Patient and public involvement mobile workshops - convenient involvement for the un-usual suspects

Background Patient and public involvement in research is a quickly-evolving area, with investigators developing new approaches in recent years. One concern about patient and public involvement is that it only appeals to certain individuals. When designing research into online GP services – a topic relevant to the general population – we recognised the importance of involving members of the public with a broad range of backgrounds who may not have the time, resources and inclination to volunteer normally. Methods We devised a strategy that aimed to involve members of the public from varied backgrounds, who would not typically be able to be involved. We ran a series of one-off mobile workshops at existing organisations where potential volunteers were already in situ. The workshops were kept short, making them convenient and easily accessible. Volunteers were also paid, to ensure taking part was appealing. Results We ran a series of 4 workshops involving 26 members of the public with office workers, supermarket staff, gym members (and their friends) and parents attending a toddler group. Overall the workshops were successful, as they enabled us to gain varied perspectives from volunteers with a broad range of backgrounds, many of whom had not previously been involved in research. A key challenge was making initial contact with members of approached organisations. This indicates that it may be beneficial to consider how to make the workshops appealing, not just onan individual level, but at an organisational level too. A carefully planned design worked as it enabled large amounts of input in a limited amount of time, apart from one workshop (the parent group) due to practical reasons. This highlighted some limitations of this approach that could be addressed by adapting the workshop design, according to the organisation with which they are being run. Conclusion Running one-off mobile workshops at already existing organisations allowed us to involve members of the public from a broad range of backgrounds, who would not typically volunteer to be involved in research. This was particularly suitable as the topic we were designing research for – booking GP appointments – is relevant to the general public

Email consultations between patients and doctors in primary care: a content analysis

Background: Increasingly consultations in healthcare settings are carried out remotely, using a range of communications technologies. Email allows for a two-way text based communication, occurring asynchronously. Studies have explored the content and nature of email consultations as a way to understand the use, structure and function of email consultation. The majority of previous content analyses of email consultation in primary care settings have been conducted in North America and these have shown that concerns and assumptions about how email consultation might work have not been realised. There has not been a United Kingdom (UK) based content analysis of email consultations. Objectives: To explore and delineate content of consultations conducted via email in English general practice, by conducting a content analysis of email consultations between General Practitioners (GPs) and patients. Methods: We conducted a content analysis of anonymised email consultations between GPs and patients in two general practices in the United Kingdom. We examined the descriptive elements of the correspondence to ascertain when emails were sent, how many emails were in an email consultation and the nature of the content. We used a normative approach to analyse the content of email consultations to explore the use of and function of email consultation. Results: We obtained 100 email consultations from 85 patients, this totalled 262 individual emails. The majority of email users were aged over 40 and over half of users were male. Email consultations were mostly short and completed in a few days. Emails were mostly sent and received during the day. Emails were mostly clinical in content rather than administrative and covered a wide range of clinical presentations. There were three key themes to the use and function of the email consultations; the role of the GP and email consultation, the transactional nature of an email consultation and the operationalisation of email consultation. Conclusions: Where email is used to have a consultation with a patient in general practice in the majority of cases the consultation is short, clinical in nature and resolved quickly. GPs approach email consultation using similar key elements of the face-to-face consultation, however, using email consultation has the potential to alter the role of the GP, leading them to engage in more administrative tasks than usual. Email consultation was not a replacement for a face-to-face consultation

Women's experiences of anal incontinence following vaginal birth : a qualitative study of missed opportunities in routine care contacts

Objectives This study aimed to explore experiences of women with anal incontinence following a childbirth injury, and to identify areas of missed opportunities within care they received. Design This is a qualitative study involving semi-structured interviews. Setting Participants were recruited via five hospitals in the UK, and via social media adverts and communication from charity organisations. Participants Women who have experienced anal incontinence following a childbirth injury, either within 7 years of sustaining the injury, or if they identified new, or worsening symptoms of AI at the time of menopause. Main outcome measures Main outcomes are experiences of women with anal incontinence following childbirth injury, and missed opportunities within the care they received. Results The following main themes were identified: opportunities for diagnosis missed, missed opportunities for information sharing and continuity and timeliness of care. Conclusions Anal Incontinence following a childbirth injury has a profound impact on women. Lack of information and awareness both amongst women and healthcare professionals contributes to delays in accurate diagnosis and appropriate treatment

The impact of Covid-19 pandemic on hospices : a systematic integrated review and synthesis of recommendations for policy and practice

Background: The Covid-19 pandemic resulted in the development of numerous recommendations for practice and policy for specialist palliative care provided by hospices in United Kingdom (UK), as hospices were significantly affected by the pandemic and protections put in place. The aim of this review is to identify and synthesise recommendations or implications for policy and practice that have been generated for adult hospice specialist palliative care during the first 24 months of the Covid-19 pandemic. Methods: AMED, BNI, CINAHL, EMBASE, EMCARE, HMIC, Medline, PsycINFO, PubMed databases were searched for peer-reviewed papers, as well as hand searchers for grey literature. Literature relating to hospices and Covid-19 in the UK were included and a thematic synthesis of recommendations for hospice policy and practice was undertaken. Results: 858 articles were identified with 12 meeting the inclusion criteria. Fifty-eight recommendations or implications were identified: 31 for policy, 27 for practice, and 10 covering both. Recommendations were organised under ten themes. There were several recommendations seeking to secure hospice resources to mitigate the short-term impact of the pandemic, as well as those focused on longer-term implications such as core funding. The impact of the pandemic on the quality of hospice care was the focus for numerous recommendations around improving integration of hospice care in the community, provision of bereavement support and better use of Advance Care Plans (ACP). However, there were significant gaps related to carer visitation in hospices, inequities of palliative care, or hospice-at-home services. Conclusion: The Covid-19 pandemic and protections exposed several ongoing policy and practice needs, especially around hospice resources, while generating novel issues for hospices to address. Significant policy gaps remain to be addressed to mitigate the impact of the pandemic on the quality of hospice specialist palliative care

Cross-Cultural Validation of the Inventory of School Motivation (ISM) in the Asian Setting: Hong Kong and the Philippines

Students’ achievement goals in school have received increasing research attention because they have been shown to be important in predicting important outcomes. As such, there has been a growing interest in measuring and comparing them across different cultural groups. However, these comparisons cannot be made until validity evidence has been attained to support the use of an instrument in the new cultural setting. In this study, we investigated the cross-cultural applicability of the Inventory of School Motivation (ISM, McInerney et al. American Educational Research Journal 34:207-236, 1997) in the Hong Kong Chinese and Philippine contexts using both within-network and between-network approaches to construct validation. The ISM measures four types of achievement goals: mastery, performance, social, and extrinsic goals. 1,406 high school students from Hong Kong (n = 697) and the Philippines (n = 709) participated. Results of the within-network test showed that the ISM had good internal consistency reliability and the confirmatory factor analysis provided support for the hypothesized four-factor model. Multigroup confirmatory factor analyses supported invariance of factor loadings across the two samples. The between-network test also indicated that these achievement goals correlated systematically with different aspects of students’ self-concepts. These findings support the applicability of the ISM among Hong Kong Chinese and Filipino students

Automated telephone communication systems may have the potential to play a positive role in healthcare

Recent years have seen communication technologies promoted as a route to improve access for patients and save resources in healthcare systems under strain.1 One such development is ATCS that are used instead of—or in conjunction with—telephone communication between patients and healthcare professionals. Rather than person-to-person communication, ATCS use computer-to-person communication to deliver voice messages to patients and/or collect health-related information from patients using touch tone keypads or voice recognition software. Unlike the use of the telephone for consultation

Patient use of an online triage platform : a mixed-methods retrospective exploration in UK primary care

Background Recent years have seen the introduction of online triage allowing patients to describe their problem via an online form. Subsequently, a GP telephones the patient, conducting a telephone consultation or arranging a face-to-face consultation. Aim This study aimed to explore patterns-of-use and patients’ experiences of using an online triage system. Design and setting This retrospective study analysed routinely collected data (from all practices using the ‘askmyGP’ platform for the duration of the study period, 19 May 2017 to 31 July 2017), using both quantitative and qualitative approaches. Data originated from an online triaging platform used by patients in nine general practices across the UK. Method Data from 5447 patients were quantitatively analysed to describe characteristics of users, patterns-of-use, and reasons given by patients for using the platform. Free-text comments left by patients (n = 569) on their experience of use were qualitatively analysed. Results Highest levels of use were observed in females (65.5%, n = 3570) and those aged 25–34 years. Patterns of use were high between 0800 and 0959, and on Mondays and Tuesdays. Use outside of GP practice opening hours was low. Common reasons for using the platform were for medication-related enquiries, for administrative requests, and to report a specific symptom. Comments left by patients suggested advantages to using the platform, for example, convenience and the written format, but these did not extend to all users. Conclusion Patterns-of-use and patient types were in line with typical contacts to GP practices. Though the age of users was broad, highest levels of use were from younger patients. The perceived advantages to using online triage, such as convenience and ease of use, are often context dependent

Automated telephone communication systems may have the potential to play a positive role in healthcare

Recent years have seen communication technologies promoted as a route to improve access for patients and save resources in healthcare systems under strain.1 One such development is ATCS that are used instead of?or in conjunction with?telephone communication between patients and healthcare professionals. Rather than person-to-person communication, ATCS use computer-to-person communication to deliver voice messages to patients and/or collect health-related information from patients using touch tone keypads or voice recognition software. Unlike the use of the telephone for consultation