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Jeddian A, Lindenmeyer A, Marshall T, Howard A, Sayadi L, Rashidian A, Jafari N. Implementation of a critical care outreach service: a qualitative study. Int Nurs Rev 2017; 64:353-362. [DOI: 10.1111/inr.12377] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- A. Jeddian
- Digestive Disease Research Institute; Tehran University of Medical Sciences; Tehran Iran
| | - A. Lindenmeyer
- Qualitative Methods; Institute of Applied Health Research; University of Birmingham; Birmingham UK
| | - T. Marshall
- Public Health & Primary Care; Institute of Applied Health Research; University of Birmingham; Birmingham UK
| | - A.F. Howard
- School of Nursing; The University of British Columbia; Vancouver BC Canada
| | - L. Sayadi
- School of Nursing and Midwifery; Nursing & Midwifery Care Research Center Tehran University of Medical Sciences; Tehran Iran
| | - A. Rashidian
- School of Public Health; Tehran University of Medical Sciences; Tehran Iran
| | - N. Jafari
- Digestive Disease Research Institute; Tehran University of Medical Sciences; Tehran Iran
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Sheppard JP, Lindenmeyer A, Mellor RM, Greenfield S, Mant J, Quinn T, Rosser A, Sandler D, Sims D, Ward M, McManus RJ. Prevalence and predictors of hospital prealerting in acute stroke: a mixed methods study. Emerg Med J 2016; 33:482-8. [PMID: 26949969 PMCID: PMC4941194 DOI: 10.1136/emermed-2014-204392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 12/26/2015] [Indexed: 01/12/2023]
Abstract
Background Thrombolysis can significantly reduce the burden of stroke but the time window for safe and effective treatment is short. In patients travelling to hospital via ambulance, the sending of a ‘prealert’ message can significantly improve the timeliness of treatment. Objective Examine the prevalence of hospital prealerting, the extent to which prealert protocols are followed and what factors influence emergency medical services (EMS) staff's decision to send a prealert. Methods Cohort study of patients admitted to two acute stroke units in West Midlands (UK) hospitals using linked data from hospital and EMS records. A logistic regression model examined the association between prealert eligibility and whether a prealert message was sent. In semistructured interviews, EMS staff were asked about their experiences of patients with suspected stroke. Results Of the 539 patients eligible for this study, 271 (51%) were recruited. Of these, only 79 (29%) were eligible for prealerting according to criteria set out in local protocols but 143 (53%) were prealerted. Increasing number of Face, Arm, Speech Test symptoms (1 symptom, OR 6.14, 95% CI 2.06 to 18.30, p=0.001; 2 symptoms, OR 31.36, 95% CI 9.91 to 99.24, p<0.001; 3 symptoms, OR 75.84, 95% CI 24.68 to 233.03, p<0.001) and EMS contact within 5 h of symptom onset (OR 2.99, 95% CI 1.37 to 6.50 p=0.006) were key predictors of prealerting but eligibility for prealert as a whole was not (OR 1.92, 95% CI 0.85 to 4.34 p=0.12). In qualitative interviews, EMS staff displayed varying understanding of prealert protocols and described frustration when their interpretation of the prealert criteria was not shared by ED staff. Conclusions Up to half of the patients presenting with suspected stroke in this study were prealerted by EMS staff, regardless of eligibility, resulting in disagreements with ED staff during handover. Aligning the expectations of EMS and ED staff, perhaps through simplified prealert protocols, could be considered to facilitate more appropriate use of hospital prealerting in acute stroke.
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Affiliation(s)
- J P Sheppard
- Nuffield Department of Primary Care Health Sciences, NIHR School for Primary Care Research, University of Oxford, Oxford, Oxfordshire, UK
| | - A Lindenmeyer
- Primary Care Clinical Sciences, NIHR School for Primary Care Research, University of Birmingham, Birmingham, West Midlands, UK
| | - R M Mellor
- Department of Public Health, NHS Lanarkshire, Bothwell, UK
| | - S Greenfield
- Department of Public Health, NHS Lanarkshire, Bothwell, UK
| | - J Mant
- Primary Care Unit, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - T Quinn
- Faculty of Health, Social Care and Education, St George's, University of London & Kingston University, London, UK
| | - A Rosser
- West Midlands Ambulance Service NHS Trust, Regional Ambulance Headquarters, Dudley, West Midlands, UK
| | - D Sandler
- Heart of England NHS Foundation Trust, Birmingham, West Midlands, UK
| | - D Sims
- Queen Elizabeth Hospital Birmingham Elderly Care, University Hospitals Birmingham NHS Foundation Trust, Birmingham, West Midlands, UK
| | - M Ward
- West Midlands Ambulance Service NHS Trust, Regional Ambulance Headquarters, Dudley, West Midlands, UK
| | - R J McManus
- Nuffield Department of Primary Care Health Sciences, NIHR School for Primary Care Research, University of Oxford, Oxford, Oxfordshire, UK
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Hearnshaw H, Lindenmeyer A, Vermeire E, Van Royen P, Wens J, Biot Y. Interventions to improve adherence to medication in people with type 2 diabetes mellitus: the role of nurses. ACTA ACUST UNITED AC 2015. [DOI: 10.1002/edn.47] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Hipwell AE, Sturt J, Lindenmeyer A, Stratton I, Gadsby R, O'Hare P, Scanlon PH. Attitudes, access and anguish: a qualitative interview study of staff and patients' experiences of diabetic retinopathy screening. BMJ Open 2014; 4:e005498. [PMID: 25510885 PMCID: PMC4267079 DOI: 10.1136/bmjopen-2014-005498] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To examine the experiences of patients, health professionals and screeners; their interactions with and understandings of diabetic retinopathy screening (DRS); and how these influence uptake. DESIGN Purposive, qualitative design using multiperspectival, semistructured interviews and thematic analysis. SETTING Three UK Screening Programme regions with different service-delivery modes, minority ethnic and deprivation levels across rural, urban and inner-city areas, in general practitioner practices and patients' homes. PARTICIPANTS 62 including 38 patients (22 regular-screening attenders, 16 non-regular attenders) and 24 professionals (15 primary care professionals and 9 screeners). RESULTS Antecedents to attendance included knowledge about diabetic retinopathy and screening; antecedents to non-attendance included psychological, pragmatic and social factors. Confusion between photographs taken at routine eye tests and DRS photographs was identified. The differing regional invitation methods and screening locations were discussed, with convenience and transport safety being over-riding considerations for patients. Some patients mentioned significant pain and visual disturbance from mydriasis drops as a deterrent to attendance. CONCLUSIONS In this, the first study to consider multiperspectival experiential accounts, we identified that proactive coordination of care involving patients, primary care and screening programmes, prior to, during and after screening is required. Multiple factors, prior to, during and after screening, are involved in the attendance and non-attendance for DRS. Further research is needed to establish whether patient self-management educational interventions and the pharmacological reformulation of shorter acting mydriasis drops, may improve uptake of DRS. This might, in turn, reduce preventable vision loss and its associated costs to individuals and their families, and to health and social care providers, reducing current inequalities.
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Affiliation(s)
- A E Hipwell
- CLAHRC-WM, Warwick Business School, University of Warwick, Coventry, UK
| | - J Sturt
- Florence Nightingale School of Nursing and Midwifery, King's College London, London, UK
| | - A Lindenmeyer
- Department of Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - I Stratton
- Gloucester Diabetic Retinopathy Research Group, Cheltenham General Hospital, Gloucester, UK
| | - R Gadsby
- Warwick Medical School Education & Development, University of Warwick, Coventry, UK
| | - P O'Hare
- Division of Metabolic & Vascular Health, Warwick Medical School, University of Warwick, Coventry, UK
| | - P H Scanlon
- Diabetic Retinopathy Screening Programme (England), Gloucestershire Eye Unit and Oxford Eye Hospital, Cheltenham General Hospital, Gloucester, UK
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Abstract
BACKGROUND People with type 2 diabetes have an increased risk of oral health problems; however, oral health is currently not included in structured diabetes reviews and education in the UK. AIM AND OBJECTIVES This study explores the patient's experience related to oral health and diabetes, especially in relation to: • Awareness of the link between oral health and diabetes and oral self-care needs. • Interaction with health professionals in dental and general practice. • Preferences for receiving oral health information and education. Methods This nested qualitative study involved semi-structured telephone interviews with a purposive sample of 20 participants from a questionnaire study on oral health awareness in patients with diabetes. Interview transcripts were analysed using a thematic framework approach. RESULTS Participants were mostly unaware of the link between oral health and diabetes. Those that had been made aware by a health professional were not given concrete self-care advice. Interactions with dental professionals were often limited to informing the dental practice of their diagnosis and current medication. Most participants were in favour of dentists screening for diabetes, but as their general practice was the hub for diabetes care, they felt GPs or nurses should provide oral health information and discuss oral health with patients. CONCLUSIONS Written information regarding diabetes and its possible effects on oral health needs to be more readily available to people with diabetes, especially at diagnosis. There may be a place for introducing a structured oral health question in routine diabetes reviews.
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Affiliation(s)
- A Lindenmeyer
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK.
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Dale J, Caramlau I, Lindenmeyer A, Williams SM. Peer support telephone call interventions for improving health. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2008. [DOI: 10.1002/14651858.cd006903] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lindenmeyer A, Hearnshaw H, Vermeire E, Van Royen P, Wens J, Biot Y. Interventions to improve adherence to medication in people with type 2 diabetes mellitus: a review of the literature on the role of pharmacists. J Clin Pharm Ther 2006; 31:409-19. [PMID: 16958818 DOI: 10.1111/j.1365-2710.2006.00759.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Pharmacists are now adopting a crucial role in the management of chronic illness in primary care, providing diabetes care and advice. This review aims to show whether a range of diabetes care interventions delivered by pharmacists is successful in improving adherence to medication. METHODS The studies reviewed formed a subgroup of a Cochrane review on interventions to improve adherence to medication in people with type 2 diabetes. Search terms were 'type 2 diabetes mellitus' and 'compliance' or 'adherence'. Studies were included if they assessed adherence to medical treatment specifically, rather than other aspects of self-management. Out of the 21 studies selected for review, five described an intervention delivered by a pharmacist. RESULTS AND DISCUSSION Two studies reported on attempts to improve adherence focused on the taking of medication. A system of reminders and packaging improved medication adherence, but measuring medicine taking through pill counts or Medication Event Monitoring System was not effective. Three studies evaluated pharmacist-led integrated management and education programmes designed to improve glycaemic control for under-served patient populations. They all succeeded in lowering glycated haemoglobin, but it remains unclear whether this resulted from improved patient adherence. CONCLUSION This review indicates a potential benefit of pharmacist interventions to improve medication adherence in diabetes, especially in providing patient education.
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Affiliation(s)
- A Lindenmeyer
- Centre for Primary Health Care Studies, Warwick Medical School, University of Warwick Coventry, UK.
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Abstract
AIMS In order to measure the effectiveness of interventions claiming to improve adherence in diabetes, valid measurement of adherence is necessary. Any measurement must first be based on a definition. This study aimed to identify and categorize definitions and measurements of adherence in living with diabetes, from a review of the literature. METHODS Publications were identified from the medline database. Adherence, compliance and concordance were used as terms in the search algorithm, along with diabetes, diabetes mellitus and treatment. Two hundred and ninety-three papers were identified. Abstracts of these papers were read by two researchers independently. Two hundred and thirty-nine papers did not contain definitions or measures of adherence and were discarded. Of the remaining 54 papers, 26 included definitions and 46 described measurements of adherence. RESULTS Definitions and measurements fell into five categories: coincidence of behaviour with professional advice, relationship as part of the process of care, outcome and process targets, taking the medication as prescribed and others. No single definition of adherence emerged. Many authors did not provide definitions of adherence. Glycated haemoglobin was the most common measurement of adherence, although this can raise problems. CONCLUSIONS Research which claims to show an intervention has, or has not, improved adherence must be interpreted cautiously. Interventions which appear to fail may actually succeed in aspects of adherence which were not defined or measured in the study. Clinicians and researchers could use clear definitions and measurements, such as the ones presented in this review.
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Affiliation(s)
- H Hearnshaw
- Warwick Diabetes Care, Warwick Medical School, University of Warwick, Warwick, UK.
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Vermeire E, Wens J, Van Royen P, Biot Y, Hearnshaw H, Lindenmeyer A. Interventions for improving adherence to treatment recommendations in people with type 2 diabetes mellitus. Cochrane Database Syst Rev 2005; 2005:CD003638. [PMID: 15846672 PMCID: PMC9022438 DOI: 10.1002/14651858.cd003638.pub2] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Research suggests adherence to treatment recommendations is low. In type 2 diabetes, which is a chronic condition slowly leading to serious vascular, nephrologic, neurologic and ophthalmological complications, it can be assumed that enhancing adherence to treatment recommendations may lead to a reduction of complications. Treatment regimens in type 2 diabetes are complicated, encompassing life-style adaptations and medication intake. OBJECTIVES To assess the effects of interventions for improving adherence to treatment recommendations in people with type 2 diabetes mellitus. SEARCH STRATEGY Studies were obtained from searches of multiple electronic bibliographic databases supplemented with hand searches of references. Date of last search: November 2002. SELECTION CRITERIA Randomised controlled and controlled clinical trials, before-after studies and epidemiological studies, assessing changes in adherence to treatment recommendations, as defined in the objectives section, were included. DATA COLLECTION AND ANALYSIS Two teams of reviewers independently assessed the trials identified for inclusion. Three teams of two reviewers assessed trial quality and extracted data. The analysis for the narrative part was performed by one reviewer (EV), the meta-analysis by two reviewers (EV, JW). MAIN RESULTS Twentyone studies assessing interventions aiming at improving adherence to treatment recommendations, not to diet or exercise recommendations, in people living with type 2 diabetes in primary care, outpatient settings, community and hospital settings, were included. Outcomes evaluated in these studies were heterogeneous, there was a variety of adherence measurement instruments. Nurse led interventions, home aids, diabetes education, pharmacy led interventions, adaptation of dosing and frequency of medication taking showed a small effect on a variety of outcomes including HbA1c. No data on mortality and morbidity, nor on quality of life could be found. AUTHORS' CONCLUSIONS Current efforts to improve or to facilitate adherence of people with type 2 diabetes to treatment recommendations do not show significant effects nor harms. The question whether any intervention enhances adherence to treatment recommendations in type 2 diabetes effectively, thus still remains unanswered.
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Affiliation(s)
- E Vermeire
- Centre for General Practice, University of Antwerp, Belgium, Universiteitsplein 1, Antwerpen, Belgium, 2610.
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