Characterising extant technology related barriers & enablers for streamlined delivery of BP@home in North Central London: Report for NCL LTC Clinical Network

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 BP@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 systems. 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

BP@home Pan-London Evaluation: Report Presented to NHSE I & LCEG (London)

Report objectives: This report summarises the key findings of a Pan-London evaluation to assess levels of implementation and identify key barriers and enablers to the streamlined implementation of the BP@home program across London. Specifically, we mapped the reception and distribution of BP@home monitors, investigated the views and experiences of primary care workers involved in the implementation of the programme, and quantify changes in outcomes using SNOMED codes. This data was synthesised and used to develop a list of evidence-based recommendations for the consideration of NHSE 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 are different levels of readiness and implementation across the 5 London ICSs. The roll-out of BP@home programme has been challenging due to a number of key factors across the pathway, including the limited IT infrastructure, insufficient human and financial resources, and the lack of adequate and specific SNOMED codes. These challenges were further increased by the competing demands on limited capacity in Primary Care, especially during the Covid-19 pandemic. However, respondents also identified some facilitators, including the onboarding material provided by NHSE, the inclusion of the UCLP criteria the EHR and the provision of conditional incentives in certain ICSs. A more structured and holistic approach to onboarding patients is needed to ensure high quality compliance and satisfactory results for patients. Another key recommendation devised by respondents was to offer BP monitors on prescription, along with the creation of specific SNOMED codes. Conclusion: At the time of redaction of this report, there are local evaluation plans in each ICS & a national evaluation of @Home programme was recently commissioned by NIHR. There is an urgent need to develop & use system-wide codes to track activity as well as carry additional research especially regarding patients’ experience and perspectives as recipients of the BP@home programme

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

Public libraries to promote public health and wellbeing: A cross-sectional study of community-dwelling adults

Purpose of research: To explore the potential of libraries as community hubs to promote mental and physical health and wellbeing. Design: Cross-sectional online survey and interview-based study with community-dwelling adults and library staff. Methods: We analysed data from 605 respondents using a 14-item electronic survey and conducted interviews with 12 library users and staff to gauge perceptions. Descriptive statistics and thematic analysis were used to identify key trends and emergent themes. Results: Libraries remain popular and are considered a'safe place' by members of the community, irrespective of whether they are frequent users of services. Library users' lack of awareness of community-facing services could act as a hurdle to improving community health and wellbeing. Targeted engagement with residents is needed to increase awareness of libraries' services, including community interventions to help tackle loneliness and inequalities in digital and health literacy. Library staff often did not feel involved in important decision-making. Various barriers, drivers and practical recommendations were identied to leverage libraries as hubs to promote community health and wellbeing. Conclusion: Libraries already offer a variety of resources that either directly or indirectly support the health and wellbeing of community-dwelling adults and young people, but public awareness of these services is limited. As we navigate postpandemic recovery, libraries can serve as platforms for community engagement, fostering resilience, mental health support, and reducing social isolation. Recognising libraries' untapped potential can lead to healthier communities and improved wellbeing

Triage and diagnostic accuracy of Online Symptom Checkers: a systematic review

Background: In the context of a deepening global shortage of health workers, and particularly the COVID-19 pandemic, there is growing international interest in and use of online symptom checkers (OSCs). However, the evidence surrounding the safety and accuracy of OSCs remains inconclusive so far. The triage and diagnostic accuracy of these tools is an essential aspect that needs to be addressed before pushing any further implementation. Objective: This systematic review aimed to summarize the existing peer-reviewed literature evaluating the triage accuracy (directing users to appropriate services based on their presenting symptoms) and diagnostic accuracy of OSCs aimed at lay users for general health concerns. Methods: Searches were conducted in Medline, Embase, CINAHL, HMIC and Web of Science. We included peer-reviewed studies published in English between 1 January 2010 and 17 February 2022 with a quantitative assessment of triage and/or diagnostic accuracy of OSCs directed at lay users. We excluded tools supporting health professionals, and disease- or speciality-specific OSCs. Screening and data extraction were carried out independently by two reviewers for each study. We performed a descriptive narrative synthesis. Results: 21,284 studies were screened and 15 were included. Six studies reported on both triage and diagnostic accuracy, eight focused on triage accuracy, and one on diagnostic accuracy. Diagnostic and triage accuracy varied between studies and OSCs; most studies showed suboptimal diagnostic and triage accuracy. Frequency and urgency of the condition were the main variables that affected the levels of diagnostic and triage accuracy, along with specific features of the OSCs. The impact of each variable differed across tools and studies, making it difficult to draw any solid conclusions. Included studies had either a moderate or high risk of bias according to the revised tool for the Quality Assessment of Diagnostic Accuracy Studies 2. Conclusions: While OSCs have significant potential to provide accessible and accurate health advice and triage recommendations to users, more research is needed to validate their triage and diagnostic accuracy prior to wide scale adoption in community and healthcare settings. Future studies should aim to use a common methodology and/or agreed standard for evaluation to facilitate objective benchmarking and validation

Sex Ratio Changes as Sentinel Health Events of Endocrine Disruption

The production and widespread use of synthetic chemicals since the 1940s have resulted in ubiquitous contamination of fish, wildlife and human populations. Since the 1960s, observers have documented major damage to wildlife reproduction across the globe, and subsequently, damage to reproductive health in exposed humans as well. The sex ratio in human communities and populations can be readily measured to ascertain whether reproductive effects, such as subtle birth defects of the reproductive tract caused by exposures to chemicals, might be occurring. Male to femalesex ratios appear to be declining in populations in several parts of the globe, possibly as a result of prenatal exposures to chemicals. Sex ratio data for communitieswith unusual occupational or environmental exposures can be compiled using traditional epidemiological techniques in pursuit of environmental justice. Local, regional and national population health researchers and occupational hygienists can use health statistics toexamine sex ratios as sentinel health events that might portend patterns of subtle structural birth defects of the reproductive tract and functional deficits in neurodevelopment

Investigating self-reported efficacy of lifestyle medicine approaches to tackle erectile dysfunction: a cross-sectional eSurvey based study

Background: Erectile dysfunction (ED) is the most common sexual dysfunction in men. Some types of ED are amenable to treatment using lifestyle medicine approaches with or without pharmacotherapy. Aim: Investigate self-reported efficacy of lifestyle medicine approaches to tackle ED. Methods: A cross-sectional online survey of 1177 community dwelling adults explored the prevalence and methods used to tackle ED in the community setting. We examined differences between participants with and without ED. Variables associated with ED in univariable analyses were included in a multivariable logistic regression to identify variables independently associated with the condition. Outcomes: Self-reported measure: perceived effectiveness of lifestyle medicine interventions to tackle ED. Results: Most respondents (76.5%) had experienced ED, and this was associated with having a long-term condition, taking anti-hypertensive medication, hypercholesterolaemia and obesity. Medication was the most common management strategy overall (65.9%), followed by stress management (43.5%) and weight loss (40.4%). Over half (53.9%) did not use any lifestyle modification strategies to tackle ED. Only 7.0% of ED sufferers received a mental health assessment and 29.2% received other tests (e.g., blood test, medical imaging) by GPs. Cardiovascular training was identified as the best rated strategy by its users (37.8%). Supplements (35.1%) and weight training/physical activity (32.6%) were also positively rated. Clinical implications Structured education to general practitioners and community dwelling adults about the impact of lifestyle behaviour modification and how this could influence the appearance or trajectory of ED could help improve personal choice when tackling ED. Strengths and limitations: To our knowledge, this is the first study to collect eSurvey responses from community dwelling adults to gauge their reliance and perceived effectiveness of lifestyle medicine approaches to tackle ED. The principal limitation was the lack of follow-up, and not recording other information including lifestyle factors such as nutrition, smoking, and the use of alcohol and recreational drugs, which may have enabled a fuller exploration of the factors that could influence the primary outcome measures examined. Conclusion: Despite the high prevalence of ED, there is not enough awareness in the community setting about effective and low-cost lifestyle medicine strategies, including cardiovascular training and the use of supplements and weight training, to help tackle this common condition