An Investigation of the Processes of Confirmation and Certification of Coronary Heart Disease Deaths in Glasgow

Coronary mortality rates for men and women in Glasgow are amongst the highest in the world. Recent studies have questioned the reliability of published mortality data. This study describes the process of death certification in Glasgow, indicating the diverse ways in which deaths occurring in a variety of circumstances are processed by a variety.of types of person so that a death certificate can be issued. The study uses this information to assess the reliability of the coronary mortality data in a manner similiar to "validity exercises" carried out elsewhere, except that the results are presented in an operational and social context. Finally, the study discusses possible measures which might be taken to improve the reliability of the coronary mortality data

The consumer challenge in the NHS: The development and application of new approaches to obtain and compare lay and professional views on the quality and need for services

Abstract Not Provided

The Asset-based Collaborative Working model (ACW model): pragmatic action research in healthcare service development

Embedding researchers in clinical practice may not be an obvious consideration in asset-constrained healthcare settings. However, with increasing calls for best practice and value-for-money, understanding what works, for whom and why, is of paramount importance. This article illustrates how a researcher embedded in a healthcare professional group not only facilitated a service development within existing resources, but also enabled the group to identify relevant theories, and their interrelationships, underpinning the group's actions during the developmental process. This resulted in the construction of a new theoretical model, the Asset-based Collaborative Working model. This research suggests that embedding research in service development is feasible and can result in substantive learning and an understanding of group working which is required in contemporary healthcare provision. While developed in the clinical field of lymphoedema, the Asset-based Collaborative-Working model may be applicable in other care settings

The Asset-based Collaborative Working model (ACW model): pragmatic action research in healthcare service development

Embedding researchers in clinical practice may not be an obvious consideration in asset-constrained healthcare settings. However, with increasing calls for best practice and value-for-money, understanding what works, for whom and why, is of paramount importance. This article illustrates how a researcher embedded in a healthcare professional group not only facilitated a service development within existing resources, but also enabled the group to identify relevant theories, and their interrelationships, underpinning the group's actions during the developmental process. This resulted in the construction of a new theoretical model, the Asset-based Collaborative Working model. This research suggests that embedding research in service development is feasible and can result in substantive learning and an understanding of group working which is required in contemporary healthcare provision. While developed in the clinical field of lymphoedema, the Asset-based Collaborative-Working model may be applicable in other care settings

Development of the Lymphoedema Genito-Urinary Cancer Questionnaire

The aim of this study was to develop a patient self-report tool to detect symptoms of genital and lower limb lymphoedema in male survivors of genitourinary cancer. The study incorporated the views of patients and subject specialists (lymphoedema and urology) in the design of a patient questionnaire based on the literature. Views on comprehensiveness, relevance of content, ease of understanding and perceived acceptability to patients were collated. The findings informed the development of the next iteration of the questionnaire. The overall view of participants was that the development and application of such a tool was of great clinical value and the Lymphoedema Genito- Urinary Cancer Questionnaire (LGUCQ) has significant potential for further development as a research tool to inform prevalence of this under-reported condition

Randomisation before consent : avoiding delay to time-critical intervention and ensuring informed consent

Peer reviewedPostprin

Measuring empathic, person-centred communication in primary care nurses:validity and reliability of the Consultation and Relational Empathy (CARE) Measure

Background Empathic patient-centred care is central to high quality health encounters. The Consultation and Relational Empathy (CARE) Measure is a patient-rated experience measure of the interpersonal quality of healthcare encounters. The measure has been extensively validated and is widely used by doctors in primary care but has not been validated in nursing. This study assessed the validity and reliability of the CARE Measure in routine nurse consultations in primary care. Methods Seventeen nurses from nine general medical practices located in three Scottish Health Boards participated in the study. Consecutive patients (aged 16 years or older) were asked to self-complete a questionnaire containing the CARE Measure immediately after their clinical encounter with the nurse. Statistical analysis included Spearman’s correlation and principal component analysis (construct validity), Cronbach’s alpha (internal consistency), and Generalisability theory (inter-rater reliability). Results A total of 774 patients (327 male and 447 female) completed the questionnaire. Almost three out of four patients (73 %) felt that the CARE Measure items were very important to their current consultation. The number of ‘not applicable’ responses and missing values were low overall (5.7 and 1.6 % respectively). The mean CARE Measure score in the consultations was 45.9 and 48 % achieved the maximum possible score of 50. CARE Measure scores correlated in predicted ways with overall satisfaction and patient enablement in support of convergent and divergent validity. Factor analysis found that the CARE Measure items loaded highly onto a single factor. The measure showed high internal consistency (Cronbach’s alpha coefficient = 0.97) and acceptable inter-rater reliability (G = 0.6 with 60 patients ratings per nurse). The scores were not affected by patients’ age, gender, self-perceived overall health, living arrangements, employment status or language spoken at home. Conclusions The CARE Measure has high face and construct validity, and internal reliability in nurse consultations in primary care. Its ability to discriminate between nurses is sufficient for educational and quality improvement purposes

Multimorbidity and socioeconomic deprivation in primary care consultations

Purpose: The influence of multimorbidity on the clinical encounter is poorly understood, especially in areas of high socioeconomic deprivation where burdensome multimorbidity is concentrated. The aim of the current study was to examine the effect of multimorbidity on general practice consultations, in areas of high and low deprivation. Methods: We conducted secondary analyses of 659 video-recorded routine consultations involving 25 general practitioners (GPs) in deprived areas and 22 in affluent areas of Scotland. Patients rated the GP’s empathy using the Consultation and Relational Empathy (CARE) measure immediately after the consultation. Videos were analyzed using the Measure of Patient-Centered Communication. Multilevel, multi-regression analysis identified differences between the groups. Results: In affluent areas, patients with multimorbidity received longer consultations than patients without multimorbidity (mean 12.8 minutes vs 9.3, respectively; P = .015), but this was not so in deprived areas (mean 9.9 minutes vs 10.0 respectively; P = .774). In affluent areas, patients with multimorbidity perceived their GP as more empathic (P = .009) than patients without multimorbidity; this difference was not found in deprived areas (P = .344). Video analysis showed that GPs in affluent areas were more attentive to the disease and illness experience in patients with multimorbidity (P < .031) compared with patients without multimorbidity. This was not the case in deprived areas (P = .727). Conclusions: In deprived areas, the greater need of patients with multimorbidity is not reflected in the longer consultation length, higher GP patient centeredness, and higher perceived GP empathy found in affluent areas. Action is required to redress this mismatch of need and service provision for patients with multimorbidity if health inequalities are to be narrowed rather than widened by primary care

The development and optimisation of a primary care-based whole system complex intervention (CARE Plus) for patients with multimorbidity living in areas of high socioeconomic deprivation

<B>OBJECTIVES</B> To develop and optimise a primary care-based complex intervention (CARE Plus) to enhance the quality of life of patients with multimorbidity in the deprived areas. <B>METHODS</B> Six co-design discussion groups involving 32 participants were held separately with multimorbid patients from the deprived areas, voluntary organisations, general practitioners and practice nurses working in the deprived areas. This was followed by piloting in two practices and further optimisation based on interviews with 11 general practitioners, 2 practice nurses and 6 participating multimorbid patients. <B>RESULTS</B> Participants endorsed the need for longer consultations, relational continuity and a holistic approach. All felt that training and support of the health care staff was important. Most participants welcomed the idea of additional self-management support, though some practitioners were dubious about whether patients would use it. The pilot study led to changes including a revised care plan, the inclusion of mindfulness-based stress reduction techniques in the support of practitioners and patients, and the stream-lining of the written self-management support material for patients. <B>DISCUSSION</B> We have co-designed and optimised an augmented primary care intervention involving a whole-system approach to enhance quality of life in multimorbid patients living in the deprived areas. CARE Plus will next be tested in a phase 2 cluster randomised controlled trial

Implementing social prescribing in primary care in areas of high socioeconomic deprivation:process evaluation of the ‘Deep End’ community links worker programme

Background: Social prescribing involving primary care-based ‘link workers’ is a key UK health policy which aims to reduce health inequalities. However, the process of implementation of the link worker approach has received little attention despite this being central to desired impact and outcomes. Aim: Our objective was to explore the implementation process of such an approach in practice. Design and Setting: Qualitative process evaluation of the ‘Deep End’ Links Worker Programme (LWP) over a two-year period, in seven general practices in deprived areas of Glasgow. Methods: We used thematic analysis to identify the extent of LWP integration in each practice and key factors associated with implementation. Analysis was informed by Normalisation Process Theory. Results: Only three of the seven practices fully integrated the LWP into routine practice within two years, based on NPT constructs of coherence, cognitive participation, and collective action. Compared to ‘Partially Integrated Practices’, ‘Fully Integrated Practices’ had better shared understanding of the programme among staff, higher staff engagement with LWP, and were implementing all aspects of LWP at patient, practice and community levels of intervention. Successful implementation was associated with GP buy-in, collaborative leadership, good team dynamics, link worker support, and the absence of competing innovations. Conclusions: Even in a well-resourced government funded programme, the majority of practices involved had not fully integrated the LWP within the first two years. Implementing social prescribing and link workers within primary care at scale is unlikely to be a ‘quick fix’ for mitigating health inequalities in deprived areas