Implementing an Integrated Acute Response Service: Professional Perceptions of Intermediate Care

Purpose: The purpose of this study is to examine the implementation, care processes and sustainability of an integrated, intermediate Acute Response Team (ART) service. The primary aims of the service are to enhance the level of health and social care integration across a range of organisations, to ensure a timelier and appropriate service for people in the community at risk of admission to hospital. Design/methodology/approach: A qualitative methodology was employed in order to gain a deep understanding of the experiences of staff members within the ART service and external stakeholders. Twenty-one professionals took part in a focus group or one-to-one interviews. Data were analysed thematically. Findings: The key to successful implementation was that the service was co-created from the “ground-up” with support from local provider organisations. The inclusion of general practitioners (GPs) as part of the team was instrumental in setting up and maintaining the service and seems to be unique in intermediate care settings. Referrals into the ART service were dependent on awareness of the service at the interface with mainstream services. Transitions out were sometimes delayed due lack of availability of social care packages. To ensure sustainability of the ART and other integrated intermediate care services, continued resources, especially skilled staff members, are necessary. Originality/value: This study adds to the intermediate care and acute response service literature by offering insights into “what works” from a professional perspective in terms of service implementation, care processes and sustainability, in an integrated care system

Who is a credible source of preventive advice? An experimental vignette study of general public attitudes towards role expansion in health and social care

© 2020 The Authors. British Journal of Health Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society Objectives: To investigate the general public’s source credibility attitudes towards health and social care professionals when giving advice associated with their ‘traditional role’ versus an ‘expanded health behaviour change’ role, to facilitate the implementation of the health behaviour change agenda. Design: A 3x3 experimental between-subjects vignette questionnaire study with nine scenarios in which a general practitioner (GP), health visitor, or firefighter offered advice on either stopping smoking, preventing cot death, or fire safety. Combinations were either congruent with a traditional role (e.g., health visitor and cot death) or an expanded role (e.g., firefighter and stopping smoking). Methods: Adults were recruited from metropolitan locations in northern England. Participants were randomized to one scenario and complete a validated 18-item source credibility questionnaire. Factor analysis explored source credibility components; ratings for traditional and expanded role scenarios were compared using Mann–Whitney tests. Results: 369 participants completed the questionnaire (49.3% women, 64% White British, age range: 16–83). Factor analysis confirmed three source credibility dimensions: competence, caring, and trustworthiness. Ratings were generally high across professions and scenarios; participants rated professionals as significantly more ‘competent’ where scenarios related to their traditional roles than expanded roles (U 9778.5, p <.001) but equally as caring (U = 14467.5, p<.485) and trustworthy (U 14250.5, p.348). Conclusions: GPs, health visitors, and firefighters were all perceived as credible sources of health behaviour change advice, but may be viewed as ‘less competent’ sources of messages associated with an expanded job role. Effective professional training and public engagement regarding the role expansion agenda are needed to support policy implementation. Statement of Contribution What is already known on this subject? Source credibility surrounds people’s perceptions of the source of advice and includes competence, caring, and trustworthiness dimensions. This may have an important influence on people’s attitudes and behaviour, especially when messages are complex or emotive. A wide range of public sector workers is now expected to routinely offer preventive health and safety advice, as part of role expansion. What does this study add? This experimental survey study compared source credibility perceptions of GPs, health visitors, and firefighters giving advice on topics associated with a traditional or expanded role. Professionals were perceived as less ‘competent’ when giving advice on ‘expanded role’ topics, such as a firefighter discussing smoking, with a small reduction in source credibility. This highlights that source credibility may be specific to professional identities. Policymakers may need to explore this further as part of implementing role expansion for prevention and self-management in health and social care

Physiotherapy and Physical Activity: A cross-sectional survey exploring physical activity promotion, knowledge of physical activity guidelines and the physical activity habits of UK physiotherapists.

Objective: Physical inactivity is a public health priority and embedding promotion of physical activity (PA) within healthcare systems is an important lever for change. Many factors influence PA promotion in routine healthcare practice, these include the PA habits of healthcare professionals and also their knowledge of the PA guidelines. Little is known about the extent to which PA is currently promoted in physiotherapy practice or the factors that influence it. Methods: Following ethical approval a cross-sectional survey of UK physiotherapists was conducted. Findings were analysed and reported in accordance with STROBE guidelines. Results: There were 522 respondents, 514 of whom were physiotherapists. Seventy seven percent of respondents routinely discussed PA with patients and 68% routinely delivered Brief Interventions. Assessment of PA status was not routine practice neither was signposting to further sources of PA support. Only 16% of respondents correctly answered questions about the content of the PA guidelines. Only 38% of respondents met current PA recommendations. Clinicians' PA levels were not associated with PA promotion activity. Conclusion: Despite the promising finding that some form of PA promotion is integrated into most respondents' practice, we report a poor understanding of Brief Interventions and poor knowledge of the PA guidelines. Additionally, the majority of respondents were not sufficiently active to meet current PA recommendations

Improving skills and care standards in the support workforce for older people: a realist synthesis of workforce development interventions

Background Support workers make up the majority of the workforce in health and social care services for older people. There is evidence to suggest that support workers are not deployed as effectively as possible, are often undervalued, and that there are gaps in understanding support worker roles across different care settings. In the context of a population that is growing older, having a skilled and knowledgeable workforce is an imperative. Workforce development includes the support required to equip those providing care to older people with the right skills, knowledge and behaviours to deliver safe and high-quality services. Objective The review answered the question ‘how can workforce development interventions improve the skills and the care standards of support workers within older people’s health and social care services?’. Design A realist synthesis was conducted. In realist synthesis, contingent relationships are expressed as context–mechanism–outcomes (CMOs), to show how particular contexts or conditions trigger mechanisms to generate outcomes. The review was conducted in four iterative stages over 18 months: (1) development of a theoretical framework and initial programme theory; (2) retrieval, review and synthesis of evidence relating to interventions designed to develop the support workforce, guided by the programme theories; (3) ‘testing out’ the synthesis findings to refine the programme theories and establish their practical relevance/potential for implementation; and (4) forming recommendations about how to improve current workforce development interventions to ensure high standards in the care of older people. Participants Twelve stakeholders were involved in workshops to inform programme theory development, and 10 managers, directors for training/development and experienced support workers were interviewed in phase 4 of the study to evaluate the findings and inform knowledge mobilisation. Results Eight CMO configurations emerged from the review process, which provide a programme theory about ‘what works’ in developing the older person’s support workforce. The findings indicate that the design and delivery of workforce development should consider and include a number of starting points. These include personal factors about the support worker, the specific requirements of workforce development and the fit with broader organisational strategy and goals. Conclusions and recommendations The review has resulted in an explanatory account of how the design and delivery of workforce development interventions work to improve the skills and care standards of support workers in older people’s health and social care services. Implications for the practice of designing and delivering older person’s support workforce development interventions are directly related to the eight CMO configuration of the programme theory. Our recommendations for future research relate both to aspects of research methods and to a number of research questions to further evaluate and explicate our programme theory. Limitations We found that reports of studies evaluating workforce development interventions tended to lack detail about the interventions that were being evaluated. We found a lack of specificity in reports about what were the perceived and actual intended impacts from the workforce development initiatives being implemented and/or evaluated. Study registration This study is registered as PROSPRERO CRD42013006283. Funding The National Institute for Health Research Health Services and Delivery Research programme