The introduction and evaluation of telehealth into a mental health service

Introduction: This two-year project involves the introduction and evaluation of telehealth into a mental health service. Phase 1 of the project explores stakeholders’ views on how telehealth in the form of video conferencing could be used to link-up inpatient and community services. Aims and objectives: Identify issues regarding: •• Quality of care •• Length of inpatient stay •• Access, communication, and relationship between inpatient, CMHT staff, service-users, carers •• Unproductive staff time, travel time and cost •• Telehealth for therapeutic work Methods: These were: •• Focus groups, interviews with: staff, service-users •• Literature review •• Piloting of video conferencing facilities Results: The main findings were: •• Focus groups/interviews: (a) isolation of different teams; (b) communication, relationship between teams; (c) staff, service-users’ views on telehealth •• Literature review: identified relevant articles from 2000 onwards on the effectiveness of telehealth in mental health services and guidelines on the uses of video conferencing. •• Utilising the findings of (i) and (ii) to make recommendation. •• Initial findings from the pilot will be presented Conclusions: The combined findings from the focus groups and literature review have identified ways of introducing and evaluating telehealth to the service: •• Per site: 1 meeting room with 1 large screen for team activities (e.g. ward rounds). •• Per site: 1 dedicated computer with web-cam for quickly arranged, 1-1 calls (e.g. professional-professional, practice sharing)

Contracting for integrated health and social care: a critical review of four models

In the current climate of service reorganisation and sensitivity surrounding cost, it is clear that commissioners and providers in the health and social care economy are striving to strengthen integrated care as a means of improving quality and reducing costs (Curry and Ham 2010; Ham and Walsh 2013). Across England, health and social care systems are having to confront many pressures. For example, most of the funding is tied up in acute and long term social care, current NHS contracts are widely regarded as insufficient for the transformation agenda with block contracts stifling innovation, and Payment by Results does not incentivise the reduction in admissions or social care changes but in fact acts as a perverse incentive (Curry et al 2011). In addition, Advanced Assistive Technology should be embedded within integrated care but is often peripheral. As a consequence, commissioners must rapidly consider commissioning and contracting arrangements to enable them to drive forward service integration that is innovative, sustainable and transferable. Recently, there has also been support from NHS England Chief Executive Simon Stevens for promoting more flexible approaches to commissioning and contracting, strongly suggesting that CCGs could explore alternative approaches. These ideas have become more formalised in NHS England’s Five Year Forward View, with Multi-Specialty Community Providers (MCPs) and Primary and Acute Care Systems (PACS) eventually evolving to hold a delegated budget for the health and care of whole populations (NHS England 2014). These new integrated care models require strong relationships and trust between the different organisations and professionals delivering care, which should be underpinned by sound contracting mechanisms that have relational concepts embedded within them. However, there is currently scanty evidence on contracting approaches that would have a good fit with the transformation agenda, particularly concerning how agencies can work towards joint outcomes. This paper presents the findings of an international literature review of contracting approaches, models and designs, with the aim of critically analysing their suitability to the integrated health and social care agenda. An important feature of this was to capitalise on learning from agencies and industries external to our health and social care systems and to identify in particular evidence of effectiveness and what could be usefully be transposed. The approach and search strategy of the literature review can be found as an appendix

Implementing population health management: an international comparative study

Purpose: The purpose of this paper is to gain insight into how population health management (PHM) strategies can successfully integrate and reorganize public health, health care, social care and community services to improve population health and quality of care while reducing costs growth, this study compared four large-scale transformation programs: Greater Manchester Devolution, Vancouver Healthy City Strategy, Gen-H Cincinnati and Gesundes Kinzigtal. Design/methodology/approach: Following the realist methodology, this explorative comparative case-study investigated PHM initiatives' key features and participants' experiences of developing such initiatives. A semi-structured interview guideline based on a theoretical framework for PHM guided the

Expression of BNIP3 in invasive breast cancer: correlations with the hypoxic response and clinicopathological features

<p>Abstract</p> <p>Background</p> <p>Bcl-2/adenovirus E1B 19 kDa-interacting protein 3 (BNIP3) is a pro-apoptotic member of the Bcl-2 family induced under hypoxia. Low or absent expression has recently been described in human tumors, including gastrointestinal tumors, resulting in poor prognosis. Little is known about BNIP3 expression in invasive breast cancer. The aim of the present study was to investigate the expression of BNIP3 in invasive breast cancer at the mRNA and protein level in correlation with the hypoxic response and clinicopathological features.</p> <p>Methods</p> <p>In 40 cases of invasive breast cancer, BNIP3 mRNA <it>in situ </it>hybridization was performed on frozen sections with a digoxigenin labeled anti-BNIP3 probe. Paraffin embedded sections of the same specimens were used to determine protein expression of BNIP3, Hypoxia Inducible Factor 1 alpha (HIF-1α) and its downstream targets Glucose Transporter 1 (Glut-1) and Carbonic Anhydrase (CAIX) by immunohistochemistry.</p> <p>Results</p> <p>BNIP3 mRNA was expressed in 16/40 (40%) of the cases and correlated with BNIP3 protein expression (p = 0.0218). Neither BNIP3 protein nor mRNA expression correlated with expression of HIF-1α expression or its downstream targets. Tumors which showed loss of expression of BNIP3 had significantly more often lymph node metastases (82% vs 39%, p = 0.010) and showed a higher mitotic activity index (p = 0.027). BNIP3 protein expression was often nuclear in normal breast, but cytoplasmic in tumor cells.</p> <p>Conclusion</p> <p>BNIP3 expression is lost in a significant portion of invasive breast cancers, which is correlated with poor prognostic features such as positive lymph node status and high proliferation, but not with the hypoxic response.</p

Implementing video conferencing in mental health practice

The aim of this paper is to provide an overview of the evidence base regarding the use of video conferencing (VC), implementation issues, policies, procedures, technical requirements and VC etiquette. The paper is based on a literature review of VC within the mental health sector and the authors' experience in implementing VC. Six themes emerged from the literature review: applications of VC, VC assessments, treatment, training and supervision, practitioner anxiety, and VC administrative processes. The results of the review support the use of VC in mental health services. Guidelines for the implementation of VC are discussed, including the importance of staff and service user consultations, training in the use of VC, clear guidance for staff with regards to usage, confidentiality and data protection policies, and VC etiquette. Challenges that can arise when implementing VC in a mental health context are also discussed. Arguably, it is not the technology, but the cultural change it represents to staff which seems to be the most important factor regarding successful implementation

'They need to ask me first'. Community engagement with low-income citizens. A realist qualitative case-study.

BACKGROUND: Community engagement is seen as key to citizen‐centred and sustainable healthcare systems as involving citizens in the designing, implementation and improvement of services and policies is thought to tailor these more closely to communities’ own needs and experiences. Organizations have struggled to reach out to and involve disadvantaged citizens. This paper examines how if, why, and when low‐income citizens wish to be involved. METHODS: For this qualitative realist case‐study, 19 interviews (one dyad) were held with (20) low‐income citizens in two Dutch municipalities. Additionally, the results were discussed with a reference panel consisting of professionals and citizens to enrich the results and to ensure the results had face validity. RESULTS: The results showed four different ways in which low‐income citizens wished to be involved: (a) in a practical/volunteer way; (b) as a buddy; (c) as a lay expert; (d) not involved at all. The factors affecting citizens’ interest and capacity to participate include citizens’ own experiences of the services they access and their personal situations, e.g. their mental or physical health, extent of financial crisis, family situation, home environment. None of the interviewees was currently involved, but all had ideas for improving health(care) services and policies. Citizens’ experiences of the services they accessed acted as a motivator for some to be involved as they wanted to ensure others would not have the same struggles, while for others their own needs and an apathetic system remained too high a barrier. To enable involvement, citizens need continued support for their own health(care) and financial situation, better communication and accessibility from services, practical support (e.g., training and bus passes) and recognition for their input (e.g., monetary compensation). CONCLUSION: The study shows that citizens’ experiences of the services they accessed influenced if and how they wanted to be involved with health and care services. Despite the fact that all participants had shared solid ideas for improving services and policies, they were hindered by a bureaucratic, impersonal and inaccessible system. Organizations seem to underestimate the required investments to reach out to low‐income citizens and the support required to ensure their involvement. PATIENT AND PUBLIC INVOLVEMENT (PPI) IN STUDY: Citizens as well as PPI organizations were members of the reference panel who helped formulate the research questions and recruitment strategy. The local reference panel also helped to interpret and refine the initial findings

Engaging citizens in local health policymaking. A realist explorative case-study.

BACKGROUND: Municipalities have been trying to involve citizens as citizen participation is thought to improve municipalities’ accountability, the quality of services, and to align policies and services to communities’ needs. This study examined citizens’ participation preferences in policymaking by investigating their health policy priorities, expectations of involvement, and required support. METHODS: For this case-study the realist evaluation approach was applied to focus groups with citizens and to a workshop with a local panel consisting of professionals, citizens and citizen representatives. RESULTS: This study showed that citizens want to be involved in (health) policymaking with the aim of improving their communities’ quality of life and living environment and prioritised local services and amenities (e.g. suitable housing, public transport, health and care services). Instead, professionals’ priorities were focussed on singular public health issues related to prevention and lifestyle factors. The results also show that citizens felt responsible for driving citizen participation and representing community needs to the municipality, but needed the municipality to improve their communication and accessibility in order to do so successfully. Furthermore, the professionals on the panel indicated that they needed training on how to reach out to citizens. Such training should highlight how to better align their language to citizens’ lived experiences. They also wanted their organisations to provide more space, flexibility and resources to build relationships with citizens in order to provide improved communication and accessibility to citizens. CONCLUSION: The difference in priorities between citizens and professionals highlights the importance of involving citizens in policymaking. Moreover, citizens’ involvement can act as a lever for change to bring a wider range of services and policy sectors together and has the potential to better align policies to citizens’ lived experiences and hopefully increase the democratic legitimacy of policymaking. However, to fulfil such potential municipalities will need to invest in improving their accessibility and communication with communities