Identifying technology related barriers & enablers to streamlining delivery of BP@home in NCL

Report objectives: This report summarises the key findings of a place-based evaluation to identify barriers and enablers to the streamlined use of digital tools to support successful implementation of BP@home in North Central London (NCL). Specifically, we characterised the IT landscape in NCL, investigated the views and experiences of HCPs regarding the use of place-based IT solutions and processes, and synthesised a list of evidence-based recommendations for the consideration of NCL leadership team. Methods: We used a mixed methods research approach and six phases of investigation to address these aims, including desktop research, personal interviews and focus groups, action research, data analysis, synthesis and reporting. Results: The evaluation showed that there was a lack of standardisation across IT systems, internal processes and templates in PCNs in NCL, leading to challenges in implementing and using digital tools to support P@home. These challenges were not unique to NCL. AccurX and the locally created NCL template are the most widely used IT tools to support the program in NCL. Other digital platforms being tested in NCL include Suvera, each with unique strengths and weaknesses. Other digital tools, such as Omron Connect, could be considered to support management of hypertension and other chronic conditions. HCPs faced challenges with patient engagement, data quality, IT system integration and resource allocation, but generally felt that the current approach works. Basic requirements for the use and adoption of IT tools and systems include adequate resources, stakeholder engagement, user-friendly interfaces, and interoperability between different ystems. We proposed 16 actionable insights and recommendations that could be implemented to help improve the delivery of BP@home in NCL. These include standardising IT systems, improving patient engagement, providing adequate training and support, and promoting the benefits of remote monitoring. Conclusion: On balance, we recommend that NCL continues to deliver BP@home using the current standard IT offer that facilitates asynchronous engagement with patients (i.e., AccurX). Embedding a quality improvement approach to identify mechanisms to continually improve the BP@home offer in NCL is recommended. Clinical leadership could also review the evaluation findings of alternative tools currently being tested locally (e.g., pilot using Suvera across one PCN) to drive evidence-based commissioning decision as the BP@home initiative becomes even more embedded in routine general practice

The Impact of Reducing Full Time Support Positions in the U.S. Army National Guard and Reserves

The United States Army is at a point in its history in which it, along with the other branches of the military, are experiencing cuts, constraints and a tightening of resources. The days of seemingly large budgets, abundant financial resources and high amounts of manpower are becoming a thing of the past. As the government reduces the allocations to the military, it is examining ways to reduce costs and improve its financial prospects. One of the positions examined for reduction or outright elimination is the full time support position in the U.S. Army National Guard (ARNG) and Reserves (USAR). The purpose of this research endeavor is to quantify the impact that these positions have on the ARNG and the USAR and determine the amount of risk associated with either reducing or eliminating them