Workplace-based interventions to promote healthy lifestyles in the NHS workforce : a rapid scoping and evidence map

Background:The health and well-being of staff working in the NHS is a significant issue for UK health care. We sought to identify research relevant to the promotion of healthy lifestyles among NHS staff on behalf of NHS England. Objectives:To map existing reviews on workplace-based interventions to promote health and well-being, and to assess the scope for further evidence synthesis work. Design:Rapid and responsive scoping search and evidence map. Participants:Adult employees in any occupational setting and in any role. Interventions:Any intervention aimed at promoting or maintaining physical or mental health and well-being. Early intervention initiatives and those addressing violence against staff, workplace bullying or harassment were also included. Main outcome measures:Any outcome related to the effectiveness, cost-effectiveness or implementation of interventions.Data sources:A scoping search of nine databases was conducted to identify systematic reviews on health and well-being at work. Searches were limited by publication date (2000 to January/February 2019). Review methods:The titles and abstracts of over 8241 records were screened and a total of 408 potentially relevant publications were identified. Information on key characteristics were extracted from the titles and abstracts of all potentially relevant publications. Descriptive statistics (counts and percentages) for key characteristics were generated and data from reviews and ‘reviews of reviews’ were used to produce the evidence map. Results:Evidence related to a broad range of physical and mental health issues was identified across 12 ‘reviews of reviews’ and 312 other reviews, including 16 Cochrane reviews. There also exists National Institute for Health and Care Excellence guidance addressing multiple issues of potential relevance. A large number of reviews focused on mental health, changing lifestyle behaviour, such as physical activity, or on general workplace health/health promotion. Most of the reviews that focused only on health-care staff addressed mental health issues, and stress/burnout in particular. Limitations:The scoping search process was extensive and clearly effective at identifying relevant publications, but the strategy used may not have identified every potentially relevant review. Owing to the large number of potentially relevant reviews identified from the scoping search, it was necessary to produce the evidence map using information from the titles and abstracts of reviews only. Conclusions: It is doubtful that further evidence synthesis work at this stage would generate substantial new knowledge, particularly within the context of the NHS Health and Wellbeing Framework published in 2018. Additional synthesis work may be useful if it addressed an identifiable need and it was possible to identify one of the following: (1) a specific and focused research question arising from the current evidence map; it may then be appropriate to focus on a smaller number of reviews only, and provide a more thorough and critical assessment of the available evidence; and (2) a specific gap in the literature (i.e. an issue not already addressed by existing reviews or guidance); it may then be possible to undertake further literature searching and conduct a new evidence review

Informing NHS policy in 'digital-first primary care': a rapid evidence synthesis

Background In ‘digital-first primary care’ models of health-care delivery, a patient’s first point of contact with a general practitioner or other health professional is through a digital channel, rather than a face-to-face consultation. Patients are able to access advice and treatment remotely from their home or workplace via a number of different technologies. Objectives This rapid responsive evidence synthesis was undertaken to inform NHS England policy in ‘digital-first primary care’. It was conducted in two stages: (1) scoping the published evidence and (2) addressing a refined set of questions produced by NHS England from the evidence retrieved during the scoping stage. Data sources Searches were conducted of five electronic databases (MEDLINE, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, the Health Technology Assessment database and PROSPERO were searched in July 2018) and relevant research/policy and government websites, as well as the National Institute for Health Research Health Service and Delivery Research programme database of ongoing and completed projects. No date or geographical limitations were applied. Review methods After examining the initial scoping material, NHS England provided a list of questions relating to the potential effects of digital modes and models of engagement, and the contracting and integration of these models into primary care. Systematic reviews and evidence syntheses, including evidence on the use of digital (online) modes and models of engagement between patients and primary care, were examined more closely, as was ongoing research and any incidentally identified primary studies focused on the use of digital (online) modes and models of engagement. All records were screened by two reviewers, with disagreements resolved by consensus or consulting a third reviewer. Results Evidence suggests that uptake of existing digital modes of engagement is currently low. Patients who use digital alternatives to face-to-face consultations are likely to be younger, female and have higher income and education levels. There is some evidence that online triage tools can divert demand away from primary care, but results vary between interventions and outcome measures. A number of potential barriers exist to using digital alternatives to face-to-face consultations, including inadequate NHS technology and staff concerns about workload and confidentiality. There are currently insufficient empirical data to either substantiate or allay such concerns. Very little evidence exists on outcomes related to quality of care, service delivery, benefits or harms for patients, or on financial costs/cost-effectiveness. No studies examining how to contract and commission alternatives to face-to-face consultations were identified. Limitations The quality of the included reviews was variable. Poor reporting of methodology and a lack of adequate study details were common issues. Much of the evidence focused on exploring stakeholder views rather than on objective measurement of potential impacts. The current evidence synthesis is based on a rapid scoping exercise and cannot provide the breadth or depth of insight that might have been achieved with a full systematic review. Conclusions Rapid scoping of the literature suggests that there is little high-quality evidence relating to ‘digital-first primary care’ as defined by NHS England. The broader evidence on alternatives to face-to-face consultation addresses certain policy-maker concerns, such as the possible impact of new technologies on workload and workforce, inequalities, local implementation and integration with existing services. However, although this evidence gives an insight into the views and experiences of health professionals in relation to such concerns, quantitative empirical data are lacking

Regulating and inspecting integrated health and social care in the UK : scoping the literature

Background: The integration of care, particularly across the health and social care sectors, has been a long-standing policy objective in the UK. We sought to scope the evidence related to the regulation and inspection of integrated care. Objective(s): To identify and classify published material that could potentially address four key questions: 1. What models of regulation and inspection of integrated care have been proposed? (Including approaches taken in other countries) 2. What evidence is available on the effectiveness of such models? 3. What are the barriers and enablers of effective regulation and inspection of integrated care? 4. Can barriers to effective regulation and inspection be overcome without legislative change? Design: Rapid scoping review. Publication type and focus: Both empirical and non-empirical publications related to the regulation and inspection of integrated care were included. Setting: Publications focused on the integration of health and social care services, or provision delivered across other settings/sectors by different professional groups working together. Outcomes: Empirical studies reporting on any outcome relevant to the regulation and/or inspection of integrated care. Non-empirical publications focusing on any relevant issue including proposed models of regulation or outcome frameworks. Data sources: A targeted search of five databases was undertaken. Additionally, we conducted supplementary searches of the websites of key organisations and searched for other grey literature using the advanced search function of Google. Key contacts were also approached, and a request made for relevant documents. Review methods: The title and abstracts of 5380 records were screened and a total of 166 publications were included. Documents were coded based on key characteristics, and a descriptive summary of the literature produced. No attempt was made to assess the quality or synthesise the findings of the retrieved evidence. Results Out of the 166 included publications, 71 were identified from database searches and 95 were included from supplementary website searches. While there were records that could be classified as relevant to one or more of the research questions identified through the stakeholder consultation, there was a notable absence of evidence relating to (a) effectiveness of regulatory/inspection strategies and (b) professional regulation. Conclusions and future work The evidence base relating to the regulation or inspection of integrated care is relatively small. There may be an opportunity to synthesise some of the existing views and experience data on system regulation and inspection identified in a more formal systematic review. However, before a useful evidence base can be developed, policy makers and researchers need to agree what constitutes ‘effective’ regulation, how this can be measured, and which study designs are most appropriate for evaluation. Related questions about what constitutes ‘successful’ integration of care should also be taken into account when planning such research. While potentially useful reforms have been proposed, empirical evidence in relation to professional regulation appears particularly scarce. Organisations responsible for regulating professionals might therefore consider incorporating some form of evaluation into any planned strategic reforms. Limitations The degree of focus on integration or regulation was a difficult criterion to apply with strict consistency

Reviews on Long COVID: a scope of the literature. : Update October 2022

Summary • For this update, we identified 29 published reviews; two completed reviews that are yet to be published; and 63 new protocols for ongoing reviews on Long COVID. • Most published reviews were focused on the frequency or risk of persistent symptoms/effects, which has been a consistent finding in all our reports. • We identified more published and ongoing reviews with a focus on treatment/rehabilitation compared to our last update

Reviews on Long COVID: A scope of the literature. : Update July 2022

This report is the second quarterly update of the rapid scope of published and ongoing systematic reviews related to Long COVID that was originally conducted for the Department of Health and Social Care in England in November 2021.1 The first update covered the period November 2021 to the end of March 2022.2 For the current update, we identified systematic reviews and review protocols focused on Long COVID that were published between the start of April and the end of June 2022. Long COVID was conceptualised broadly as any symptoms or effects that persist or develop after acute COVID-19 infection

Treatment and rehabilitation of Long COVID: a scope of the literature. : Update October 2022

Summary • We identified 11 randomised controlled trials published since June 2022 that were focused on Long COVID treatment or rehabilitation. Across two reports, we have now identified and assessed 25 trials published in 2022. • A majority of trials focused on evaluating treatments for people with persistent problems with their sense of smell (olfactory dysfunction). • Trial quality varied and inadequate reporting of methods often prevented a full assessment of the risk of bias. However, six trials were rated positively for at least 11 out of the 13 criteria that we assessed

Treatment and rehabilitation of Long COVID: a scope of the RCT literature : July 2022

Summary • We identified 14 randomised controlled trials published in the last six months, which examined the effectiveness of a range of interventions focused on Long COVID treatment or rehabilitation. • Across trials, the post COVID period ranged widely from a few weeks after symptom onset or diagnosis to several months post recovery from active infection or hospital discharge. • Trial quality varied and inadequate reporting of methods frequently precluded a full assessment of the risk of bias. However, six trials were rated positively for at least 75% of the domains we assessed

Treatment and rehabilitation of Long COVID: A scope of the literature. : Update April 2023

Summary • We identified 18 randomised controlled trials published since December 2022 that were focused on Long COVID treatment or rehabilitation. Across our four reports produced to date, we have identified and assessed 55 trials published between January 2022 and March 2023. • A third of the trials included in this update had a primary focus on treating persistent problems with respiratory function and physical fitness (n=6). Other trials focused on olfactory dysfunction (n=5); long-term fatigue (n=2); headaches (n=1) and cognitive impairment, physical and mental fatigue and neuropsychiatric issues (n=1). Three trials evaluated interventions for treating non-specific Long COVID symptoms, all of which were focused on improving physical fitness. • Five trials were rated positively for at least 11 out of the 13 criteria that we assessed. Four trials met 10 criteria and nine gained a positive rating for between five and nine criteria

Reviews on Long COVID: a scope of the literature. : Update April 2023

Summary • For this update, we identified 37 published reviews and 73 new protocols for ongoing reviews on Long COVID. The number of published reviews is lower than in our last quarterly report in January (n=50), but higher than in our October report (n=29), all of which used the same databases and search strategy. • Most published reviews were focused on symptoms or effects, which is consistent with the earlier reports. • We identified fewer published reviews with a primary focus on Long COVID risk factors (3/37) than in January (10/50). • Most of the protocols for ongoing reviews focused on Long COVID treatment or rehabilitation (30/73), as was the case in the January report (33/56). • Most of the other protocols focused on symptoms or effects (21/73), or risk factors (13/73)

Treatment and rehabilitation of Long COVID: A scope of the literature. : Update January 2023

Summary • We identified 12 randomised controlled trials published since September 2022 that were focused on Long COVID treatment or rehabilitation. Across our three reports produced to date, we have identified and assessed 37 trials published between January and December 2022. • Half of the trials included in this update had a primary focus on treating persistent problems with respiratory function and physical fitness (n=6). Other trials focused on olfactory dysfunction (n=2); and cognitive problems and long-term fatigue (n=1). Three trials evaluated non-specific interventions for treating Long COVID symptoms (n=3). • Seven trials were rated positively for at least 11 out of the 13 criteria that we assessed