A ‘Tripadvisor’ for disability? Social enterprise and ‘digital disruption’ in Australia

We explore how social enterprises can use platform technologies to plug ‘informational gaps’ in the provision of disability services. Such gaps are made more apparent by policies promoting self-directed care as a means of giving service users more choice and control. We use a case study of a start-up social enterprise seeking to provide a TripAdvisor style service to examine the potential for social innovation to ‘disrupt’ current models of service. The case study suggests that any disruptive effects of such changes are not due to new digital technology per se, nor to novel platform business models, but rather rest in the manner in which the moral orders which justify current patterns of social disablement can be challenged by social innovation

A pilot survey of physical activity in men with an intellectual disability

People with intellectual disability are reported as a sedentary population with increased risks of poor health due to an inactive and sedentary lifestyle. As the benefits of physical activity are acknowledged, measuring physical activity accurately is important to help identify reasons for low and high physical activity in order to assist and maintain recommended levels for optimal health. This paper reports a pilot study undertaken to validate the use of a physical activity monitor (Sensewear Armband) and the International Physical Activity Questionnaire (IPAQ) as instruments for measuring and exploring physical activity of men with intellectual disability. The design was a one group descriptive study and data were collected over a 7 day period from 17 men. The Sensewear Armband enabled continuous and long-term measurement of 14 objective physical activity metrics. The IPAQ examined details of physical activity reported over the 7 days. Equivalent results were found in both instruments indicating a positive correlation between the Sensewear Armband and the IPAQ. The results show 50% have low activity levels and the national recommended physical activity levels been achieved at a very low active intensity. No sustainable high physical activity intensity levels were recorded. The results confirmed the Sensewear Armband and the IPAQ as a practical means of measuring and understanding physical activity levels of men with intellectual disability

Priority setting in health care: Lessons from the experiences of eight countries

All health care systems face problems of justice and efficiency related to setting priorities for allocating a limited pool of resources to a population. Because many of the central issues are the same in all systems, the United States and other countries can learn from the successes and failures of countries that have explicitly addressed the question of health care priorities

Impact of a nurse-led intervention to improve screening for cardiovascular risk factors in people with severe mental illnesses. Phase-two cluster randomised feasibility trial of community mental health teams

Background: People with severe mental illnesses (SMI) are at increased risk of cardiovascular disease (CVD). Clinical guidelines recommend regular screening for CVD risk factors. We evaluated a nurse led intervention to improve screening rates across the primary-secondary care interface.Methods: Six community mental health teams (CMHTs) were randomised to receive either the nurse led intervention plus education pack (n = 3) or education pack only (n = 3). Intervention (6 months): The nurse promoted CVD screening in primary care and then in CMHTs. Patients who remained unscreened were offered screening by the nurse. After the intervention participants with SMI were recruited from each CMHT to collect outcome data. Main outcome: Numbers screened during the six months, confirmed in General Practice notes.Results: All six CMHTs approached agreed to randomisation. 121 people with SMI participated in outcome interviews during two waves of recruitment (intervention arm n = 59, control arm n = 62). Participants from both arms of the trial had similar demographic profiles and rates of previous CVD screening in the previous year, with less than 20% having been screened for each risk factor. After the trial, CVD screening had increased in both arms but participants from the intervention arm were significantly more likely to have received screening for blood pressure (96% vs 68%; adjusted Odds Ratio (OR) 13.6; 95% CI: 3.5-38.4), cholesterol (66.7% vs 26.9%, OR 6.1; 3.2-11.5), glucose (66.7% vs 36.5% OR 4.4; 2.7-7.1), BMI (92.5% vs 65.2% OR 6.5; 2.1-19.6), and smoking status (88.2% vs 57.8% OR 5.5; 3.2-9.5) and have a 10 year CVD risk score calculated (38.2% vs 10.9%) OR 5.2 1.8-15.3). Within the intervention arm approximately half the screening was performed in general practice and half by the trial nurse.Conclusions: The nurse-led intervention was superior, resulting in an absolute increase of approximately 30% more people with SMI receiving screening for each CVD risk factor. The feasibility of the trial was confirmed in terms of CMHT recruitment and the intervention, but the response rate for outcome collection was disappointing; possibly a result of the cluster design. The trial was not large or long enough to detect changes in risk factors.Trial Registration: International Standard Randomised Controlled Trial Registration Number (ISRCTRN) 58625025

Technology assessment and resource allocation for predictive genetic testing: A study of the perspectives of Canadian genetic health care providers

<p>Abstract</p> <p>Background</p> <p>With a growing number of genetic tests becoming available to the health and consumer markets, genetic health care providers in Canada are faced with the challenge of developing robust decision rules or guidelines to allocate a finite number of public resources. The objective of this study was to gain Canadian genetic health providers' perspectives on factors and criteria that influence and shape resource allocation decisions for publically funded predictive genetic testing in Canada.</p> <p>Methods</p> <p>The authors conducted semi-structured interviews with 16 senior lab directors and clinicians at publically funded Canadian predictive genetic testing facilities. Participants were drawn from British Columbia, Alberta, Manitoba, Ontario, Quebec and Nova Scotia. Given the community sampled was identified as being relatively small and challenging to access, purposive sampling coupled with snowball sampling methodologies were utilized.</p> <p>Results</p> <p>Surveyed lab directors and clinicians indicated that predictive genetic tests were funded provincially by one of two predominant funding models, but they themselves played a significant role in how these funds were allocated for specific tests and services. They also rated and identified several factors that influenced allocation decisions and patients' decisions regarding testing. Lastly, participants provided recommendations regarding changes to existing allocation models and showed support for a national evaluation process for predictive testing.</p> <p>Conclusion</p> <p>Our findings suggest that largely local and relatively ad hoc decision making processes are being made in relation to resource allocations for predictive genetic tests and that a more coordinated and, potentially, national approach to allocation decisions in this context may be appropriate.</p

Disseminating research findings: what should researchers do? A systematic scoping review of conceptual frameworks

Background: Addressing deficiencies in the dissemination and transfer of research-based knowledge into routine clinical practice is high on the policy agenda both in the UK and internationally. However, there is lack of clarity between funding agencies as to what represents dissemination. Moreover, the expectations and guidance provided to researchers vary from one agency to another. Against this background, we performed a systematic scoping to identify and describe any conceptual/organising frameworks that could be used by researchers to guide their dissemination activity.Methods: We searched twelve electronic databases (including MEDLINE, EMBASE, CINAHL, and PsycINFO), the reference lists of included studies and of individual funding agency websites to identify potential studies for inclusion. To be included, papers had to present an explicit framework or plan either designed for use by researchers or that could be used to guide dissemination activity. Papers which mentioned dissemination (but did not provide any detail) in the context of a wider knowledge translation framework, were excluded. References were screened independently by at least two reviewers; disagreements were resolved by discussion. For each included paper, the source, the date of publication, a description of the main elements of the framework, and whether there was any implicit/explicit reference to theory were extracted. A narrative synthesis was undertaken.Results: Thirty-three frameworks met our inclusion criteria, 20 of which were designed to be used by researchers to guide their dissemination activities. Twenty-eight included frameworks were underpinned at least in part by one or more of three different theoretical approaches, namely persuasive communication, diffusion of innovations theory, and social marketing.Conclusions: There are currently a number of theoretically-informed frameworks available to researchers that can be used to help guide their dissemination planning and activity. Given the current emphasis on enhancing the uptake of knowledge about the effects of interventions into routine practice, funders could consider encouraging researchers to adopt a theoretically-informed approach to their research dissemination

Information transfer: what do decision makers want and need from researchers?

<p>Abstract</p> <p>Purpose</p> <p>The purpose of this study was to undertake a systematic assessment of the need for research-based information by decision-makers working in community-based organizations. It is part of a more comprehensive knowledge transfer and exchange strategy that seeks to understand both the content required and the format/methods by which such information should be presented.</p> <p>Methods</p> <p>This was a cross-sectional telephone survey. Questions covered current practices, research use, and demographic information, as well as preferences for receiving research information. Three types of organizations participated: Children's Treatment Centres of Ontario (CTCs); Ontario Community Care Access Centres (CCACs); and District Health Councils (DHCs). The analysis used descriptive statistics and analyses of variance (ANOVA) to describe and explore variations across organizations.</p> <p>Results</p> <p>The participation rate was 70%. The highest perception of barriers to the use of research information was reported by the CCAC respondents, followed by CTCs and DHCs. The CTCs and DHCs reported greater use of research evidence in planning decisions as compared to the CCACs. Four sources of information transfer were consistently identified. These were websites, health-related research journals, electronic mail, and conferences and workshops. Preferred formats for receiving information were executive summaries, abstracts, and original articles.</p> <p>Conclusion</p> <p>There were a number of similarities across organization type with respect to perceived barriers to research transfer, as well as the types of activities the organizations engaged in to promote research use in decision-making. These findings support the importance of developing interactive, collaborative knowledge transfer strategies, as well as the need to foster relationships with health care decision-makers, practitioners and policymakers.</p

Resource allocation and priority setting in health care: a multi-criteria decision analysis problem of value?

A methodological approach is needed for allocating health care resources in an efficient and fair way that gives legitimacy to decisions. Currently, most priority setting approaches tend to focus on single or limited benefit dimensions, even though the value of new health care interventions is multi-dimensional. Explicit elicitation of social value trade-offs is usually not possible and decision-makers often adopt intuitive or heuristic modes for simplification purposes as part of an ad hoc decision-making process which might diminish the reasonableness and credibility of the decisions. In this paper, we suggest that multi-criteria decision analysis could provide a more comprehensive and transparent approach in health care to systematically capture decision-makers’ concerns, compare value trade-offs and elicit their value preferences. We conclude that such methods could inform the development of a decision support system in health care, contributing towards more efficient, rational and legitimate resource allocation decisions

A person-centred approach to implementation of psychosocial interventions with people who have an intellectual disability and dementia-A participatory action study

Background Numbers of people with an intellectual disability and dementia are increasing with a need to reduce associated stress or agitation. This study aimed to identify effectiveness of psychosocial interventions in social care settings and, uniquely, explore use of photovoice methodology to develop dialogue about dementia. Methods This mixed-method participatory action study used goal-setting theory with 16 participants with intellectual disability and dementia, and 22 social care staff across 11 sites. Five co-researchers with intellectual disability were part of an inclusive research team collecting data using existing and bespoke tools including photovoice. Analysis used descriptive and inferential statistics and framework analysis. Results 74% of individual goals met or exceeded expectations with reduction in some ‘as required’ medication. Qualitative findings include themes of enabling care and interventions as tools for practice. Photovoice provided insight into previously unreported fears about dementia. Conclusions Individualised psychosocial interventions have potential to reduce distress or agitation