Real world evaluation of three models of NHS smoking cessation service in England

<p>Abstract</p> <p>Background</p> <p>NHS Stop Smoking Services provide various options for support and counselling. Most services have evolved to suit local needs without any retrospective evaluation of their efficiency.</p> <p>Three local service evaluations were carried out at Bournemouth & Poole Teaching Primary Care Trust (PCT) (PCT1), NHS South East Essex (PCT2) and NHS Warwickshire (PCT3) to describe the structure and outcomes associated with different services.</p> <p>Result</p> <p>Standardised interviews with key personnel in addition to analysis of data from 400 clients accessing the service after 1^stApril 2008 in each PCT. The PCTs varied in geography, population size and quit rate (47%-63%). Services were delivered by PCT-led specialist teams (PCT1), community-based healthcare providers (PCT3) and a combination of the two (PCT2) with varying resources and interventions in each.</p> <p>Group support resulted in the highest quit rates (64.3% for closed groups v 42.6% for one-to-one support (PCT1)). Quit rates were higher for PCT (75.0%) v GP (62.0%) and pharmacist-delivered care (41.0%) where all existed in the same model (PCT2). The most-prescribed therapy was NRT (55.8%-65.0%), followed by varenicline (24.5%-34.3%), counselling alone (6.0%-7.8%) and bupropion (2.0%-4.0%).</p> <p>Conclusion</p> <p>The results suggest that service structure, method of support, healthcare professional involved and pharmacotherapy all play a role in a successful quit. Services must be tailored to support individual needs with patient choice and access to varied services being key factors.</p

Well-Being in Adolescence-An Association With Health-Related Behaviors: Findings From Understanding Society, the UK Household Longitudinal Study

The objective of this study was to investigate the demographic distribution of selected health-related behaviors and their relationship with different indicators of well-being. The data come from Wave 1 of the youth panel of Understanding Society household panel study. The Strengths and Difficulties Questionnaire (SDQ) measured socio-emotional difficulties. Markers of happiness in different life domains were combined to assess levels of happiness. Generally, younger youth participated in more health-protective behaviors, while older youth reported more health-risk behaviors. Higher consumption of fruit and vegetables and greater participation in sport were associated with higher odds of high happiness. Healthier eating was associated with lower odds of socio-emotional difficulties, while increased fast food consumption was associated with higher odds of socio-emotional difficulties. Smoking, drinking, and decreased sport participation were all associated with socio-emotional difficulties. Health-protective behaviors were associated with happiness, while health-risk behaviors were associated with socio-emotional difficulties. © The Author(s) 2013

When a workforce strategy won't work : critique on current policy direction in England, UK

“The final, definitive version of this article has been published in the Journal, Journal of Intellectual Disabilities: JOID, Vol.14 Issue 4, 2010, Copyright SAGE Publications Ltd on SAGE Journals Online: http://online.sagepub.com/ "This editorial is based on findings from a regional review of educational commissioning, and workforce issues for one Strategic Health Authority in England. Known as the ‘Valued People Project’ (VPP) it commenced in May 2008 and was undertaken in response to expressed concerns by regional key stakeholders regarding education commissioning specifically of pre-registration learning disability nursing, and the contribution of the specialist learning disability health workforce more generally (Gates, 2009). This work was also undertaken as a consequence of the scale and cumulative effect of changes to education, workforce, professional regulation and central health and social care policy that has affected people with learning disabilities, and the services and personnel that support them.Peer reviewedFinal Accepted Versio

Projections of multi-morbidity in the older population in England to 2035: estimates from the Population Ageing and Care Simulation (PACSim) model

Background models projecting future disease burden have focussed on one or two diseases. Little is known on how risk factors of younger cohorts will play out in the future burden of multi-morbidity (two or more concurrent long-term conditions). Design a dynamic microsimulation model, the Population Ageing and Care Simulation (PACSim) model, simulates the characteristics (sociodemographic factors, health behaviours, chronic diseases and geriatric conditions) of individuals over the period 2014–2040. Population about 303,589 individuals aged 35 years and over (a 1% random sample of the 2014 England population) created from Understanding Society, the English Longitudinal Study of Ageing, and the Cognitive Function and Ageing Study II. Main outcome measures the prevalence of, numbers with, and years lived with, chronic diseases, geriatric conditions and multi-morbidity. Results between 2015 and 2035, multi-morbidity prevalence is estimated to increase, the proportion with 4+ diseases almost doubling (2015:9.8%; 2035:17.0%) and two-thirds of those with 4+ diseases will have mental ill-health (dementia, depression, cognitive impairment no dementia). Multi-morbidity prevalence in incoming cohorts aged 65–74 years will rise (2015:45.7%; 2035:52.8%). Life expectancy gains (men 3.6 years, women: 2.9 years) will be spent mostly with 4+ diseases (men: 2.4 years, 65.9%; women: 2.5 years, 85.2%), resulting from increased prevalence of rather than longer survival with multi-morbidity. Conclusions our findings indicate that over the next 20 years there will be an expansion of morbidity, particularly complex multi-morbidity (4+ diseases). We advocate for a new focus on prevention of, and appropriate and efficient service provision for those with, complex multi-morbidity

Public support for older disabled people: evidence from the English Longitudinal Study of Ageing on receipt of disability benefits and social care subsidy

In England, state support for older people with disabilities consists of a national system of non-means tested cash disability benefits, and a locally-administered means-tested system of social care. Evidence on how the combination of the two systems targets those in most need is lacking. We estimate a latent factor structural equation model of disability and receipt of one or both forms of support. The model integrates the measurement of disability and its influence on receipt of state support, allowing for the socio-economic gradient in disability, and adopts income and wealth constructs appropriate to each part of the model. We find that receipt of each form of support rises as disability increases, with a strong concentration on the most disabled, especially for LA-funded care. The overlap between the two programmes is confined to the most disabled. Less than half of recipients of local authority-funded care also receive a disability benefit; a third of those in the top 10% of the disability distribution receive neither form of support. Despite being non means-tested, disability benefits display a degree of income and wealth targeting, as a consequence of the socio-economic gradient in disability and likely disability benefit claims behaviour. The scope for improving income/wealth targeting of disability benefits by means testing them, as some have suggested, is thus less than might be expected

Data Resource Profile: Clinical Practice Research Datalink (CPRD).

The Clinical Practice Research Datalink (CPRD) is an ongoing primary care database of anonymised medical records from general practitioners, with coverage of over 11.3 million patients from 674 practices in the UK. With 4.4 million active (alive, currently registered) patients meeting quality criteria, approximately 6.9% of the UK population are included and patients are broadly representative of the UK general population in terms of age, sex and ethnicity. General practitioners are the gatekeepers of primary care and specialist referrals in the UK. The CPRD primary care database is therefore a rich source of health data for research, including data on demographics, symptoms, tests, diagnoses, therapies, health-related behaviours and referrals to secondary care. For over half of patients, linkage with datasets from secondary care, disease-specific cohorts and mortality records enhance the range of data available for research. The CPRD is very widely used internationally for epidemiological research and has been used to produce over 1000 research studies, published in peer-reviewed journals across a broad range of health outcomes. However, researchers must be aware of the complexity of routinely collected electronic health records, including ways to manage variable completeness, misclassification and development of disease definitions for research.LS is supported by a Wellcome Trust Senior Research Fellowship in Clinical Science grant number 098504/Z/12/Z

Can Healthcare Assistant Training (CHAT) improve the relational care of older people? A developmental and feasibility study of a complex intervention

Background: Older people account for an increasing proportion of those receiving NHS acute care. The quality of healthcare delivered to older people has come under increased scrutiny. Healthcare assistants (HCAs) provide much of the direct care of older people in hospital. Patients’ experience of care tends to be based on the relational aspects of that care including dignity, empathy and emotional support. Objective(s): We aimed to: understand the relational care training needs of HCAs caring for older people; design a relational care training intervention for HCAs; and assess the feasibility of a cluster-randomised controlled trial to test the new intervention against HCA training as usual. Design: (1) Telephone survey of all NHS hospital Trusts in England to assess current HCA training provision; (2) focus groups of older people and carers and (3) semi-structured interviews with HCAs and other care staff to establish training needs and inform intervention development; (4) feasibility cluster-randomised controlled trial. Setting: (1) All acute NHS hospital Trusts in England; (2,3,4) Three acute NHS hospital Trusts in England and the populations they serve. Participants: (1) 113 of 161 (70.2%) Trusts took part in the telephone survey; (2) 29 older people or carer participants of three focus groups; (3) 30 HCA and 24 ‘other staff’ interviewees; (4) 12 wards (four per Trust); 112 HCAs; 92 patients during the pre-randomisation period and 67 patients during the post-randomisation period. Interventions: For the feasibility trial a training intervention (Older People’s Shoes) for HCAs developed as part of the study was compared with HCA training as usual. Main outcome measures: Patient level outcomes were the experience of emotional care and quality of life during their hospital stay as measured by the Patient Evaluation of Emotional Care during Hospitalisation (PEECH) and the European Quality of Life (EQ-5D) questionnaires. HCA outcomes were empathy measured by the Toronto Empathy Questionnaire (TEQ) and attitudes towards older people measured by the Age Group Evaluation and Description (AGED) Inventory. Ward level outcomes were the quality of HCA/patient interaction measured by the Quality of Interaction Scale (QUIS). Results: (1) A third of Trust telephone survey participants reported HCA training content that we considered to be ‘relational care’. Training for HCAs is variable across Trusts and focused on new recruits. The biggest challenge for HCA training is getting HCAs released from ward duties. (2) Older people and carers are aware of the pressures ward staff are under but good relationships with care staff determines whether the experience of hospital is positive. (3) HCAs have training needs related to ‘difficult conversations’ with patients and relatives; they have particular preferences for learning styles that are not always reflected in available training. (4) In the feasibility trial 187 of the 192 planned ward observation sessions were completed; response to HCA questionnaires at baseline, eight and 12 weeks post-randomisation was 64.2%, 46.4% and 35.7% respectively; 57.2% of eligible patients returned completed questionnaires. Limitations: This was an intervention development and feasibility study so no conclusions can be drawn about the effectiveness of the intervention. Conclusions: The intervention had high acceptability among nurse trainers and HCA learners. Viability of a definitive trial is conditional on overcoming specific methodological (patient recruitment processes) and contextual (involvement of wider ward team) challenges. Future work: Methods to ease the burden of questionnaire completion without compromising ethics or methodological rigour need to be explored. Study registration: ISRCTN1038579

Effect of a health-improvement pilot programme for older adults delivered by a professional football club: the Burton Albion case study

Older adults are a priority within policy designed to facilitate healthy lifestyles through physical activities. Golden Goal is a pilot programme of physical activity-led health improvement for older adults, 55 years and older. Activities were delivered at Burton Albion Football Club. Sessions involved weekly moderate to vigorous intensity exercise sessions including exer-gaming (exercise-orientated video-games), indoor bowls, cricket, new age curling, walking football, and traditional board games and skittles. Secondary analysis of data collected through the original programme evaluation of Golden Goal investigated the impact of the intervention on participants. Older adults completed self-reports for demographics, health screening/complications and quality of life. Attendees, n = 23 males (42.6%) and n = 31 females (57.4%) with a mean age of 69.38 (±5.87) (n = 40), ranging from 55-85 years took part. The mean attendance was 7.73 (±3.12) sessions for all participants, (n = 51). Older adults with two or more health complications (n = 22, 42.3%) attended fewer sessions on average (6.91 ± 3.322) compared to those reporting less than two health complications (8.65 ± 2.694). Self-rated health was higher for women (87.32 ± 9.573) vs. men (80.16 ± 18.557), although this was not statistically significant (U = 223.500, p = 0.350). Results support the potential of football-led health interventions for recruiting older adults, including those reporting health problems. © 2014 © 2014 Taylor & Francis

Risk and teenage parenthood: an early sexual health intervention

Purpose - This paper outlines the development of a resource designed to support practitioners, who were not sexual health specialists, but who worked with young people who may be at risk of teenage pregnancy or parenthood. Its aim was to enable practitioners to carry out an assessment using a screening tool, and to use educational interventions designed to reduce risk-taking behaviour or refer to a sexual health specialist. We report a research project to examine the perceptions of practitioners who had used the resource. Design/methodology/approach – The resource was based on a local needs assessment and developed by a multi-agency working group. The research utilised an on-line questionnaire and telephone interviews with practitioners. Findings - Practitioners reported using the screening tool with young people with an average age of 13.1 years. They thought the educational interventions provided knowledge and helped with communication, self-awareness, reflection, confidence, attitudes and values clarification. Research limitations/implications - The project was based in one county in England. A sample of seventeen per cent of the practitioners responded to the questionnaire, and they might be those who had engaged most, or most positively, with the resource. Three practitioners undertook interviews. The views and behaviours of young people are yet to be evaluated. Originality/value - Within a climate of limited resources, the findings suggest that the project was providing an acceptable proportionate universalist, early sexual health intervention for young people

Trading between healthy food, alcohol and physical activity behaviours

BACKGROUND: While recent lifestyle studies have explored the role that food, alcohol or physical activity have on health and wellbeing, few have explored the interplay between these behaviours and the impact this has on a healthy lifestyle. Given the long term health advantages associated with leading healthier lifestyles, this study seeks to: 1) explore the interplay between the food, alcohol and physical activity behaviours of young adults (aged 19–26 years) in the North East of England; 2) explore the trade-offs young adults make between their food, alcohol and physical activity behaviours; and 3) recognise the positive and negative associations between the three behaviours. METHODS: Qualitative self-reported lifestyle diaries and in-depth interviews were conducted with 50 young adults from the North East of England between February and June 2008. Qualitative thematic analysis was undertaken using Nvivo QSR software, and diary coding using Windiets software. RESULTS: Young adults who attempt to achieve a ‘healthy lifestyle’ make trade-offs between the food and alcohol they consume, and the amounts of physical activity they undertake. There are negative reasons and positive consequences associated with these trade-offs. Young adults recognise the consequences of their behaviours and as a result are prepared to undertake healthy behaviours to compensate for unhealthy behaviours. They prefer certain strategies to promote healthier behaviours over others, in particular those that relate to personalised advice and support, more affordable ways to be healthier and easily-accessed advice from a range of media sources. CONCLUSIONS: Young adults seek to compensate unhealthy behaviours (e.g. binge drinking) with healthy behaviours (e.g. physical activity). Creative solutions may be required to tackle these trade-offs and promote a balance across the food, alcohol and physical activity behaviours of this age group. Solutions that may be effective with this age group include environmental changes (e.g. green spaces and increasing the price of alcohol) designed to encourage and facilitate young people making healthier choices and improving their access to, and lowering the price of, healthy food products. Solutions must recognise these trade-offs and in particular, the strong reluctance of young adults to alter their higher-than-recommended levels of alcohol consumption