Research, article no. BJSTR-CAR-19-RW-153.
The aim is to is to provide a greater understanding of the existing crisis interventions and prev... more The aim is to is to provide a greater understanding of the existing crisis interventions and preventative support available for individuals with learning disabilities (LD) who are cared for by an ageing carer within the UK. This will include evaluating the outcomes and effectiveness of available interventions, including cost-efficiency (where this information is provided).The current review aimed to synthesize all available evidence on the availability and effectiveness of the interventions available to support people with LD who are being cared for by older carers in times of crisis. This includes a review of the financial implications of such crises and interventions.
Introduction: Social prescription promotes the use of the community and voluntary sector within p... more Introduction: Social prescription promotes the use of the community and voluntary sector within primary healthcare. It provides healthcare professionals with a non-medical referral option, which can operate alongside medical treatments, to address the non-clinical needs of patients. Social deprivation or psychosocial problems are often the source of health problems, poor wellbeing, and may lead to frequent primary and secondary care visits. To address the non-clinical needs of people, social prescribing links patients with sources of support within the third sector. There is evidence that social prescribing interventions have the potential to improve service user outcomes, however, most evaluations are small scale and limited by poor design and reporting. This study aimed to assess and explore the service user outcomes for the patients who participated in a social prescription intervention in the East of England Luton. Methods: A mixed-methods study was conducted including ten semi-...
Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy
The aim of this study is to investigate the relationship between childhood maternal level of educ... more The aim of this study is to investigate the relationship between childhood maternal level of education (CMLE) and changes in anthropometric and laboratory risk markers of metabolic syndrome (MetS) in mid-adulthood using results from the 1958 British Birth Cohort Study. Design: Cohort study. Participants: A total of 9376 study samples consisting of subjects that participated in the biomedical survey of the national child development study (NCDS) carried out between 2002 and 2004 were used for the analysis. Main Outcome Measures: Five risk markers of MetS: (i) HDL-cholesterol (ii) triglyceride (iii) blood pressure (BP) including systolic (SBP) and diastolic (DBP) (iv) waist circumference (WC) and (v) glycated haemoglobin (HbA1c). Methods: The NCDS or the 1958 British birth cohort data deposited in the UK data service by the centre for longitudinal studies were used for analyses. Ordinary least squares regression was used to determine unit changes in the outcome variables given CMLE. Results: The estimates for unadjusted regression analysis of individual risk markers indicated a significant relationship between CMLE and alterations in the five risk markers of MetS (HDL-cholesterol, triglyceride, WC, HbA1c, and BP) in midlife. After adjustment for birth and lifestyle characteristics/health behaviours, the relationship between CMLE and the risk markers was attenuated for HDL-cholesterol, triglycerides, and HbA1c but remained significant for WC 0.70 (95% confidence interval (CI) 0.065-1.30, p<0.001) and SBP 1.48 (95% CI 0.48-2.47 p<0.001). Conclusion: There was a positive association between lower CMLE and the risk of MetS using the NCDS data. Lifestyle characteristics may be influential determinants of MetS risk in mid-adulthood.
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