Use of progression criteria to support monitoring and commissioning decision making of public health services: : lessons from Better Start Bradford

BACKGROUND:Commissioning and monitoring of community-based interventions is a challenge due to the complex nature of the environment and the lack of any explicit cut-offs to guide decision making. At what point, for example, is participant enrolment to interventions, course completion or satisfaction deemed to be acceptable or sufficient for continued funding? We aimed to identify and quantify key progression criteria for fourteen early years interventions by (1) agreeing the top three criteria for monitoring of successful implementation and progress; and (2) agreeing boundaries to categorise interventions as 'meeting anticipated target' (green); 'falling short of targets' (amber) and 'targets not being met' (red). METHODS:We ran three workshops in partnership with the UK's Big Lottery Fund commissioned programme 'Better Start Bradford' (implementing more than 20 interventions to improve the health, wellbeing and development of children aged 0-3) to support decision making by agreeing progression criteria for the interventions being delivered. Workshops included 72 participants, representing a range of professional groups including intervention delivery teams, commissioners, intervention-monitoring teams, academics and community representatives. After discussion and activities, final decisions were submitted using electronic voting devices. All participants were invited to reconsider their responses via a post-workshop questionnaire. RESULTS:Three key progression criteria were assigned to each of the 14 interventions. Overall, criteria that participants most commonly voted for were recruitment, implementation and reach, but these differed according to each intervention. Cut-off values used to indicate when an intervention moved to 'red' varied by criteria; the lowest being for recruitment, where participants agreed that meeting less than 65% of the targeted recruitment would be deemed as 'red' (falling short of target). CONCLUSIONS:Our methodology for monitoring the progression of interventions has resulted in a clear pathway which will support commissioners and intervention teams in local decision making within the Better Start Bradford programme and beyond. This work can support others wishing to implement a formal system for monitoring the progression of public health interventions

Psychotropic medication profile in a community youth mental health service in Australia

© 2018 Aim: There has been a rise in the use of psychotropic medication in young people, despite limited risk-benefit profile of psychotropic medication for this population. Given their side effect profile, the use of psychotropic medications should occur with caution. This study investigated psychotropic prescribing pattern in a public youth community mental health service and gives an estimate of general level of psychotropic medication use in this setting. Methods: A retrospective file review was undertaken of all young people aged 12–17 who received care from the service in 2016 (N = 189) for a range of mental health problems, excluding psychosis. Files were reviewed for demographical information (age, gender), diagnosis/presenting issues, prescribed medications, indications of medications, and prescriber type (e.g. psychiatrist, general practitioners (GPs), paediatrician). The data was analysed descriptively. Results: Over 60% (60.8%, n = 115) of young people were prescribed psychotropic medications. Over half of the entire sample were on antidepressants (51.32%, n = 97), nearly a quarter (n = 46, 24%) on antipsychotics, 6% on ADHD medications (6.35%, n = 12), and a fifth (19.58%, n = 37) on polypharmacy. Antidepressants and antipsychotics were mostly used off-label, prescribed by public psychiatric staff. Quetiapine was the most prescribed antipsychotic predominantly for insomnia. Fluoxetine and fluvoxamine were the most prescribed antidepressants predominantly for anxiety disorders. Girls are more likely to be prescribed psychotropic medications than boys, specifically antipsychotic medication. Conclusions: A high proportion of young people were prescribed psychotropic medication, including antipsychotic medication, mostly for the treatment of anxiety and depressive disorders. There is little evidence around how psychotropic medication is used in youth mental health settings, and this study contributes to this gap

Column Chromatography To Obtain Organic Cation Sorption Isotherms

Column chromatography was evaluated as a method to obtain organic cation sorption isotherms for environmental solids while using the peak skewness to identify the linear range of the sorption isotherm. Custom packed HPLC columns and standard batch sorption techniques were used to intercompare sorption isotherms and solid–water sorption coefficients (<i>K</i>_d) for four organic cations (benzylamine, 2,4-dichlorobenzylamine, phenyltrimethylammonium, oxytetracycline) with two aluminosilicate clay minerals and one soil. A comparison of Freundlich isotherm parameters revealed isotherm linearity or nonlinearity was not significantly different between column chromatography and traditional batch experiments. Importantly, skewness (a metric of eluting peak symmetry) analysis of eluting peaks can establish isotherm linearity, thereby enabling a less labor intensive means to generate the extensive data sets of linear <i>K</i>_d values required for the development of predictive sorption models. Our findings clearly show that column chromatography can reproduce sorption measures from conventional batch experiments with the benefit of lower labor-intensity, faster analysis times, and allow for consistent sorption measures across laboratories with distinct chromatography instrumentation

Integrating research and system-wide practice in public health to enhance the evidence-base of interventions: lessons learnt from Better Start Bradford

NoBig Lottery Fund (as part of the A Better Start programme), National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care Yorkshire and Humbe