BackgroundHealth services internationally are exploring the potential of telehealth to support th... more BackgroundHealth services internationally are exploring the potential of telehealth to support the management of the growing number of people with long-term conditions (LTCs).AimTo develop, implement and evaluate new care programmes for patients with LTCs, focusing on two common LTCs as exemplars: depression or high cardiovascular disease (CVD) risk.MethodsDevelopmentWe synthesised quantitative and qualitative evidence on the effectiveness of telehealth for LTCs, conducted a qualitative study based on interviews with patients and staff and undertook a postal survey to explore which patients are interested in different forms of telehealth. Based on these studies we developed a conceptual model [TElehealth in CHronic disease (TECH) model] as a framework for the development and evaluation of the Healthlines Service for patients with LTCs.ImplementationThe Healthlines Service consisted of regular telephone calls to participants from health information advisors, supporting them to make b...
Journal of Health Services Research & Policy, 2012
To determine the extent to which primary care trusts (PCTs) in England employed processes associa... more To determine the extent to which primary care trusts (PCTs) in England employed processes associated with quality commissioning and to assess whether changes occurred in these processes during a policy drive to improve commissioning. Telephone surveys of PCT managers leading commissioning for diabetes, chronic obstructive pulmonary disease (COPD), coronary heart disease (CHD), and emergency and urgent care in all 152 PCTs in both 2009 and 2010. The response rate was 51% (77/152) of PCTs in 2009 and 60% (91/152) in 2010. Two-thirds of commissioners had commissioned initiatives starting in the previous financial year. Over half of initiatives starting in 2008/09 had been instigated by the PCT alone. This reduced to a third in 2010, showing a shift towards partnership working. Commissioners reported that a large proportion of initiatives had been developed and shaped with the involvement of general practitioners (GPs) with direct links to the PCT and of specialist clinicians (70%), but that a lower proportion of initiatives had involvement from other GPs (40%). Patients or the public were less likely to be involved in initiatives than clinicians, but there was evidence of increasing involvement over the two years from 35% (52/149) to 51% (67/132) of initiatives. There was no evidence of changes in whether needs assessment was undertaken, how evidence was used or how initiatives were led and performance managed. PCT commissioners reported clinical engagement in the majority of commissioning initiatives, a shift towards partnership commissioning, and increased involvement of patients and public in the development of initiatives. The new model of commissioning in England through clinical commissioning groups will need to improve on these processes if it is to demonstrate a higher quality approach to commissioning.
BACKGROUND: High levels of asthma-related fear and panic exacerbate asthma symptoms and complicat... more BACKGROUND: High levels of asthma-related fear and panic exacerbate asthma symptoms and complicate the management of asthma. Asthma-specific fear may be reduced by a cognitive behavioural intervention. We aimed to test if there is a reduction in asthma-specific fear after cognitive behavioural intervention compared with routine treatment. METHODS: Adults with asthma registered with family doctors in Sheffield UK were screened for anxiety and 94 highly anxious patients were randomly allocated to receive either a cognitive ...
Introduction There is growing evidence about the effectiveness of acupuncture in the short term t... more Introduction There is growing evidence about the effectiveness of acupuncture in the short term treatment of chronic low back pain but little is known about long term outcomes. To address this question we followed up participants of a past randomised controlled trial of acupuncture to assess outcomes after 5.5 to 7 years. Methods Apostal questionnaire assessing pain, quality of life, disability, experience with back pain and healthcare resource use was sent to all 239 participants of the York Acupuncture for Back Pain trial. Results Response to the survey was low at 43.9%. Pain measured by the SF-36 Bodily Pain dimension was maintained in the acupuncture group since the last follow up 3.5 to 5 years previously. The usual care group had improved over the intervening years and there was now no evidence of a difference between the groups (difference -0.4 points, 95% confidence interval -10.1 to 9.7). The results were unchanged on sensitivity analysis using multiple imputation. In both groups back pain had not completely resolved and worry about back health was moderate. Physiotherapy and acupuncture were used at similar rates for continuing treatment. Discussion We theorise that exposure to a short course of acupuncture speeds natural recovery from a back pain episode, but improvements plateau after two years. Acupuncture is often accessed privately for long term management of back pain but is rarely available within the health service. While our study methods were robust, the low response rate means that our findings should be interpreted with caution.
Background Patients may find it difficult to distinguish between the symptoms of anxiety and thos... more Background Patients may find it difficult to distinguish between the symptoms of anxiety and those of asthma. Findings are equivocal on whether there is a specific link between anxiety and asthma. The aims of this study were to i) to identify the prevalence of anxiety, depression and panic fear in adults with asthma compared with that of the general population ii) to investigate whether there is a specific relationship between asthma and anxiety. Methods An epidemiological survey of 872 adults with a diagnosis of asthma identified from six General Practices in Sheffield, England. Community postal survey using self-completion questionnaire. Results The response rate was 59%. People with asthma had higher mean Hospital Anxiety and Depression Scale (HADS) anxiety scores than UK norms with a higher proportion above the clinical cut-off. Mean HADS depression scores were significantly higher than UK norms and norms for a general population sample of people registered with the same practice. These effects were age-related with the relationship between asthma and psychological distress most marked over the age of 45. The prevalence of asthma-specific panic fear was 15.7%. Conclusion A significant minority of people have high levels of panic fear (as measured by the Asthma Symptom Checklist) associated with asthma. However, in adults with asthma there is also high prevalence of both generalised anxiety and depression (as measured by the HADS), suggesting that the link of anxiety to asthma may be part of a broader relationship between psychological distress and chronic disease rather than a specific one.
BackgroundHealth services internationally are exploring the potential of telehealth to support th... more BackgroundHealth services internationally are exploring the potential of telehealth to support the management of the growing number of people with long-term conditions (LTCs).AimTo develop, implement and evaluate new care programmes for patients with LTCs, focusing on two common LTCs as exemplars: depression or high cardiovascular disease (CVD) risk.MethodsDevelopmentWe synthesised quantitative and qualitative evidence on the effectiveness of telehealth for LTCs, conducted a qualitative study based on interviews with patients and staff and undertook a postal survey to explore which patients are interested in different forms of telehealth. Based on these studies we developed a conceptual model [TElehealth in CHronic disease (TECH) model] as a framework for the development and evaluation of the Healthlines Service for patients with LTCs.ImplementationThe Healthlines Service consisted of regular telephone calls to participants from health information advisors, supporting them to make b...
Journal of Health Services Research & Policy, 2012
To determine the extent to which primary care trusts (PCTs) in England employed processes associa... more To determine the extent to which primary care trusts (PCTs) in England employed processes associated with quality commissioning and to assess whether changes occurred in these processes during a policy drive to improve commissioning. Telephone surveys of PCT managers leading commissioning for diabetes, chronic obstructive pulmonary disease (COPD), coronary heart disease (CHD), and emergency and urgent care in all 152 PCTs in both 2009 and 2010. The response rate was 51% (77/152) of PCTs in 2009 and 60% (91/152) in 2010. Two-thirds of commissioners had commissioned initiatives starting in the previous financial year. Over half of initiatives starting in 2008/09 had been instigated by the PCT alone. This reduced to a third in 2010, showing a shift towards partnership working. Commissioners reported that a large proportion of initiatives had been developed and shaped with the involvement of general practitioners (GPs) with direct links to the PCT and of specialist clinicians (70%), but that a lower proportion of initiatives had involvement from other GPs (40%). Patients or the public were less likely to be involved in initiatives than clinicians, but there was evidence of increasing involvement over the two years from 35% (52/149) to 51% (67/132) of initiatives. There was no evidence of changes in whether needs assessment was undertaken, how evidence was used or how initiatives were led and performance managed. PCT commissioners reported clinical engagement in the majority of commissioning initiatives, a shift towards partnership commissioning, and increased involvement of patients and public in the development of initiatives. The new model of commissioning in England through clinical commissioning groups will need to improve on these processes if it is to demonstrate a higher quality approach to commissioning.
BACKGROUND: High levels of asthma-related fear and panic exacerbate asthma symptoms and complicat... more BACKGROUND: High levels of asthma-related fear and panic exacerbate asthma symptoms and complicate the management of asthma. Asthma-specific fear may be reduced by a cognitive behavioural intervention. We aimed to test if there is a reduction in asthma-specific fear after cognitive behavioural intervention compared with routine treatment. METHODS: Adults with asthma registered with family doctors in Sheffield UK were screened for anxiety and 94 highly anxious patients were randomly allocated to receive either a cognitive ...
Introduction There is growing evidence about the effectiveness of acupuncture in the short term t... more Introduction There is growing evidence about the effectiveness of acupuncture in the short term treatment of chronic low back pain but little is known about long term outcomes. To address this question we followed up participants of a past randomised controlled trial of acupuncture to assess outcomes after 5.5 to 7 years. Methods Apostal questionnaire assessing pain, quality of life, disability, experience with back pain and healthcare resource use was sent to all 239 participants of the York Acupuncture for Back Pain trial. Results Response to the survey was low at 43.9%. Pain measured by the SF-36 Bodily Pain dimension was maintained in the acupuncture group since the last follow up 3.5 to 5 years previously. The usual care group had improved over the intervening years and there was now no evidence of a difference between the groups (difference -0.4 points, 95% confidence interval -10.1 to 9.7). The results were unchanged on sensitivity analysis using multiple imputation. In both groups back pain had not completely resolved and worry about back health was moderate. Physiotherapy and acupuncture were used at similar rates for continuing treatment. Discussion We theorise that exposure to a short course of acupuncture speeds natural recovery from a back pain episode, but improvements plateau after two years. Acupuncture is often accessed privately for long term management of back pain but is rarely available within the health service. While our study methods were robust, the low response rate means that our findings should be interpreted with caution.
Background Patients may find it difficult to distinguish between the symptoms of anxiety and thos... more Background Patients may find it difficult to distinguish between the symptoms of anxiety and those of asthma. Findings are equivocal on whether there is a specific link between anxiety and asthma. The aims of this study were to i) to identify the prevalence of anxiety, depression and panic fear in adults with asthma compared with that of the general population ii) to investigate whether there is a specific relationship between asthma and anxiety. Methods An epidemiological survey of 872 adults with a diagnosis of asthma identified from six General Practices in Sheffield, England. Community postal survey using self-completion questionnaire. Results The response rate was 59%. People with asthma had higher mean Hospital Anxiety and Depression Scale (HADS) anxiety scores than UK norms with a higher proportion above the clinical cut-off. Mean HADS depression scores were significantly higher than UK norms and norms for a general population sample of people registered with the same practice. These effects were age-related with the relationship between asthma and psychological distress most marked over the age of 45. The prevalence of asthma-specific panic fear was 15.7%. Conclusion A significant minority of people have high levels of panic fear (as measured by the Asthma Symptom Checklist) associated with asthma. However, in adults with asthma there is also high prevalence of both generalised anxiety and depression (as measured by the HADS), suggesting that the link of anxiety to asthma may be part of a broader relationship between psychological distress and chronic disease rather than a specific one.
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Papers by Lisa Esmonde