Developing a complex intervention to improve prescribing safety in primary care:mixed methods feasibility and optimisation pilot study

Objectives (A) To measure the extent to which different candidate outcome measures identified high-risk prescribing that is potentially changeable by the data-driven quality improvement in primary care (DQIP) intervention.(B) To explore the value of reviewing identified high-risk prescribing to clinicians.(C) To optimise the components of the DQIP intervention.  Design Mixed method study.  Setting General practices in two Scottish Health boards.  Participants 4 purposively sampled general practices of varying size and socioeconomic deprivation.  Outcome measures Prescribing measures targeting (1) high-risk use of the non-steroidal anti-inflammatory drugs (NSAIDs) and antiplatelets; (2) ‘Asthma control’ and (3) ‘Antithrombotics in atrial fibrillation (AF)’.  Intervention The prescribing measures were used to identify patients for review by general practices. The ability of the measures to identify potentially changeable high-risk prescribing was measured as the proportion of patients reviewed where practices identified a need for action. Field notes were recorded from meetings between researchers and staff and key staff participated in semistructured interviews exploring their experience of the piloted intervention processes.  Results Practices identified a need for action in 68%, 25% and 18% of patients reviewed for prescribing measures (1), (2) and (3), respectively. General practitioners valued being prompted to review patients, and perceived that (1) ‘NSAID and antiplatelet’ and (2) ‘antithrombotics in AF’ were the most important to act on. Barriers to initial and ongoing engagement and to sustaining improvements in prescribing were identified.  Conclusions ‘NSAIDs and antiplatelets’ measures were selected as the most suitable outcome measures for the DQIP trial, based on evidence of this prescribing being more easily changeable. In response to the barriers identified, the intervention was designed to include a financial incentive, additional ongoing feedback on progress and reprompting review of patients, whose high-risk prescribing was restarted after a decision to stop.  Trial registration number Clinicaltrials.govNCT01425502

Qualitative exploration of the acceptability of a postnatal pelvic floor muscle training intervention to prevent urinary incontinence.

Background: Childbirth is a major risk factor for urinary incontinence (UI). As a result, pelvic floor muscle training (PFMT) is commonly recommended during and after pregnancy to prevent the onset of UI. PFMT is often classed as a physical activity (PA) behaviour, hence PA guidelines for postnatal women encourage PFMT alongside aerobic activities. However, postnatal lifestyle interventions tend to overlook PFMT which can be detrimental to women’s health and future health risks, including urinary incontinence. This study aimed to explore perceptions and acceptability of a postnatal physical activity and PFMT intervention with postnatal women in Scotland. Methods: We recruited women who had given birth within the last 5 years by displaying posters in health centres and community centres in Stirling and through Facebook. Data was gathered via online and face-to-face focus groups, that were audio recorded and transcribed verbatim. Analytic themes were initially organised under related concepts derived from the topic guide and thematic analysis conducted. Subsequent analysis was by the Framework technique. Results: A total of seven online and face-to-face focus group discussions with 31 women identified there was a clear intention behaviour gap for engagement in PA, with both psychological and logistical barriers identified such as motivation and childcare. This was distinct from PFMT where there was a feeling of helplessness around not knowing how to perform a correct PFMT contraction subsequently resulting in women not adhering to PFMT guidance. Women felt there was no accessible PFMT advice available through the NHS. Some participants had received PFMT advice after childbirth and spoke of the Squeezee app being useful in adhering to a PFMT regimen but they did require additional teaching on how to do correct contractions. There was need for clarity and practical support for PFMT in the postnatal period with an approved intervention incorporating an accessible app being suggested by participants. Conclusions: Women would like to be trained on postnatal PFMT but face barriers to accessing adequate information and education on how to do a PFMT contraction. An intervention combining PFMT training and an app would be the most useful for their needs and circumstances

Exploring the facilitators and barriers of a wearable device to treat newborn jaundice at home: protocol for an integrative review.

This review will investigate how home phototherapy and wearable technology is used for the treatment of new born babies with jaundice. Also, what are the experiences of parents and healthcare professionals regarding caring for newborn infants receiving home phototherapy treatment for newborn jaundice

Why is so much clinical research ignored and what can we do about it?

Key points  Research evidence from clinical trials is not being translated into clinical practice in a timely manner and this represents an enormous waste of resources and missed opportunities.  Trials do not publish information about the context in which the intervention was implemented to allow the results to be transferred beyond the trial setting.  Health care professionals need contextual information to be able to make the judgement ‘will it work in my setting?’  The outcome detected in the trial could be the treatment, elements of the context, the research process or a combination of all three.  Context is recognised as important but there is poor conceptualisation and no agreed definition.  Funding into methodological research is urgently required to address this problem and to stop wasting up to 85% of research investment.Output Type: Editoria

Billions are spent on clinical research that gets ignored – here’s the answer

First paragraph: Heart failure is a major killer, affecting well over a million people in the UK alone. We now have over 20 years' worth of evidence from clinical trials that show strong benefits for a package of treatment involving not only drugs and devices but also where patients stay, how they are cared for and how the different healthcare professionals work with one another. Yet in many cases, doctors are not acting on the findings.  Access this article on The Conversation website: https://theconversation.com/billions-are-spent-on-clinical-research-that-gets-ignored-heres-the-answer-6059

Process evaluation of the Data-driven Quality Improvement in Primary Care (DQIP) trial:Quantitative examination of variation between practices in recruitment, implementation and effectiveness

Objectives: - The cluster randomised trial of the Data-driven Quality Improvement in Primary Care (DQIP) intervention showed that education, informatics and financial incentives for general medical practices to review patients with ongoing high-risk prescribing of non-steroidal anti-inflammatory drugs and antiplatelets reduced the primary end point of high-risk prescribing by 37%, where both ongoing and new high-risk prescribing were significantly reduced. This quantitative process evaluation examined practice factors associated with (1) participation in the DQIP trial, (2) review activity (extent and nature of documented reviews) and (3) practice level effectiveness (relative reductions in the primary end point). Setting/participants: - Invited practices recruited (n=33) and not recruited (n=32) to the DQIP trial in Scotland, UK. Outcome measures: - (1) Characteristics of recruited versus non-recruited practices. Associations of (2) practice characteristics and 'adoption? (self-reported implementation work done by practices) with documented review activity and (3) of practice characteristics, DQIP adoption and review activity with effectiveness. Results: - (1) Recruited practices had lower performance in the quality and outcomes framework than those declining participation. (2) Not being an approved general practitioner training practice and higher self-reported adoption were significantly associated with higher review activity. (3) Effectiveness ranged from a relative increase in high-risk prescribing of 24.1% to a relative reduction of 77.2%. High-risk prescribing and DQIP adoption (but not documented review activity) were significantly associated with greater effectiveness in the final multivariate model, explaining 64.0% of variation in effectiveness. Conclusions: - Intervention implementation and effectiveness of the DQIP intervention varied substantially between practices. Although the DQIP intervention primarily targeted review of ongoing high-risk prescribing, the finding that self-reported DQIP adoption was a stronger predictor of effectiveness than documented review activity supports that reducing initiation and/or re-initiation of high-risk prescribing is key to its effectiveness

A real time, longitudinal, qualitative evaluation of the first two cohorts to participate in the Queen’s Nurse Development Programme.

Background: The Queens Nurse Development Programme (QNDP) has been delivered to community nurses in Scotland since 2017, born out of a commitment to reintroduce the Queen’s Nurse title in Scotland after 50 years. The aim of the QNDP was to connect individuals with a shared passion for delivering high - quality nursing throughout Scotland’s communities, to create a safe space where participants could develop and grow on a personal level to become change makers, to inspire others, help those most in need and champion community nursing. As such, the participants selected were employed in a wide-range of diverse roles, from throughout Scotland. The programme takes place over a nine-months, during which participants engaged with a varied programme involving residential workshops, where they experienced a range of creative and contemplative awareness based change practices, the development of a practice issue, and individual coaching. This report presents an independent evaluation of the QNDP based on the first two cohorts of participants to engage with the programme (2017 & 2018). Evaluating the QNDP is important to optimise the programme for subsequent cohorts of Queen’s nurses and to inform the transferability of the programme to other professions and contexts. Methods: A comprehensive, longitudinal, qualitative evaluation, where data was collected at various time points, using interviews, focus groups and a ‘member-checking’ event with all 41 QNDP participants (20 fromcohort 1 and 21 fromcohort 2), as well as 12 community nursing managers and the 3 QNDP facilitators. The purpose was to uncover and explore perceptions and experiences of the QNDP: what was learned; how this was implemented into everyday practice; as well as the impacts and sustainability of changes. The data was analysed using Braun and Clarke’s six-point framework of analysis; familiarisation, coding, generating themes, reviewing themes, defining and naming themes and writing up (Clarke et al., 2015). Double coding and independent analysis ensured trustworthy, rigorous and valid findings. Summary and Conclusions: Participants were overwhelmingly positive about the programme, and appreciated its design, facilitation, approach and methods utilised, as well as the resulting impacts and outcomes. Engaging with the QNDP led to an unexpected ‘journey of self-discovery and transformation’, with notable self-development, growth and positive change. Essentially, the programme enabled participants to see through a new lens, re-position themselves and embody new (person-centred) ways of being and doing, which transcended both their personal and professional lives as community nurses, colleagues, ‘leaders’, service providers, networkers, family members and friends. The participants perceptions of this work and learning was that as it was personal, changing their thinking and identity and therefore, the impact of the programme and the personal and professional transformation and changes introduced were perceived to be sustainable for the rest of their professional life and beyond. The programme facilitated the building of close bonds with their peers which enabled them to confidently share problems and challenges, reinforce their learnings and new thinking, and engage them in a journey of transformation. As such, a community of practice has been created within and across the cohorts which has the potential to become a social movement as intended by QNIS. The programme also equipped them with novel, creative approaches, skills and tools that they were able to share with colleagues, friends and family. Thus, the programme achieved a key aim of connecting individuals and equipping QNDP participants with a range of new skills. The findings of this evaluation and the QNDP are likely to be transferable to other health and social care professionals and beyond the Scottish context

What is the impact of long term COVID-19 on workers in healthcare settings? A rapid review of current evidence. [Protocol]

The objective of this systematic rapid review is to assess the effects of long COVID among healthcare workers and its impact on their self-reported health status, professional working lives, personal circumstances and use of health services. A range of clinical and social science databases will be searched, including MEDLINE, Embase, CINAHL, Web of Science, PsycINFO, and ASSIA. Eligible studies will be those assessing i) the experiences and views of healthcare workers with symptoms of long COVID as well as ii) the impact of long COVID symptoms on health status, working performance, personal circumstances and use of healthcare resources. The eligible population will be healthcare workers with symptoms of long COVID. All clinical and non-clinical staff will be eligible for inclusion, for example, cleaners, domestic staff, receptionists, estate workers