A qualitative exploratory study of training requirements for general practitioners attending older people resident in care homes

Purpose: Older people who reside in care homes have varying access and quality of medical care; in the UK, this is provided by general practitioners (GPs). The authors aimed to explore the experiences of trainee GPs in delivering integrated care and discuss, with senior GPs, opportunities to improve training. Design/methodology/approach: Two trainees and thirteen senior GPs were recruited through professional networks and participated in semi-structured interviews. Transcriptions were analysed using thematic analysis, and the theory of negotiated order was used to interpret findings. Findings: Trainees received no specific training on working with care homes. Exposure to the care home setting was variable, and could be negligible, depending on the GP practice placement. Senior GPs expressed concerns about patient safety, due to practical challenges of the consultation and a sense of lack of control. Considering the theory of negotiated order, where GPs had trusting relationships with care home staff, the input of the staff could mitigate the sense of risk. Care plans could communicate needs and preferences within the team and may be a way of extending the negotiated order, for example giving care homes authority to implement end-of-life care when the GP is not present. Research limitations/implications: The authors identified a need for trainees to engage with the organisational aspect of the care home to deliver integrated care. Trusted relationships with staff led to improved consultations, care plans, and better management of risk. Originality/value: This is the first study of learning needs for GP trainees to provide integrated care for older care home residents

Citizens’ Juries: When Older Adults Deliberate on the Benefits and Risks of Smart Health and Smart Homes

open access articleBackground: Technology-enabled healthcare or smart health has provided a wealth of products and services to enable older people to monitor and manage their own health conditions at home, thereby maintaining independence, whilst also reducing healthcare costs. However, despite the growing ubiquity of smart health, innovations are often technically driven, and the older user does not often have input into design. The purpose of the current study was to facilitate a debate about the positive and negative perceptions and attitudes towards digital health technologies. Methods: We conducted citizens’ juries to enable a deliberative inquiry into the benefits and risks of smart health technologies and systems. Transcriptions of group discussions were interpreted from a perspective of life-worlds versus systems-worlds. Results: Twenty-three participants of diverse demographics contributed to the debate. Views of older people were felt to be frequently ignored by organisations implementing systems and technologies. Participants demonstrated diverse levels of digital literacy and a range of concerns about misuse of technology. Conclusion: Our interpretation contrasted the life-world of experiences, hopes, and fears with the systems-world of surveillance, e ciencies, and risks. This interpretation o ers new perspectives on involving older people in co-design and governance of smart health and smart homes

Improving community support for older people’s needs through commissioning third sector services: a qualitative study

Aim: This exploratory study of commissioning third sector services for older people aimed to explore whether service data was fed back to commissioners and whether this could improve intelligence about the population and hence inform future commissioning decisions. Background: Third sector services are provided through charities and non-profit community organisations, and services that assess and advise people for self-management or provide wellbeing support in the community have developed over recent years. Third sector services have an opportunity to reach vulnerable populations and to provide intelligence about them. Some third sector services are state funded (commissioned) in the United Kingdom (UK). While evidence is available about the commissioning of statutory health and social care, as well as private providers, there is limited evidence about how third sector health services are funded. Methods: Participants were recruited from commissioner organisations and third sector organisations, both with an interest in supporting the independence, self-management and wellbeing of older people. Organisations were recruited from five purposively selected sites within one region of England (East Midlands). Semi-structured interviews explored the relationships between commissioners and providers and the nature of funding arrangements, including co-production. Interviews also explored collection of data within the service and how data was fed back to commissioners. Focus groups were held with older people with the potential to benefit from wellbeing services.Results: Commissioning arrangements were varied, sometimes complex, and often involved co-production with the third sector. Commissioners valued third sector organisations for their engagement with the local community, value for money, outreach services and ability to provide information about the community. Assessing the needs and outcomes of individuals was integral to delivery of support and advice to older people. Diverse approaches were used to assess an individual’s needs and outcomes, although there were concerns that some assessment questionnaires may be too complex for this vulnerable group. Assessment and outcomes data were also used to monitor the service contract and there was potential for the data to be summarised to inform commissioning strategies, but commissioners did not report using assessment data in this way. While the policy context encouraged partnerships with third sector organisations and their involvement in decision-making, the relationship with third sector organisations was not valued within contract arrangements, and may have been made more difficult by the tendering process and the lack of analysis of service data.Conclusion: This exploratory study has demonstrated a diversity of commissioning arrangements for third sector services across one region of England. Most commissioners invited co-production; that is, the commissioners sought input from the third sector while specifying details of the service. Service data, including assessments of needs and outcomes, were reported to commissioners, however commissioners did not appear to use this to full advantage to inform future commissioning decisions. This may indicate a need to improve measurement of needs and outcomes in order to improve the credibility of commissioning process

First point of contact physiotherapy; a qualitative study

© 2020 The Authors Objectives: First point of contact physiotherapy (FPCP) provides patients direct access to a physiotherapist. Literature demonstrates efficacy of FPCP. Evidence has highlighted the need for cultural shifts from both patient and professional perspectives to optimise FPCP. This study explored stakeholder perceptions of patient awareness and understanding of FPCP to better inform FPCP implementation. Design, setting, participants: A qualitative methodology utilised semi-structured interviews and focus groups. Findings from a previous realist review were used to generate a priori topic guides. Participants included patients, physiotherapists, GPs, administration staff, and commissioners. A thematic analysis was undertaken. Results: Four themes emerged that are described: level of patient awareness of the FPCP role situated against the GP as first contact practitioner, patients attain an awareness of FPCP from a variety of sources, patient understanding of physiotherapy arises from several sources and is poorly aligned with the FPCP model, characteristics and behaviours of patients influence access to FPCP services. Patient awareness and understanding was poor. Patients tended to view the GP as the default first contact practitioner. Traditional advertising approaches appeared on the whole invisible to patients and there was a reliance on signposting to facilitate patient access. Conclusion: Findings from this study can inform implementation of FPCP. Several obstacles to the optimisation of FPCP were highlighted. Improved marketing of physiotherapy generally and FPCP specifically may increase patient awareness and understanding. However, it is likely further time will be required to bring about the cultural shift in public perception required to optimise the potential of FPCP

Using comprehensive geriatric assessment for quality improvements in healthcare of older people in UK care homes: protocol for realist review within Proactive Healthcare of Older People in Care Homes (PEACH) study

Introduction Care home residents are relatively high users of healthcare resources and may have complex needs. Comprehensive geriatric assessment (CGA) may benefit care home residents and improve efficiency of care delivery. This is an approach to care in which there is a thorough multidisciplinary assessment (physical and mental health, functioning and physical and social environments) and a care plan based on this assessment, usually delivered by a multidisciplinary team. The CGA process is known to improve outcomes for community-dwelling older people and those in receipt of hospital care, but less is known about its efficacy in care home residents. Methods and analysis Realist review was selected as the most appropriate method to explore the complex nature of the care home setting and multidisciplinary delivery of care. The aim of the realist review is to identify and characterise a programme theory that underpins the CGA intervention. The realist review will extract data from research articles which describe the causal mechanisms through which the practice of CGA generates outcomes. The focus of the intervention is care homes, and the outcomes of interest are health-related quality of life and satisfaction with services; for both residents and staff. Further outcomes may include appropriate use of National Health Service services and resources of older care home residents. The review will proceed through three stages: (1) identifying the candidate programme theories that underpin CGA through interviews with key stakeholders, systematic search of the peer-reviewed and non-peer-reviewed evidence, (2) identifying the evidence relevant to CGA in UK care homes and refining the programme theories through refining and iterating the systematic search, lateral searches and seeking further information from study authors and (3) analysis and synthesis of evidence, involving the testing of the programme theories. Ethics and dissemination The PEACH project was identified as service development following submission to the UK Health Research Authority and subsequent review by the University of Nottingham Research Ethics Committee. The study protocols have been reviewed as part of good governance by the Nottinghamshire Healthcare Foundation Trust. We aim to publish this realist review in a peer-reviewed journal with international readership. We will disseminate findings to public and stakeholders using knowledge mobilisation techniques. Stakeholders will include the Quality Improvement Collaboratives within PEACH study. National networks, such as British Society of Gerontology and National Care Association will be approached for wider dissemination

Breastfeeding in infants diagnosed with phenylketonuria

Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows:. To assess the effects of breastfeeding (exclusive or partial) compared to low-Phe formula feeding in the first six months after birth in infants diagnosed with PKU

"Our biggest killer": multimodal discourse representations of dementia in the British press

A recent (2016) Office for National Statistics report stated that dementia is now “the leading cause of death” in England and Wales. Ever fixated with the syndrome (an unfailingly newsworthy topic), the British press was quick to respond to the bulletin, consistently headlining that dementia was the nation’s “biggest killer,” while (re)formulating other aspects of the report in distorting and emotive metaphorical terms. In this paper we examine how the media, through use of a recurring set of linguistic and visual semiotic tropes, portrayed dementia as an agentive entity, a “killer,” which remorselessly attacks its “victims.” Such a broadly loaded and sensationalist representation, we argue, not only construed dementia as a direful and pernicious disease, but also, crucially, obscured the personal and social contexts in which the syndrome is understood and experienced (not least by people with dementia themselves). This intensely lurid type of representation not only fails to address the ageist misinformation and common misunderstandings that all too commonly surround dementia, but is also likely to exacerbate the stress and depression frequently experienced by people with dementia and their families

Systematic review of EASY-care needs assessment for community-dwelling older people

Background: Undertaking comprehensive geriatric assessments (CGAs) combined with long-term health and social care management can improve the quality of life of older people [ 1]. The EASY-Care tool is a CGA instrument designed for assessing the physical, mental and social functioning and unmet health and social needs of older people in community settings or primary care. It has also been used as a frailty assessment tool and for gathering population-level data. Objective: To review the evidence of reliability, validity and acceptability of EASY-Care and its appropriateness for assessing the needs of community-dwelling older people. Methods: Systematic search of literature databases using pre-defined search terms (January 1994—May 2014) for English language articles reporting on the reliability, validity, acceptability and implementation of EASY-Care in primary care and community settings. Eligible articles were critically reviewed. Discussion papers mapping professionals' use of the tool were also included as these could be considered an aspect of validity. Results: Twenty-nine papers met the inclusion criteria and underwent data extraction. A narrative synthesis was performed, because there was a variety of quantitative and qualitative outcomes and characteristics. Reliability evidence for EASY-Care is minimal. Evidence for validity is good, and it has received numerous positive endorsements of acceptability in international settings from older people and practitioners. Conclusion: Evidence supports the use of EASY-Care for individual needs assessment; further research is needed for other uses. Of the papers that made statements about who should administer EASY-Care, the majority indicated that nurses were preferable to self-completion

Quality improvement in long term care settings: a scoping review of effective strategies used in care homes

The file attached to this record is the author's final peer reviewed version.Purpose We conducted a scoping review of quality improvement in care homes. We aimed to identify participating occupational groups and methods for evaluation. Secondly, we aimed to describe resident-level interventions and which outcomes were measured. Methods Following extended PRISMA guideline for scoping reviews, we conducted systematic searches of Medline, CINAHL, Psychinfo, ASSIA (2000-2019). Furthermore, we searched systematic reviews databases including Cochrane Library and JBI, and the grey literature database, Greylit. Four co-authors contributed to selection and data extraction. Results 65 studies were included, 6 of which had multiple publications (75 articles overall). A range of quality improvement strategies were implemented, including audit-feedback and quality improvement collaboratives. Methods consisted of controlled trials, quantitative time series and qualitative interview and observational studies. Process evaluations, involving staff of various occupational groups, described experiences and implementation measures. Many studies measured resident-level outputs and health outcomes. 14 studies reported improvements to a clinical measure, however four of these articles were of low quality. Larger randomized controlled studies did not show statistically significant benefits to resident health outcomes. Conclusion In care homes, quality improvement has been applied with several different strategies, being evaluated by a variety of measures. In terms of measuring benefits to residents, process outputs and health outcomes have been reported. There was no pattern of which quality improvement strategy was used for which clinical problem. Further development of reporting of quality improvement projects and outcomes could facilitate implementation