Barriers and enablers of integrated care in the UK: a rapid evidence review of review articles and grey literature 2018-2022

Reconfiguring Pain Interpretation Within a Social Model of Health Using a Simplified Version of Wilber's All Quadrant All Levels Framework: An Integral Vision

Despite the proliferation of biomedical and psychological treatments, the global burden of chronic intractable (long-term) pain remains high-a treatment-prevalence paradox. The biopsychosocial model, introduced in the 1970s, is central to strategies for managing pain, but has been criticised for being decontextualised and fragmented, compromising the effectiveness of healthcare pain support services and patient care. The aim of this study was to apply a simplified version of Ken Wilber's All Quadrant All Levels (AQAL) framework to pain in a healthcare context to advance a biopsychosocial understanding. Utilising domain knowledge, the author mapped features of pain and coping to intrasubjective, intraobjective, intersubjective, and interobjective quadrants (perspectives), as well as levels of psychological development. Narratives were crafted to synthesize the findings of mapping with literature from diverse disciplines within the contexts of salutogenesis and a social model of health. The findings showed that AQAL-mapping enhanced contextual biopsychosocial coherence and exposed the conceptual error of reifying pain. Its utility lay in highlighting upstream influences of the painogenic environment, supporting the reconfiguration of pain within a social model of health, as exemplified by the UK's Rethinking Pain Service. In conclusion, a simple version of the AQAL framework served as a heuristic device to develop an integral vision of pain, opening opportunities for health promotion solutions within a salutogenic context.

Community-Based Health-Social Partnership Programme (C-HSPP) for enhancing self-care management among older adults: protocol for a hybrid effectiveness-implementation trial

BACKGROUND

The global ageing population imposes increasing demands on healthcare and social systems. Integrating the health and social service sectors has been proposed as a preferred solution to support healthy ageing, yet implementation in real settings remains challenging. Using an implementation science framework, this protocol outlines a Type-2 hybrid effectiveness-implementation design to adopt localized strategies for a Community-Based Health-Social Partnership Programme (C-HSPP) and test its effectiveness in enhancing self-care management among older adults in the community.

METHODS

This study has two primary foci: to evaluate both the effectiveness and the implementation outcomes of C-HSPP in a non-governmental organization that operates seven community elderly centres across Hong Kong. A cluster randomized controlled trial (CRCT) with a two-arm, matched-pair, pragmatic design has been adopted to evaluate the programme's effectiveness. Regarding implementation outcomes, the reach, adoption, implementation, and maintenance of the programme will be examined using multiple data sources with quantitative and qualitative data. The trial will include 732 older adults aged 60 or above from four matched pairs of community centres, with each paired centre randomly assigned to either the 12-week C-HSPP intervention or to the usual community services. The C-HSPP intervention features a comprehensive assessment-intervention-evaluation framework using the Omaha System with health-social case management. Data will be collected at three time-points: baseline, post-intervention, and three months post-intervention, with self-efficacy as the primary outcome and other health indicators as secondary outcomes. An effectiveness analysis will be conducted using mixed-effects models and generalized estimating equations, incorporating degrees-of-freedom corrections and adjustments for clustering. Regarding the implementation outcome analysis, quantitative data including service statistics and a satisfaction survey will be presented using descriptive analysis. Qualitative data involving interview transcripts will be analysed using directed content analysis.

DISCUSSION

By simultaneously evaluating both clinical effectiveness and implementation outcomes, this study will validate the evidence-based intervention and identify facilitators and barriers in the implementation process. The findings will support the adoption of an effective evidence-based programme in real-world settings, provide insights on the implementation process to ensure its sustainability, and furnish evidence for policymakers to adopt an integrated health-social partnership programme in the community.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT05621720, First Posted on 2022-11-18.

Interprofessional collaboration across sectors for unemployed refugees with post-traumatic stress disorder in Denmark: a panacea to person-centered care?

Many refugees suffer from post-traumatic stress disorder (PTSD), influenced by traumatic experiences and post-migration stressors, including unemployment. This complexity calls for person-centered care (PCC) and interprofessional collaboration across sectors. In this qualitative study we aimed to understand what refugees and professionals from two sectors value about participating in cross-sector network meetings to coordinate and agree on shared plans for PTSD treatment and assessing employability. We conducted interviews with 24 unemployed refugees, 10 physicians, and 20 municipal employment case workers. Results from our thematic analysis demonstrated that all participants appreciated the value of coordinating care and agreeing on next steps. However, the meetings were not void of power dynamics. The refugees valued the physicians being health advocates and preferred the physicians to explain mental health challenges. Equally, the employment case workers looked to the physicians to validate the experiences of the refugees. The physicians thus played a central role in helping refugee patients and employment case workers come to a mutual understanding and way forward. Our results suggest that interprofessional collaboration across sectors supports PCC by fostering trust-building and holistic understanding. However, PCC is also challenged by interprofessional collaboration due to the validated information and documentation required by organizational practices.

Education of a nurse practitioner in the hospital at home setting: A qualitative study

AIM(S)

To explore barriers, facilitators, and practical implications of educating a nurse practitioner in hospital at home setting from the perspective of the nurse practitioner in training, healthcare professionals, educators, and managers.

BACKGROUND

Hospital at home care is considered promising to deal with current healthcare challenges. Nurse practitioners can have a pivotal role in delivering hospital at home care. Currently there is limited knowledge on education of nurse practitioners in this setting.

DESIGN

A generic qualitative study.

METHODS

Semi-structured interviews were conducted with the nurse practitioner in training, educators, healthcare professionals, and managers working at the hospital or community care organization. The interviews focused on experiences, barriers, and facilitators related to learning and working in the hospital at home setting. Data were coded and thematised.

RESULTS

The following six themes emerged: 1) Provide care aligned with the patient's journey; 2) Articulating a clear vision on training in the hospital at home setting; 3) Integrated learning and working requires a wide range of competencies; 4) Integrated learning requires a coherent and motivated team; 5) Practical obstacles require a pragmatic approach; and 6) Clarity on the positioning of nurse practitioners is essential.

CONCLUSIONS

The findings show that an educational trajectory for a nurse practitioner in a hospital at home setting can be successfully established. Various factors were identified that need to be considered in the development and executing of such learning trajectory. Organizations are recommended to take shared responsibility for these learning trajectories.

REPORTING METHOD

EQUATOR guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Use of commercial WAMs for monitoring individual with lung cancer. A systematic review

This systematic review explored the feasibility and impact of interventions using commercial activity monitors to track physical activity and health-related outcomes during lung cancer treatment. Inclusion criteria focused on studies involving commercially available activity trackers that provided monitoring feedback to lung cancer patients. The devices selected were popular models, including Fitbit, Garmin, Apple, Samsung, and Polar. Studies assessing the reliability or validity of these trackers, as well as qualitative studies, protocols, non-English publications, and those featuring non-commercial devices, were excluded. Additionally, studies incorporating physical activity with other interventions (e.g., robotic surgery) were excluded if exercise outcomes could not be analysed independently. Searches were conducted across various electronic databases, including the Cochrane Database of Systematic Reviews, CINAHL Complete®, Science Citation Index, Google Scholar, Scopus, IEEE Xplore, and PubMed, covering the period from January 2000 to November 2023. The quality of the studies was assessed using the Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I) and the Risk of Bias in Randomised Trials (RoB 2.0) tools. Twelve studies met the inclusion criteria, utilising commercial wearable technology for monitoring lung cancer patients over an average of 6.3 ± 4.7 weeks. A key limitation of this review was the wide variation in how interventions were implemented across studies. Yet, the interventions significantly improved daily activity levels and intensity, quality of life, psychological impact, and physical function compared to usual care. These monitors show promise in predicting, monitoring, and detecting physical activity, motivating patients, and aiding in recovery. However, limitations exist, and further evidence is needed to confirm their efficacy as primary monitoring tools in lung cancer treatment.

Successes and challenges of partnership working to tackle health inequalities using collaborative approaches to community-based research: mixed methods analysis of focus group evidence

BACKGROUND

The concept of collaborative approaches involves community residents in joint decision-making processes to maintain or enhance their material and social conditions. During COVID-19, public services saw the benefits of actively collaborating with communities and involving residents in decision-making processes. As communities have resources and assets, they are well-placed to contribute to developing local health and wellbeing initiatives. An interdisciplinary and nationally funded three-phase research programme, "Mobilising community assets to tackle health inequalities", was established with the objective of utilising local, cultural, and natural assets to support health and wellbeing. The current study aimed to synthesise evidence collected by research teams awarded funding in phase one of the programme, comprising academic and non-academic, health and social care, voluntary and community partners.

METHODS

Ten online focus groups were conducted with research teams from across the UK exploring the successes and challenges of partnership working to tackle health inequalities using collaborative approaches to community-based research. Eight focus group questions were split between partnership working and health inequalities.

RESULTS

Thematic and content analysis produced 185 subthemes from which 12 themes were identified. Major themes representing an above average number of coded responses were research evidence; funding; relationships with partners; health inequalities and deprivation; community involvement; and health service and integrated care systems. Minor themes were link workers and social prescribing; training and support; place-based factors; longevity of programmes; setting up and scaling up programmes; and mental health.

CONCLUSIONS

Successes included employing practice-based and arts-based methods, being part of a research project for those not normally involved in research, sharing funding democratically, building on established relationships, and the vital role that local assets play in involving communities. Challenges involved a lack of sustainable financial support, the short-term nature of funding, inconsistencies in reaching the poorest people, obtaining the right sort of research evidence, making sufficient research progress, building relationships with already over-burdened health care staff, and redressing the balance of power in favour of communities. Despite the challenges, participants were mainly optimistic that collective approaches and meaningful co-production would create opportunities for future research partnerships with communities.