Talking together : consumer communities in healthcare

Consumer involvement in computer mediated communities (CMCs) is increasing particularly in high involvement services such as healthcare. This paper examines the role of CMCs as providers of patient information and support and the subsequent effect on the relationship between 'informed' consumers and health care providers. The evolving dialogue between consumers in virtual communities provides one key axis along which professional service consumption will evolve. The challenge for service consumers is to develop frameworks that facilitate robust dialogue and exchange of information and emotional support to complement their rising authority. The parallel challenge is for the established medical profession to recognise the consequences of this evolving dialogue and develop approaches to service delivery that effectively engage with consumers on the basis of this increasing authority

Designing a gamified social platform for people living with dementia and their live-in family caregivers

In the current paper, a social gamified platform for people living with dementia and their live-in family caregivers, integrating a broader diagnostic approach and interactive interventions is presented. The CAREGIVERSPRO-MMD (C-MMD) platform constitutes a support tool for the patient and the informal caregiver - also referred to as the dyad - that strengthens self-care, and builds community capacity and engagement at the point of care. The platform is implemented to improve social collaboration, adherence to treatment guidelines through gamification, recognition of progress indicators and measures to guide management of patients with dementia, and strategies and tools to improve treatment interventions and medication adherence. Moreover, particular attention was provided on guidelines, considerations and user requirements for the design of a User-Centered Design (UCD) platform. The design of the platform has been based on a deep understanding of users, tasks and contexts in order to improve platform usability, and provide adaptive and intuitive User Interfaces with high accessibility. In this paper, the architecture and services of the C-MMD platform are presented, and specifically the gamification aspects. © 2018 Association for Computing Machinery.Peer ReviewedPostprint (author's final draft

Identifying acne treatment uncertainties via a James Lind Alliance Priority Setting Partnership

Objectives: The Acne Priority Setting Partnership (PSP) was set up to identify and rank treatment uncertainties by bringing together people with acne, and professionals providing care within and beyond the National Health Service (NHS). Setting: The UK with international participation. Participants: Teenagers and adults with acne, parents, partners, nurses, clinicians, pharmacists, private practitioners. Methods: Treatment uncertainties were collected via separate online harvesting surveys, embedded within the PSP website, for patients and professionals. A wide variety of approaches were used to promote the surveys to stakeholder groups with a particular emphasis on teenagers and young adults. Survey submissions were collated using keywords and verified as uncertainties by appraising existing evidence. The 30 most popular themes were ranked via weighted scores from an online vote. At a priority setting workshop, patients and professionals discussed the 18 highest-scoring questions from the vote, and reached consensus on the top 10. Results: In the harvesting survey, 2310 people, including 652 professionals and 1456 patients (58% aged 24 y or younger), made submissions containing at least one research question. After checking for relevance and rephrasing, a total of 6255 questions were collated into themes. Valid votes ranking the 30 most common themes were obtained from 2807 participants. The top 10 uncertainties prioritised at the workshop were largely focused on management strategies, optimum use of common prescription medications and the role of nondrug based interventions. More female than male patients took part in the harvesting surveys and vote. A wider range of uncertainties were provided by patients compared to professionals. Conclusions: Engaging teenagers and young adults in priority setting is achievable using a variety of promotional methods. The top 10 uncertainties reveal an extensive knowledge gap about widely used interventions and the relative merits of drug versus non-drug based treatments in acne management

An Exploration of the Role of Substance Misuse Nurses in Scotland

Executive Summary Background With the increase of drug misuse over the past two decades, the role of the Substance Misuse Nurse has increased dramatically. Research on the role of nurses working in this field is minimal and there is little known about what they do, what they think about their clients and their role, and how they approach treatment. A pilot study on substance misuse nurses in Grampian indicated that nurses may be key gatekeepers to specialist services and some nurses appeared to have an important role in clinical decision making. However, clinical decision making and other key aspects of nurse practice may vary across services in different geographical areas. This research was designed to gain a better understanding of the role of the substance misuse nurse in Scotland. Aims and Objectives The aim of this research was to describe and analyse the role of substance misuse nurses working with drug misusers in Scotland. The objectives were: • to identify the population of specialist nurses working directly in the management of illicit drug users in Scotland and gain baseline data on their demography, caseload, services provided and level of interaction with other health professionals; • to compare their attitudes to drug misusers with those of other health professionals; • to explore their beliefs about the effectiveness of different treatment options; • to examine their role in the initial client assessment and subsequent management; • to describe their interaction with the client; • to explore their relationship with other professionals. Methods Mixed quantitative and qualitative methods were used. The population of Substance Misuse Nurses and midwives working specifically with drug misusers across Scotland were identified and posted a comprehensive questionnaire. The questionnaire covered issues including qualifications, training, attitudes and beliefs about treatment and aspects of practice such as caseloads, services provided and relationships with other health and social professionals. Face-to-face interviews were conducted with a sub-sample of nurses including a range of gender, experience, and NHS areas. Interviews covered nurses’ assessment and decision making regarding treatment and relationships with other professionals. Observations of specialist nurse and client consultations allowed for some insight into the general structure of the consultation, the setting where the consultation took place and the roles of nurse and client in assessment and treatment planning. Characteristics of SMS nurses and services • A scoping exercise indentified 272 nurses. Of these 244 were sent a questionnaire (the remainder having left or being on sick leave). Of these, 79% responded. • Seventy percent (70%) were Grade G or above indicating a senior level workforce. • Most nurses were employed in substance misuse services (48%) or, similarly, drug and alcohol services (30%). • Formal training (university certificate/diploma) in substance misuse had been undertaken by 40% of nurses, induction training (i.e. at the start of employment) by 62% of nurses. • The median caseload was 38 clients. • The majority of consultations took place in clinical consultation rooms but this was not observed to influence the consultation. • Nurses reported that the average length of a consultation was 38 minutes. All of the observed consultations were scheduled for 30 minutes but half over-ran. Motivation, attitudes and beliefs • The challenging nature of working with drug misusers was a positive motivating factor for nurses working in this field. • Seventy-seven percent (77%) of nurses considered working with drug misusers to be rewarding, although 79% also considered that this population were not easy to deal with. Opinion was split about whether drug misusers could be manipulative in consultations. Initial assessment of clients • Waiting times for assessment were generally an issue of concern to nurses. • A detailed assessment was almost always conducted at the first consultation. • An SMR24 was almost always completed at the first consultation. • Interviews and observation of nurse-client consultations found that the approach to assessment seemed consistent across geographical areas. • Assessment included: brief physical examination, urine sampling, detailed exploration of drug use, exploration of physical problems, discussion of social and family support, housing and employment status and history of involvement in the criminal justice system. • Consultations were often brought to a close by discussing treatment expectations. • Initial assessment could take place over more than one appointment and several appointments could be required before a treatment plan was implemented. Making treatment decisions • Clients were actively encouraged to participate in treatment decisions. • Although 84% of nurses reported they were expected to follow a treatment protocol only 44% said they always did (for any treatment). • Eighty-six percent (86%) of nurses had seen the National Clinical Guidelines (DoH, 1999), and those who were interviewed felt that these provided a good framework for treatment, although they were perhaps lacking in detail. • Nurses reported that they often consulted widely with other health professionals but, most frequently, with the client, before making a treatment decision. • A third of nurses reported writing prescriptions for a doctor to sign. • Seventy percent (70%) of respondents felt nurses should be able write prescriptions but only if they were experienced nurses with appropriate training. Comparing beliefs of nurses with those of GPs and pharmacists Nurses were asked some questions which had been asked of GPs and pharmacists in previous national surveys conducted in 2000. This allowed for comparisons to be made: • When making treatment decisions nurses were less influenced than GPs by the attitude and behaviour of drug misusers. • When making treatment decisions nurses were more influenced than GPs by societal factors such as reducing the transmission of infectious disease. • Nurses were less likely than GPs to favour detoxification as a treatment approach, although 83% of nurses agreed that a community based detoxification programme was an effective tool for the treatment of drug misuse. • Nurses were more confident than GPs about their ability to successfully manage polydrug users. • Nurses and GPs were split in their beliefs about the effectiveness of dihydrocodeine. • Nurses believed more strongly than pharmacists that maintenance prescribing could stop the use of illicit drugs. • Fewer nurses than pharmacists believed that controlled drug dispensing should take place in central clinics rather than community pharmacies. Multidisciplinary working • Over half of nurses considered their relationship with pharmacists, GPs, health visitors/community nurses, hospital doctors and social workers to be good. • Opportunities to discuss services with local policy makers were considered insufficient. • Relationships with GPs seemed positive because nurses felt GPs valued their specialist knowledge. • Nurses had frequent contact with pharmacists and respected the difficulties of a pharmacist’s work. • Relationships with social services were variable. Some nurses felt undervalued by their social work colleagues, or felt there was a lack of joint planning for individual client care. • Nurses were clear about what circumstances should lead to a break in confidentiality between services and of how to go about this. • Integrated drug services were seen as potentially beneficial but there were specific concerns about the implications for clients of sharing information with other agencies and practical concerns about the size of joint assessment tools. Health and Safety at work • Sixty-four percent (64%) of nurses reported that they had been physically or verbally abused by clients, and half of those who had been subject to abuse felt current safety provision in their service was insufficient. Nurses in most areas said that the safety of staff was considered to be a high service priority, but there was evidence from interviews this was still lacking in some areas. • Greater use of personal alarms and alarms in consultation rooms, use of mobile phones, and specialised training were suggested as ways of improving safety. • Nurses said that the majority of their consultations take place in clinics/consultation rooms rather than clients’ homes. • The feeling was commonly expressed among interviewees that their work could be stressful, and this was seen as due to paperwork, excessive caseloads and working in isolation. Discussion of Findings This study provides baseline information which can be used to inform individual nurses, services, policy makers and researchers. Some individual nurses reading this report might find an element that is simply describing what they already know. This is inevitable but it is hoped individual nurses will still find interest in the views and practice of others within their profession. The value of this report is that it has quantified these findings on a national basis, providing robust data for workforce planning and needs assessment. It has not been possible to compare findings, and thus the practice of substance misuse nurses in Scotland, with other areas or countries because there is no comparable published work. It is also not possible to give guidelines or examples of ‘good practice’ as this would have involved data collection from clients and other professionals which was outwith this study’s remit. This study has found a reassuring consistence of practice across Scotland. Although many substance misuse nurses work in some degree of isolation there is an apparently high level of discussion and consultation with other service colleagues which provides support. The role of the nurse in the initial assessment and treatment plan is critical. Nevertheless, decisions regarding treatment plans were made largely between nurses and clients, with nurses making use of service protocols/guidelines. Some might question whether a nurse is the most appropriate person to undertake these tasks. Ability to conduct physical examination, some knowledge of pharmacology, mental health and psychology as well as an ability to explore the wider social context is required. On reflection a nurse, with mental health qualifications seems to have the most appropriate skills for this. There is a willingness by nurses to take on the role of prescribing albeit in a limited capacity, and only by very experienced nurses with appropriate training. Currently, a minority of nurses reported writing prescriptions to be signed by doctors, which is possible for doctors with handwriting exemptions. This raises issues about clinical governance. In signing the prescription a GP is still taking responsibility even though s/he may know little about the patient’s current condition. An important strand of a substance misuse nurse’s practice is ongoing support or counselling for clients. This raises issues about models of counselling followed and nurses’ competencies in doing this. The nature or model of counselling used by nurses was not explicitly covered in this research and further exploration of counselling would be an area for future research. Relationships with other professionals, were generally reported to be good. Nurses generally believed GPs valued their role. Comparison of attitudes of substance misuse nurses with earlier surveys of pharmacists and GPs indicates they are more positive in general and about treatment outcomes in particular. Nurses viewed the challenging aspect of working with drug misusers more positively than pharmacists and GPs. Nurses were less positive about their ability to influence policy. Currently substance misuse nurses have little input at policy level. At a local level, through Drug and Alcohol Action Teams (DAATs) this could improve the feeling of ownership towards service developments related to the Joint Future agenda. Service managers are currently the key link between nurses and DAATs. Perhaps a service nurse with more client contact should also attend to provide client feedback. At a national level greater nursing input into policy could give this specialist group a greater feeling of professional cohesion as well as keeping policy makers informed. Concerns about health and safety at work need to be considered at a national professional level as well as locally. Whether these issues should be addressed through the involvement of an organisation such as the Association of Nurses in Substance Abuse (ANSA) or an appointed individual is for discussion. Recommendations • All substance misuse nurses should receive induction training prior to commencing their post. Greater time should be protected to allow participation in training. • There should be further exploration of what models of counselling, if any, are followed to assess whether current training is adequate. • Appointment scheduling may need review as there was evidence that consultation time was routinely underestimated. Frequency of missed appointments needs to be considered at the same time. • Staffing of substance misuse nurses should be expanded in order to reduce: excessive caseloads; lengthy waiting lists; insufficient cover for holidays, training and absences; and occupational stress. • Nurses could be involved in GP training to share their experience of managing difficult cases such as poly-drug users and widen GPs perspective of the social benefits of drug misuse treatment. • Nurses should be kept aware of developments on integrated care for drug misusers. This would allow them to understand the principles behind integrated care and be aware of how their service fits into the overall plan. • Extending the role of senior substance misuse nurses to include the prescribing of controlled drugs should be considered. • A clearer job title should be given to nurses working in substance misuse so that they may be easily identified and representable at both DAAT and Scottish Executive level, e.g. Specialist Nurse in Substance Misuse. • Efforts should be made to improve substance misuse nurses’ opportunities to influence policy. • All substance misuse nurses should be provided with appropriate on going training, procedures and practices to allow them to carry out their work safely

Email for clinical communication between healthcare professionals

Background Email is a popular and commonly-used method of communication, but its use in healthcare is not routine. Where email communication has been utilised in health care, its purposes have included use for clinical communication between healthcare professionals, but the effects of using email in this way are not known. This review assesses the use of email for two-way clinical communication between healthcare professionals. Objectives To assess the effects of healthcare professionals using email to communicate clinical information, on healthcare professional outcomes, patient outcomes, health service performance, and service efficiency and acceptability, when compared to other forms of communicating clinical information. Search methods We searched: the Cochrane Consumers and Communication Review Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1 2010), MEDLINE (OvidSP) (1950 to January 2010), EMBASE (OvidSP) (1980 to January 2010), PsycINFO (1967 to January 2010), CINAHL (EbscoHOST) (1982 to February 2010), and ERIC (CSA) (1965 to January 2010). We searched grey literature: theses/dissertation repositories, trials registers and Google Scholar (searched July 2010). We used additional search methods: examining reference lists, contacting authors. Selection criteria Randomised controlled trials, quasi-randomised trials, controlled before and after studies and interrupted time series studies examining interventions in which healthcare professionals used email for communicating clinical information, and that took the form of 1) unsecured email 2) secure email or 3) web messaging. All healthcare professionals, patients and caregivers in all settings were considered. Data collection and analysis Two authors independently assessed studies for inclusion, assessed the included studies' risk of bias, and extracted data. We contacted study authors for additional information. We report all measures as per the study report. Main results We included one randomised controlled trial involving 327 patients and 159 healthcare providers at baseline. It compared an email to physicians containing patient-specific osteoporosis risk information and guidelines for evaluation and treatment with usual care (no email). This study was at high risk of bias for the allocation concealment and blinding domains. The email reminder changed health professional actions significantly, with professionals more likely to provide guideline-recommended osteoporosis treatment (bone density measurement and/or osteoporosis medication) when compared with usual care. The evidence for its impact on patient behaviours/actions was inconclusive. One measure found that the electronic medical reminder message impacted patient behaviour positively: patients had a higher calcium intake, and two found no difference between the two groups. The study did not assess primary health service outcomes or harms. Authors' conclusions As only one study was identified for inclusion, the results are inadequate to inform clinical practice in regard to the use of email for clinical communication between healthcare professionals. Future research needs to use high-quality study designs that take advantage of the most recent developments in information technology, with consideration of the complexity of email as an intervention, and costs

Email for clinical communication between healthcare professionals

Email is one of the most widely used methods of communication, but its use in healthcare is still uncommon. Where email communication has been utilised in health care, its purposes have included clinical communication between healthcare professionals, but the effects of using email in this way are not well known. We updated a 2012 review of the use of email for two-way clinical communication between healthcare professionals

Stroke education for healthcare professionals: making it fit for purpose

<b>Research questions:</b> 1. What are healthcare professionals’ (HCPs) educational priorities regarding stroke care? 2. Do stroke care priorities vary across the primary and secondary sectors? 3. How do HCPs conceive stroke care will be delivered in 2010? <b>Study design:</b> This was a two-year study using focus groups and interviews for instrument development, questionnaires for data collection and workshops to provide study feedback. Data were collected in 2005–06. <b>Study site:</b> One Scottish health board. <b>Inclusion criteria:</b> All National Health Service healthcare professionals working wherever stroke care occurred. <b>Population and sample:</b> Participants were drawn from 4 university teaching hospitals, 2 community hospitals, 1 geriatric medicine day hospital, 48 general practices (GPs), 12 care homes and 15 community teams. The sample comprised 155 doctors, 313 nurses, 133 therapists (physiotherapists, occupational therapists, speech and language therapists), and 29 ‘other HCPs’ (14 dieticians, 7 pharmacists, 2 podiatrists and 6 psychologists). <b>Results:</b> HCPs prefer face-to-face, accredited education but blended approaches are required that accommodate uni- and multidisciplinary demands. Doctors and nurses are more inclined towards discipline-specific training compared to therapists and other healthcare professionals (HCPs). HCPs in primary care and stroke units want more information on the social impact of stroke while those working in stroke units in particular are concerned with leadership in the multidisciplinary team. Nurses are the most interested in teaching patients and carers. <b>Conclusions</b> Stroke requires more specialist stroke staff, the upskilling of current staff and a national education pathway given that stroke care is most effectively managed by specialists with specific clinical skills. The current government push towards a flexible workforce is welcome but should be educationally-sound and recognise the career aspirations of healthcare professionals

TREC-Rio trial: a randomised controlled trial for rapid tranquillisation for agitated patients in emergency psychiatric rooms [ISRCTN44153243]

Agitated or violent patients constitute 10% of all emergency psychiatric treatment. Management guidelines, the preferred treatment of clinicians and clinical practice all differ. Systematic reviews show that all relevant studies are small and none are likely to have adequate power to show true differences between treatments. Worldwide, current treatment is not based on evidence from randomised trials. In Brazil, the combination haloperidol-promethazine is frequently used, but no studies involving this mix exist. TREC-Rio (Tranquilização Rápida-Ensaio Clínico [Translation: Rapid Tranquillisation-Clinical Trial]) will compare midazolam with haloperidol-promethazine mix for treatment of agitated patients in emergency psychiatric rooms of Rio de Janeiro, Brazil. TREC-Rio is a randomised, controlled, pragmatic and open study. Primary measure of outcome is tranquillisation at 20 minutes but effects on other measures of morbidity will also be assessed. TREC-Rio will involve the collaboration of as many health care professionals based in four psychiatric emergency rooms of Rio as possible. Because the design of this trial does not substantially complicate clinical management, and in several aspects simplifies it, the study can be large, and treatments used in everyday practice can be evaluated

International Profiles of Health Care Systems, 2011

This publication presents overviews of the health care systems of Australia, Canada, Denmark, England, France, Germany, Japan, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States. Each overview covers health insurance, public and private financing, health system organization, quality of care, health disparities, efficiency and integration, use of health information technology, use of evidence-based practice, cost containment, and recent reforms and innovations. In addition, summary tables provide data on a number of key health system characteristics and performance indicators, including overall health care spending, hospital spending and utilization, health care access, patient safety, care coordination, chronic care management, disease prevention, capacity for quality improvement, and public views

Evaluation of children's centres in England (ECCE) : strand 1: first survey of children's centre leaders in the most deprived areas

This report is the first output from the Evaluation of Children's Centres in England (ECCE), a six year study commissioned by the Department for Education and undertaken by NatCen Social Research, the University of Oxford and Frontier Economics. The aim of ECCE is to provide an in-depth understanding of children's centre services, including their effectiveness in relation to different management and delivery approaches and the cost of delivering different types of services. The aim of Strand 1 is to profile children’s centres in the most disadvantaged areas, providing estimates on different aspects of provision with which to select centres for subsequent stages of the evaluation and to explore different models of provision. The findings below relate to 500 children's centres that are representative of all phase 1 and 2 centres (i.e. those in the 30percent most deprived areas).</p