A case study of stakeholder perceptions of patient held records: the Patients Know Best (PKB) solution

Introduction: Patients Know Best (PKB) provide a patient portal with integrated, patient controlled digital care record. Patient controlled personal health records facilitate coordinated management of chronic disease through improved communications among, and about patients across professional and organizational boundaries. An NHS foundation trust hospital has used PKB to support self-management in patients with Inflammatory Bowel disease; this paper presents a case study of usage. Methods: The Stakeholder Empowered Adoption Model provided a framework for consulting variously placed stakeholders. Qualitative interviews with clinical stakeholders and a patient survey. Results: Clinicians reported PKB to have enabled a new way of managing stable patients, this facilitated clinical and cost effective use of specialist nurses; improved two-way communications, and more optimal use of outpatient appointments and consultant time. The portal also facilitated a single, rationalised pathway for stable patients, enabling access to information and pro-active support. For patients, the system was a source of support when unwell and facilitated improved communication with specialists. Three main barriers to adoption were identified, these related to concerns over security; risk averse attitudes of users; and problems with data integration. Conclusions: Patient controlled personal health records offer significant potential in supporting self-management. Digital connection to healthcare can help patients to understand their condition better and access appropriate, timely clinical advice

Using Telemedicine in Practice: Implications for Workforce Development

The aim of this article is to present a discussion of the impact of telemedicine on professional practice, and the implications for the workforce. Telemedicine, or the use of video-conferencing for remote consultations between clinician(s) and patients, is now a mature technology. Many pilot studies have taken place, generally showing positive benefits to patients. There is emerging evidence that the impact on staff is more mixed; with concerns about changes to job role, skills development, and poor understanding of the organisational benefits. Evidence also highlights enablers of successful telemedicine implementation, including senior leadership, peer motivation, understanding of patient benefits, and time for safe experimentation. Following a review of qualitative data from four case study telemedicine projects undertaken within the authors’ research group, evidence from published literature is discussed. The four projects explore telemedicine services provided between an acute hospital service and nursing homes (remote assessment of swallowing difficulties), an acute hospital service and home (video-link to renal patients undergoing home dialysis), between a specialist teaching hospital service and a district general hospital (fetal abnormalities ultrasound telemedicine clinic), and a survey of mental health professionals across acute and community services within a locality. The introduction of telemedicine at scale requires an organisational and system-level approach that recognises the specific challenges and issues for the workforce. Education and training need to be provided at all levels. In conclusion: there are significant opportunities to realise the benefits of remote consultations, to improve the patient experience and staff productivity, if workforce issues are addressed

An Examination of the Indices of Deprivation - North Cumbria Area.

Intro: A presentation of data from the Indices of Deprivation for the North Cumbria Area Methods: Secondary analysis of the Indices of Deprivation Findings: Examination of higher-level data (i.e. county and district) illustrated how analyses across larger areas can obscure the existence of deprivation at the local level. As such, data for Cumbria County Council suggests it to be a relatively comfortable area with only moderate levels of deprivation. Analysis of lower-level (LSOA) data revealed a range of deprivation levels in North Cumbria and suggested some polarisation between and within LSOAs. This was apparent on the main domains for income and employment. Two domains stood out from the others due to the distribution of rankings being skewed towards most deprived; these are the domains for education, training and skills, and health deprivation and disability. Conclusions: The Indices of Deprivation reveal concentrations of deprivation in North Cumbria. However, more localised, pocket deprivation is remains hidden due geographically large and polarised LSOAs

‘Teleswallowing’: a case study of remote swallowing assessment

Purpose: Telemedicine has enabled speech and language therapists (SLTs) to remotely assess swallowing difficulties (dysphagia) experienced by nursing home residents. The new technique, “teleswallowing”, was designed by the Speech and Language Therapy Service at Blackpool Teaching Hospitals NHS Foundation Trust. It allows prompt assessment, avoiding potential risks of aspiration pneumonia, malnutrition, poor rehabilitation, increased hospital stays and reduced quality of life (Hinchey et al., 2005; Langmore et al., 1998). The purpose of this paper is to report on a second pilot of teleswallowing and the concomitant adoption study. Design/methodology/approach: The adoption study employed qualitative methods, including consultations with senior managers, semi-structured interviews with nursing home matrons/managers and nurses, two focus groups and semi-structured interviews with SLTs. The project clinical lead kept an activity log, which was used to estimate resource savings. Findings: Over a three-month period, six SLTs and 17 patients in five nursing homes participated in teleswallowing assessments. Teleswallowing benefited both patients and participating nursing homes. Better use of therapist time and cost savings were demonstrated and evidence showed that the service could be successfully scaled up. Despite this, a number of barriers to service transformation were identified. Originality/value: This is the first implementation of teleswallowing in the UK, but it has been used in Australia (Ward et al., 2012). The approach to engaging stakeholders to understand and address barriers to adoption is novel. The value lies in the lessons learned for future innovations

Health Inequalities in Cumbria - Initial analyses of Survey Responses.

Intro: The Centre for Research in Health and Society (CRiHS) at University of Cumbria wanted to understand the most pressing health inequalities in Cumbria and the factors driving in order to target our research agenda. Methods: Short, online consultation with variety of Cumbrian stakeholders (49 responses). Findings: Inequity in healthcare is apparent in Cumbria; respondents reported uneven access to mental health services, secondary care, ambulance and emergency services as well as differences in commissioning practices across the county. Inequity in health was also reported which was caused by the synergetic effects of multiple (upstream and downstream) factors upon individuals. Conclusions: The provision of healthcare in Cumbria is challenging, as is tackling the wider determinants of health. There is a need for health and wellbeing eco-systems to combine actions at all levels and across sectors, for example, health services (front line, managerial, commissioning), local authorities, local business and VCFSE, together with the development of participation structures for community engagement

Living well in north Cumbria

Dr Elaine Bidmead (University of Cumbria) & Dr Jo Wildman (Newcastle University) led this workshop at the LOC in the Lakes Conference on health inequalities. Despite the NHS's 'free at the point of delivery' system, horizontal inequities exist in healthcare utilisation. Poverty-proofing of healthcare settings identifies barriers faced by people living in poverty. This workshop will give you the opportunity to contribute towards research, and to begin the co-design of a ‘poverty proofing toolkit’. The conference was hosted by CLIC (Cumbria Learning and Improvement Collaborative) and sponsored by the Academic Health Science Network

Service user and staff acceptance of fetal ultrasound telemedicine

Objective We present qualitative findings from interviews with frontline clinicians and service users of a fetal telemedicine service. Methods Semi-structured interviews with clinical stakeholders and service users were conducted, undertaken as part of a service evaluation. Data collection was undertaken by different teams, using interview schedules aligned to independent evaluation aims. Data were subjected to thematic analysis. Results Sonographers reported four main challenges: delivering a shared consultation; the requirement to resist scanning intuitively; communications during the scan; and restricted room space. Notwithstanding, all clinicians reported that participating women were accepting of the technology. Service users reported few concerns. The main benefits of fetal telemedicine were identified as upskilled staff, increased access to specialist support and improved management of complex pregnancies. Convenience was identified as the main benefit by service users, including savings in time and money from not having to travel, take time off work, and arrange childcare. Conclusions Service users and clinical stakeholders were accepting of the service. Service users reported satisfaction with communications during the consultation and awareness that telemedicine had facilitated local access to clinical expertise. Whilst clinical stakeholders reported challenges, the iterative nature of the evaluation meant that concerns were discussed, responded to, and overcome as the pilot developed. Clinical stakeholders’ perception of benefits for service users encouraged their acceptance. Moreover, the evaluation established that fetal ultrasound telemedicine is a viable method to access expertise safely and remotely. It provided demonstrable evidence of a potential solution to some of the healthcare challenges facing rural hospitals

The introduction of a fetal ultrasound telemedicine service: quality outcomes and family costs

Introduction: The complexity of fetal medicine (FM) referrals that can be managed in a district general hospital (DGH) is dependent on the availability of specialist ultrasound expertise. Telemedicine can effectively transfer real-time ultrasound images via video-conferencing. We report the successful introduction of a fetal ultrasound telemedicine service. Methods: All women referred for FM consultation from the linked DGH were seen via a weekly telemedicine service, excluding cases where invasive testing was anticipated. Image and audio quality were rated (using a 5 point scale) following each consultation. Women referred for their first appointment were asked to complete a questionnaire following the consultation. Figures presented are median [range]. Results: 80 women had a telemedicine consultation between October 2015 and September 2016. 37 cases were new referrals because of fetal anomaly (n = 17), exclusion of abnormal placental invasion (n = 11), small-for-gestational-age (n = 7) and prior history of fetal anomaly (n = 2) and 43 cases were follow-up consultations. Median gestation was 29 [13–36] weeks. Image quality was of sufficient quality to achieve the aims of the consultation in 79 cases with an image score of 4 [3–5] and audio score of 5 [3–5]. Journey to the telemedicine consultation was 20 [4–150] minutes in comparison to an estimated journey time of 238 [120–450] minutes to the FM centre. Estimated family costs for attendance at the FM centre were £95 [20–555]. Conclusion: We have demonstrated that a fetal ultrasound telemedicine service can be successfully introduced and used to provide high quality consultations

A rapid review of children and young people's views of poverty and welfare in the context of Universal Credit

Children and young people's (CYP) life chances depend heavily on family resources. This paper reports a rapid review of qualitative/mixed method studies about Universal Credit undertaken with CYP in the UK; subsequently expanded to include additional descriptors of economic disadvantage. Sixteen studies were reviewed; narrative synthesis was used to explore themes. Most recruited CYP with experience of economic disadvantage; none explicitly reported perspectives of CYP experiencing disability or rurality. Findings show growing up in poverty has significant, negative impacts on health and well‐being, causing feelings of exclusion, shame and unfairness; raising important questions about the adequacy of welfare support in the UK

Poverty proofing healthcare: A qualitative study of barriers to accessing healthcare for low-income families with children in northern England

Poverty impacts negatively on children’s health and future life chances. Access to the UK’s National Health Service (NHS) is based on clinical need rather than the ability to pay but horizontal inequities in access exist. Children North East, a charity supporting children experiencing poverty, are working with partners to reduce the impacts of poverty on NHS access. This collaborative study aimed to understand barriers to healthcare access faced by families living on low incomes to validate and support further development of a Poverty Proofing© healthcare tool. Twenty-four parents and eight Voluntary Community Social Enterprise sector staff participated in qualitative interviews or focus groups. Data were analysed thematically, and three main themes were identified as impacting access to healthcare: hidden costs, securing appointments and developing relationships with healthcare providers. We conclude that low-income families experience both financial and other barriers to accessing NHS healthcare and that these barriers are exacerbated for low-income families living in remote/rural areas