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Michelet F, Smyth M, Lall R, Noordali H, Starr K, Berridge L, Yeung J, Fuller G, Petrou S, Walker A, Mark J, Canaway A, Khan K, Perkins GD. Randomised controlled trial of analgesia for the management of acute severe pain from traumatic injury: study protocol for the paramedic analgesia comparing ketamine and morphine in trauma (PACKMaN). Scand J Trauma Resusc Emerg Med 2023; 31:84. [PMID: 38001541 PMCID: PMC10668487 DOI: 10.1186/s13049-023-01146-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Prehospital analgesia is often required after traumatic injury, currently morphine is the strongest parenteral analgesia routinely available for use by paramedics in the United Kingdom (UK) when treating patients with severe pain. This protocol describes a multi-centre, randomised, double blinded trial comparing the clinical and cost-effectiveness of ketamine and morphine for severe pain following acute traumatic injury. METHODS A two arm pragmatic, phase III trial working with two large NHS ambulance services, with an internal pilot. Participants will be randomised in equal numbers to either (1) morphine or (2) ketamine by IV/IO injection. We aim to recruit 446 participants over the age of 16 years old, with a self-reported pain score of 7 or above out of 10. Randomised participants will receive a maximum of 20 mg of morphine, or a maximum of 30 mg of ketamine, to manage their pain. The primary outcome will be the sum of pain intensity difference. Secondary outcomes measure the effectiveness of pain relief and overall patient experience from randomisation to arrival at hospital as well as monitoring the adverse events, resource use and cost-effectiveness outcomes. DISCUSSION The PACKMAN study is the first UK clinical trial addressing the clinical and cost-effectiveness of ketamine and morphine in treating acute severe pain from traumatic injury treated by NHS paramedics. The findings will inform future clinical practice and provide insights into the effectiveness of ketamine as a prehospital analgesia. TRIAL REGISTRATION ISRCTN, ISRCTN14124474. Registered 22 October 2020, https://www.isrctn.com/ISRCTN14124474.
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Affiliation(s)
- F Michelet
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.
| | - M Smyth
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - R Lall
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - H Noordali
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - K Starr
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - L Berridge
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - J Yeung
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
- Critical Care Directorate, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - G Fuller
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - S Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - A Walker
- West Midlands Ambulance Services NHS Trust, Brierley Hill, Dudley, UK
| | - J Mark
- Yorkshire Ambulance Services NHS Trust, Wakefield, UK
| | - A Canaway
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - K Khan
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - G D Perkins
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
- Critical Care Directorate, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Appleton R, Canaway A, Tuomainen H, Dieleman G, Gerritsen S, Overbeek M, Maras A, van Bodegom L, Franić T, de Girolamo G, Madan J, McNicholas F, Purper-Ouakil D, Schulze UME, Tremmery S, Singh SP. Predictors of transitioning to adult mental health services and associated costs: a cross-country comparison. BMJ Ment Health 2023; 26:e300814. [PMID: 37879676 PMCID: PMC10603405 DOI: 10.1136/bmjment-2023-300814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/20/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Young people are at risk of falling through the care gap after leaving child and adolescent mental health services (CAMHS) despite an ongoing need for mental health support. Currently, little is known about the predictors of transitioning to adult mental health services (AMHS), and associated healthcare and societal costs as young people cross the transition boundary. OBJECTIVE To conduct a secondary data analysis exploring predictors of transitioning or falling through the gap and associated costs. METHODS Data were used from a longitudinal study, which followed young people from seven European countries for 2 years after reaching their CAMHS boundary. Predictors of transitioning (including sociodemographic and clinical variables) and longitudinal resource use were compared for 488 young people who transitioned to AMHS versus those who fell through the gap. FINDINGS Young people were more likely to transition to AMHS if they were severely ill. Those from Italy, the Netherlands and the UK were more likely to fall through the gap than transition to AMHS. Healthcare costs fell for all young people over the study, with a sharper decrease for those who fell through the gap. CONCLUSIONS Total healthcare costs fell for all participants, indicating that the intensity of mental health support reduces for all young people as they cross the CAMHS boundary, regardless of clinical need. CLINICAL IMPLICATIONS It is important that alternative forms of mental health support are available for young people who do not meet the AMHS care threshold but still have mental health needs after leaving CAMHS.
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Affiliation(s)
| | | | | | - Gwen Dieleman
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Suzanne Gerritsen
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Mathilde Overbeek
- Yulius Academy, Yulius Mental Health Organization, Dordrecht, The Netherlands
- ARQ National Pyschotrauma Centre, Diemen, The Netherlands
- Clinical Child and Family Studies, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Athanasios Maras
- Yulius Academy, Yulius Mental Health Organization, Dordrecht, The Netherlands
- ARQ National Pyschotrauma Centre, Diemen, The Netherlands
| | - Larissa van Bodegom
- Yulius Academy, Yulius Mental Health Organization, Dordrecht, The Netherlands
| | - Tomislav Franić
- Department of Psychiatry, Clinical Hospital Center Split, Split, Croatia
| | - Giovanni de Girolamo
- Unit of Epidemiological Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Jason Madan
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Fiona McNicholas
- Department of Academic Child and Adolescent Psychiatry, University College Dublin, School of Medicine & Medical Science, Dublin, Ireland
- Lucena Child and Adolescent Mental Health Services, St. John of God Community Services, Dublin, Ireland
| | - Diane Purper-Ouakil
- Service de Médecine Psychologique de l'Enfant et de l'Adolescent, Centre Hospitalo-Universitaire de Montpellier, Montpellier, France
- Team PsyDev, CESP U1018, INSERM, Université de Versailles Saint-Quentin-en-Yvelines, University Paris Saclay, Paris, France
| | - Ulrike M E Schulze
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
- Centre for Psychiatry Calw, Böblingen, Germany
| | | | - Swaran P Singh
- Warwick Medical School, University of Warwick, Coventry, UK
- Children and Young People's Mental Health Service, Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
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Canaway A, Appleton R, van Bodegom L, Dieleman G, Franić T, Gerritsen S, de Girolamo G, Maras A, McNicholas F, Overbeek M, Paul M, Purper-Ouakil D, Santosh P, Schulze U, Singh SP, Street C, Tah P, Tremmery B, Tuomainen H, Verhulst FC, Wolke D, Madan J. Healthcare costs for young people transitioning the boundary between child/adolescent and adult mental health services in seven European countries: results from the MILESTONE study. BJPsych Open 2023; 9:e175. [PMID: 37749976 PMCID: PMC10617498 DOI: 10.1192/bjo.2023.559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND The boundary between services for children and adolescents and adults has been identified as problematic for young people with mental health problems. AIMS To examine the use and cost of healthcare for young people engaged in mental healthcare before and after the child/adolescent and adult service boundary. METHOD Data from 772 young people in seven European countries participating in the MILESTONE trial were analysed. We analysed and costed healthcare resources used in the 6-month period before and after the service boundary. RESULTS The proportion of young people engaging with healthcare services fell substantially after crossing the service boundary (associated costs €7761 pre-boundary v. €3376 post-boundary). Pre-boundary, the main cost driver was in-patient care (approximately 50%), whereas post-boundary costs were more evenly spread between services; cost reductions were correlated with pre-boundary in-patient care. Severity was associated with substantially higher costs pre- and post-boundary, and those who were engaged specifically with mental health services after the service boundary accrued the greatest healthcare costs post-service boundary. CONCLUSIONS Costs of healthcare are large in this population, but fall considerably after transition, particularly for those who were most severely ill. In part, this is likely to reflect improvement in the mental health of young people. However, qualitative evidence from the MILESTONE study suggests that lack of capacity in adult services and young people's disengagement with formal mental health services post-transition are contributing factors. Long-term data are needed to assess the adverse long-term effects on costs and health of this unmet need and disengagement.
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Affiliation(s)
- Alastair Canaway
- Centre for Health Economics at Warwick, Warwick Medical School, University of Warwick, UK
| | - Rebecca Appleton
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK
| | - Larissa van Bodegom
- Yulius Academy, Yulius Mental Health Organization, The Netherlands; and Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, The Netherlands
| | - Gwen Dieleman
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, The Netherlands
| | - Tomislav Franić
- Department of Psychiatry, University Hospital Split, Croatia; and School of Medicine, University of Split, Croatia
| | - Suzanne Gerritsen
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, The Netherlands
| | - Giovanni de Girolamo
- Unit of Epidemiological Psychiatry and Evaluation, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Italy
| | - Athanasios Maras
- Yulius Academy, Yulius Mental Health Organization, The Netherlands; and Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, The Netherlands
| | - Fiona McNicholas
- School of Medicine and Medical Science, University College Dublin, Republic of Ireland; and Lucena Child and Adolescent Mental Health Services, St. John of God Community Services, Republic of Ireland
| | - Mathilde Overbeek
- Yulius Academy, Yulius Mental Health Organization, The Netherlands and Clinical Child and Family Studies, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, The Netherlands
| | - Moli Paul
- Warwick Medical School, University of Warwick, UK and Children and Young People’s Mental Health Service, Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - Diane Purper-Ouakil
- Child and Adolescent Psychiatry Unit, Centre Hospitalier Universitaire de Montpellier, Saint Eloi Hospital, France; and Team PsyDev, CESP U1018, INSERM, Université de Versailles Saint-Quentin-en-Yvelines, University Paris Saclay, France
| | - Paramala Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, UK; and HealthTracker Ltd, UK
| | - Ulrike Schulze
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Germany
| | - Swaran P. Singh
- Warwick Medical School, University of Warwick, UK and Children and Young People’s Mental Health Service, Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - Cathy Street
- Warwick Medical School, University of Warwick, UK
| | - Priya Tah
- Warwick Medical School, University of Warwick, UK
| | | | | | - Frank C. Verhulst
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, The Netherlands; and Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Dieter Wolke
- Department of Psychology, University of Warwick, UK
| | - Jason Madan
- Centre for Health Economics at Warwick, Warwick Medical School, University of Warwick, UK
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Singh SP, Tuomainen H, Bouliotis G, Canaway A, De Girolamo G, Dieleman GC, Franić T, Madan J, Maras A, McNicholas F, Paul M, Purper-Ouakil D, Santosh P, Schulze UME, Street C, Tremmery S, Verhulst FC, Wells P, Wolke D, Warwick J. Effect of managed transition on mental health outcomes for young people at the child-adult mental health service boundary: a randomised clinical trial. Psychol Med 2023; 53:2193-2204. [PMID: 37310306 PMCID: PMC10123823 DOI: 10.1017/s0033291721003901] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/03/2021] [Accepted: 09/03/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Poor transition planning contributes to discontinuity of care at the child-adult mental health service boundary (SB), adversely affecting mental health outcomes in young people (YP). The aim of the study was to determine whether managed transition (MT) improves mental health outcomes of YP reaching the child/adolescent mental health service (CAMHS) boundary compared with usual care (UC). METHODS A two-arm cluster-randomised trial (ISRCTN83240263 and NCT03013595) with clusters allocated 1:2 between MT and UC. Recruitment took place in 40 CAMHS (eight European countries) between October 2015 and December 2016. Eligible participants were CAMHS service users who were receiving treatment or had a diagnosed mental disorder, had an IQ ⩾ 70 and were within 1 year of reaching the SB. MT was a multi-component intervention that included CAMHS training, systematic identification of YP approaching SB, a structured assessment (Transition Readiness and Appropriateness Measure) and sharing of information between CAMHS and adult mental health services. The primary outcome was HoNOSCA (Health of the Nation Outcome Scale for Children and Adolescents) score 15-months post-entry to the trial. RESULTS The mean difference in HoNOSCA scores between the MT and UC arms at 15 months was -1.11 points (95% confidence interval -2.07 to -0.14, p = 0.03). The cost of delivering the intervention was relatively modest (€17-€65 per service user). CONCLUSIONS MT led to improved mental health of YP after the SB but the magnitude of the effect was small. The intervention can be implemented at low cost and form part of planned and purposeful transitional care.
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Affiliation(s)
- S. P. Singh
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
- Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - H. Tuomainen
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - G. Bouliotis
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - A. Canaway
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - G. De Girolamo
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - G. C. Dieleman
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - T. Franić
- Department of Psychiatry, Clinical Hospital Center Split, Split, Croatia
| | - J. Madan
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - A. Maras
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, the Netherlands
- Yulius Academy, Rotterdam, the Netherlands
| | - F. McNicholas
- Department of Child and Adolescent Psychiatry, University College Dublin School of Medicine and Medical Science, Dublin, Republic of Ireland
- Geary Institute, University College Dublin, Dublin, Republic of Ireland
- Department of Child Psychiatry, Our Lady's Hospital for Sick Children, Dublin, Republic of Ireland
- Lucena Clinic SJOG, Dublin, Republic of Ireland
| | - M. Paul
- Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - D. Purper-Ouakil
- Centre Hospitalier Universitaire de Montpellier, Saint Eloi Hospital, Unit of Child and Adolescent Psychiatry (MPEA1), Montpellier, France
| | - P. Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD), National and Specialist Child and Adolescent Mental Health Services, Maudsley Hospital, London, UK
- HealthTracker Ltd, Gillingham, UK
| | - U. M. E. Schulze
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - C. Street
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - S. Tremmery
- Department of Neurosciences, Child & Adolescent Psychiatry, University of Leuven, Leuven, Belgium
| | - F. C. Verhulst
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - P. Wells
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - D. Wolke
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
- Department of Psychology, University of Warwick, Coventry, UK
| | - J. Warwick
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
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Bruce J, Mazuquin B, Mistry P, Rees S, Canaway A, Hossain A, Williamson E, Padfield EJ, Lall R, Richmond H, Chowdhury L, Lait C, Petrou S, Booth K, Lamb SE, Vidya R, Thompson AM. Exercise to prevent shoulder problems after breast cancer surgery: the PROSPER RCT. Health Technol Assess 2022; 26:1-124. [PMID: 35220995 DOI: 10.3310/jknz2003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Upper limb problems are common after breast cancer treatment. OBJECTIVES To investigate the clinical effectiveness and cost-effectiveness of a structured exercise programme compared with usual care on upper limb function, health-related outcomes and costs in women undergoing breast cancer surgery. DESIGN This was a two-arm, pragmatic, randomised controlled trial with embedded qualitative research, process evaluation and parallel economic analysis; the unit of randomisation was the individual (allocated ratio 1 : 1). SETTING Breast cancer centres, secondary care. PARTICIPANTS Women aged ≥ 18 years who had been diagnosed with breast cancer and were at higher risk of developing shoulder problems. Women were screened to identify their risk status. INTERVENTIONS All participants received usual-care information leaflets. Those randomised to exercise were referred to physiotherapy for an early, structured exercise programme (three to six face-to-face appointments that included strengthening, physical activity and behavioural change strategies). MAIN OUTCOME MEASURES The primary outcome was upper limb function at 12 months as assessed using the Disabilities of Arm, Hand and Shoulder questionnaire. Secondary outcomes were function (Disabilities of Arm, Hand and Shoulder questionnaire subscales), pain, complications (e.g. wound-related complications, lymphoedema), health-related quality of life (e.g. EuroQol-5 Dimensions, five-level version; Short Form questionnaire-12 items), physical activity and health service resource use. The economic evaluation was expressed in terms of incremental cost per quality-adjusted life-year and incremental net monetary benefit gained from an NHS and Personal Social Services perspective. Participants and physiotherapists were not blinded to group assignment, but data collectors were blinded. RESULTS Between 2016 and 2017, we randomised 392 participants from 17 breast cancer centres across England: 196 (50%) to the usual-care group and 196 (50%) to the exercise group. Ten participants (10/392; 3%) were withdrawn at randomisation and 32 (8%) did not provide complete baseline data. A total of 175 participants (89%) from each treatment group provided baseline data. Participants' mean age was 58.1 years (standard deviation 12.1 years; range 28-88 years). Most participants had undergone axillary node clearance surgery (327/392; 83%) and 317 (81%) had received radiotherapy. Uptake of the exercise treatment was high, with 181 out of 196 (92%) participants attending at least one physiotherapy appointment. Compliance with exercise was good: 143 out of 196 (73%) participants completed three or more physiotherapy sessions. At 12 months, 274 out of 392 (70%) participants returned questionnaires. Improvement in arm function was greater in the exercise group [mean Disabilities of Arm, Hand and Shoulder questionnaire score of 16.3 (standard deviation 17.6)] than in the usual-care group [mean Disabilities of Arm, Hand and Shoulder questionnaire score of 23.7 (standard deviation 22.9)] at 12 months for intention-to-treat (adjusted mean difference Disabilities of Arm, Hand and Shoulder questionnaire score of -7.81, 95% confidence interval -12.44 to -3.17; p = 0.001) and complier-average causal effect analyses (adjusted mean difference -8.74, 95% confidence interval -13.71 to -3.77; p ≤ 0.001). At 12 months, pain scores were lower and physical health-related quality of life was higher in the exercise group than in the usual-care group (Short Form questionnaire-12 items, mean difference 4.39, 95% confidence interval 1.74 to 7.04; p = 0.001). We found no differences in the rate of adverse events or lymphoedema over 12 months. The qualitative findings suggested that women found the exercise programme beneficial and enjoyable. Exercise accrued lower costs (-£387, 95% CI -£2491 to £1718) and generated more quality-adjusted life years (0.029, 95% CI 0.001 to 0.056) than usual care over 12 months. The cost-effectiveness analysis indicated that exercise was more cost-effective and that the results were robust to sensitivity analyses. Exercise was relatively cheap to implement (£129 per participant) and associated with lower health-care costs than usual care and improved health-related quality of life. Benefits may accrue beyond the end of the trial. LIMITATIONS Postal follow-up was lower than estimated; however, the study was adequately powered. No serious adverse events directly related to the intervention were reported. CONCLUSIONS This trial provided robust evidence that referral for early, supported exercise after breast cancer surgery improved shoulder function in those at risk of shoulder problems and was associated with lower health-care costs than usual care and improved health-related quality of life. FUTURE WORK Future work should focus on the implementation of exercise programmes in clinical practice for those at highest risk of shoulder problems. TRIAL REGISTRATION This trial is registered as ISRCTN35358984. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 15. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Julie Bruce
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Bruno Mazuquin
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Pankaj Mistry
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Sophie Rees
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Alastair Canaway
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Anower Hossain
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
- Institute of Statistical Research and Training (ISRT), University of Dhaka, Dhaka, Bangladesh
| | - Esther Williamson
- Centre for Rehabilitation Research, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Emma J Padfield
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Ranjit Lall
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Helen Richmond
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada
| | - Loraine Chowdhury
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Clare Lait
- Gloucestershire Care Services NHS Trust, Gloucester, UK
| | - Stavros Petrou
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Katie Booth
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Sarah E Lamb
- College of Medicine and Health, University of Exeter, Exeter, UK
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6
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Bruce J, Mazuquin B, Canaway A, Hossain A, Williamson E, Mistry P, Lall R, Petrou S, Lamb SE, Rees S, Padfield E, Vidya R, Thompson AM. Exercise versus usual care after non-reconstructive breast cancer surgery (UK PROSPER): multicentre randomised controlled trial and economic evaluation. BMJ 2021; 375:e066542. [PMID: 34759002 PMCID: PMC8579424 DOI: 10.1136/bmj-2021-066542] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate whether a structured exercise programme improved functional and health related quality of life outcomes compared with usual care for women at high risk of upper limb disability after breast cancer surgery. DESIGN Multicentre, pragmatic, superiority, randomised controlled trial with economic evaluation. SETTING 17 UK National Health Service cancer centres. PARTICIPANTS 392 women undergoing breast cancer surgery, at risk of postoperative upper limb morbidity, randomised (1:1) to usual care with structured exercise (n=196) or usual care alone (n=196). INTERVENTIONS Usual care (information leaflets) only or usual care plus a physiotherapy led exercise programme, incorporating stretching, strengthening, physical activity, and behavioural change techniques to support adherence to exercise, introduced at 7-10 days postoperatively, with two further appointments at one and three months. MAIN OUTCOME MEASURES Disability of Arm, Hand and Shoulder (DASH) questionnaire at 12 months, analysed by intention to treat. Secondary outcomes included DASH subscales, pain, complications, health related quality of life, and resource use, from a health and personal social services perspective. RESULTS Between 26 January 2016 and 31 July 2017, 951 patients were screened and 392 (mean age 58.1 years) were randomly allocated, with 382 (97%) eligible for intention to treat analysis. 181 (95%) of 191 participants allocated to exercise attended at least one appointment. Upper limb function improved after exercise compared with usual care (mean DASH 16.3 (SD 17.6) for exercise (n=132); 23.7 (22.9) usual care (n=138); adjusted mean difference 7.81, 95% confidence interval 3.17 to 12.44; P=0.001). Secondary outcomes favoured exercise over usual care, with lower pain intensity at 12 months (adjusted mean difference on numerical rating scale -0.68, -1.23 to -0.12; P=0.02) and fewer arm disability symptoms at 12 months (adjusted mean difference on Functional Assessment of Cancer Therapy-Breast+4 (FACT-B+4) -2.02, -3.11 to -0.93; P=0.001). No increase in complications, lymphoedema, or adverse events was noted in participants allocated to exercise. Exercise accrued lower costs per patient (on average -£387 (€457; $533) (95% confidence interval -£2491 to £1718; 2015 pricing) and was cost effective compared with usual care. CONCLUSIONS The PROSPER exercise programme was clinically effective and cost effective and reduced upper limb disability one year after breast cancer treatment in patients at risk of treatment related postoperative complications. TRIAL REGISTRATION ISRCTN Registry ISRCTN35358984.
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Affiliation(s)
- Julie Bruce
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Bruno Mazuquin
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Alastair Canaway
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Anower Hossain
- Institute of Statistical Research and Training (ISRT), University of Dhaka, Dhaka, Bangladesh
| | - Esther Williamson
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Pankaj Mistry
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Ranjit Lall
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sarah E Lamb
- Institute of Health Research, University of Exeter, Exeter, UK
| | - Sophie Rees
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Emma Padfield
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | | | - Alastair M Thompson
- Department of Surgery, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
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7
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Osborn D, Lamb D, Canaway A, Davidson M, Favarato G, Pinfold V, Harper T, Johnson S, Khan H, Kirkbride J, Lloyd-Evans B, Madan J, Mann F, Marston L, McKay A, Morant N, Smith D, Steare T, Wackett J, Weich S. Acute day units in non-residential settings for people in mental health crisis: the AD-CARE mixed-methods study. Health Serv Deliv Res 2021. [DOI: 10.3310/hsdr09180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
For people in mental health crisis, acute day units provide daily structured sessions and peer support in non-residential settings as an alternative to crisis resolution teams.
Objectives
To investigate the provision, effectiveness, intervention acceptability and re-admission rates of acute day units.
Design
Work package 1 – mapping and national questionnaire survey of acute day units. Work package 2.1 – cohort study comparing outcomes during a 6-month period between acute day unit and crisis resolution team participants. Work package 2.2 – qualitative interviews with staff and service users of acute day units. Work package 3 – a cohort study within the Mental Health Minimum Data Set exploring re-admissions to acute care over 6 months. A patient and public involvement group supported the study throughout.
Setting and participants
Work package 1 – all non-residential acute day units (NHS and voluntary sector) in England. Work packages 2.1 and 2.2 – four NHS trusts with staff, service users and carers in acute day units and crisis resolution teams. Work package 3 – all individuals using mental health NHS trusts in England.
Results
Work package 1 – we identified 27 acute day units in 17 out of 58 trusts. Acute day units are typically available on weekdays from 10 a.m. to 4 p.m., providing a wide range of interventions and a multidisciplinary team, including clinicians, and having an average attendance of 5 weeks. Work package 2.1 – we recruited 744 participants (acute day units, n = 431; crisis resolution teams, n = 312). In the primary analysis, 21% of acute day unit participants (vs. 23% of crisis resolution team participants) were re-admitted to acute mental health services over 6 months. There was no statistically significant difference in the fully adjusted model (acute day unit hazard ratio 0.78, 95% confidence interval 0.54 to 1.14; p = 0.20), with highly heterogeneous results between trusts. Acute day unit participants had higher satisfaction and well-being scores and lower depression scores than crisis resolution team participants. The health economics analysis found no difference in resource use or cost between the acute day unit and crisis resolution team groups in the fully adjusted analysis. Work package 2.2 – 36 people were interviewed (acute day unit staff, n = 12; service users, n = 21; carers, n = 3). There was an overwhelming consensus that acute day units are highly valued. Service users found the high amount of contact time and staff continuity, peer support and structure provided by acute day units particularly beneficial. Staff also valued providing continuity, building strong therapeutic relationships and providing a variety of flexible, personalised support. Work package 3 – of 231,998 individuals discharged from acute care (crisis resolution team, acute day unit or inpatient ward), 21.4% were re-admitted for acute treatment within 6 months, with women, single people, people of mixed or black ethnicity, those living in more deprived areas and those in the severe psychosis care cluster being more likely to be re-admitted. Little variation in re-admissions was explained at the trust level, or between trusts with and trusts without acute day units (adjusted odds ratio 0.96, 95% confidence interval 0.80 to 1.15).
Limitations
In work package 1, some of the information is likely to be incomplete as a result of trusts’ self-reporting. There may have been recruitment bias in work packages 2.1 and 2.2. Part of the health economics analysis relied on clinical Health of the Nations Outcome Scale ratings. The Mental Health Minimum Data Set did not contain a variable identifying acute day units, and some covariates had a considerable number of missing data.
Conclusions
Acute day units are not provided routinely in the NHS but are highly valued by staff and service users, giving better outcomes in terms of satisfaction, well-being and depression than, and no significant differences in risk of re-admission or increased costs from, crisis resolution teams. Future work should investigate wider health and care system structures and the place of acute day units within them; the development of a model of best practice for acute day units; and staff turnover and well-being (including the impacts of these on care).
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 18. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- David Osborn
- Division of Psychiatry, University College London, London, UK
| | - Danielle Lamb
- Division of Psychiatry, University College London, London, UK
| | - Alastair Canaway
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | | | | | | | | | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
| | | | - James Kirkbride
- Division of Psychiatry, University College London, London, UK
| | | | - Jason Madan
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Farhana Mann
- Division of Psychiatry, University College London, London, UK
| | - Louise Marston
- Division of Psychiatry, University College London, London, UK
| | - Adele McKay
- Camden and Islington NHS Foundation Trust, London, UK
| | - Nicola Morant
- Division of Psychiatry, University College London, London, UK
| | | | - Thomas Steare
- Division of Psychiatry, University College London, London, UK
| | | | - Scott Weich
- Mental Health Research Unit, University of Sheffield, Sheffield, UK
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8
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Coast J, Bailey C, Canaway A, Kinghorn P. "It is not a scientific number it is just a feeling": Populating a multi-dimensional end-of-life decision framework using deliberative methods. Health Econ 2021; 30:1033-1049. [PMID: 33647181 PMCID: PMC8129721 DOI: 10.1002/hec.4239] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 08/28/2020] [Accepted: 12/11/2020] [Indexed: 06/12/2023]
Abstract
The capability approach is potentially valuable for economic evaluation at the end of life because of its conceptualization of wellbeing as freedom and the potential for capturing outcomes for those at end of life and those close to persons at the end of life. For decision making, however, this information needs to be integrated into current evaluation paradigms. This research explored weights for an integrated economic evaluation framework using a deliberative approach. Twelve focus groups were held (38 members of the public, 29 "policy makers," seven hospice volunteers); budget pie tasks were completed to generate weights. Constant comparison was used to analyze qualitative data, exploring principles behind individuals' weightings. Average weights elicited from members of the general population and policy makers for the importance that should be given to close persons (vs. patients) were very similar, at around 30%. A "sliding scale" of weights between health gain and the capability for a good death resulted from the policy maker and volunteer groups, with increasing weight given to the capability for a good death as the trajectory got closer to death. These weights can be used in developing a more comprehensive framework for economic evaluation at end of life.
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Affiliation(s)
- Joanna Coast
- Health Economics BristolPopulation Health SciencesBristol Medical SchoolUniversity of BristolBristolUK
| | - Cara Bailey
- School of NursingInstitute of Clinical SciencesUniversity of BirminghamBirminghamUK
| | - Alastair Canaway
- Warwick Clinical TrialsWarwick Medical SchoolUniversity of WarwickWarwickUK
| | - Philip Kinghorn
- Health Economics UnitInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
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9
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Lamb D, Steare T, Marston L, Canaway A, Johnson S, Kirkbride JB, Lloyd-Evans B, Morant N, Pinfold V, Smith D, Weich S, Osborn DP. A comparison of clinical outcomes, service satisfaction and well-being in people using acute day units and crisis resolution teams: cohort study in England. BJPsych Open 2021; 7:e68. [PMID: 33736743 PMCID: PMC8058818 DOI: 10.1192/bjo.2021.30] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND For people in mental health crisis, acute day units (ADUs) provide daily structured sessions and peer support in non-residential settings, often as an addition or alternative to crisis resolution teams (CRTs). There is little recent evidence about outcomes for those using ADUs, particularly compared with those receiving CRT care alone. AIMS We aimed to investigate readmission rates, satisfaction and well-being outcomes for people using ADUs and CRTs. METHOD We conducted a cohort study comparing readmission to acute mental healthcare during a 6-month period for ADU and CRT participants. Secondary outcomes included satisfaction (Client Satisfaction Questionnaire), well-being (Short Warwick-Edinburgh Mental Well-being Scale) and depression (Center for Epidemiologic Studies Depression Scale). RESULTS We recruited 744 participants (ADU: n = 431, 58%; CRT: n = 312, 42%) across four National Health Service trusts/health regions. There was no statistically significant overall difference in readmissions: 21% of ADU participants and 23% of CRT participants were readmitted over 6 months (adjusted hazard ratio 0.78, 95% CI 0.54-1.14). However, readmission results varied substantially by setting. At follow-up, ADU participants had significantly higher Client Satisfaction Questionnaire scores (2.5, 95% CI 1.4-3.5, P < 0.001) and well-being scores (1.3, 95% CI 0.4-2.1, P = 0.004), and lower depression scores (-1.7, 95% CI -2.7 to -0.8, P < 0.001), than CRT participants. CONCLUSIONS Patients who accessed ADUs demonstrated better outcomes for satisfaction, well-being and depression, and no significant differences in risk of readmission, compared with those who only used CRTs. Given the positive outcomes for patients, and the fact that ADUs are inconsistently provided in the National Health Service, their value and place in the acute care pathway needs further consideration and research.
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Affiliation(s)
- Danielle Lamb
- NIHR ARC North Thames, Department of Applied Health Research, University College London, UK
| | - Thomas Steare
- Division of Psychiatry, University College London, UK
| | - Louise Marston
- Department of Primary Care and Population Health, University College London, UK
| | | | - Sonia Johnson
- Division of Psychiatry, University College London, UK; and Camden and Islington NHS Foundation Trust, UK
| | | | | | - Nicola Morant
- Division of Psychiatry, University College London, UK
| | | | | | - Scott Weich
- School of Health and Related Research, University of Sheffield, UK
| | - David P Osborn
- Division of Psychiatry, University College London, UK; and Camden and Islington NHS Foundation Trust, UK
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10
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Duncan C, Weich S, Moon G, Twigg L, Fenton SJ, Bhui K, Canaway A, Crepaz-Keay D, Keown P, Madan J, McBride O, Parsons H, Singh S. Moving beyond randomized controlled trials in the evaluation of compulsory community treatment. J Eval Clin Pract 2020; 26:812-818. [PMID: 31359526 DOI: 10.1111/jep.13245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 07/16/2019] [Accepted: 07/16/2019] [Indexed: 11/30/2022]
Abstract
Compulsory community treatment for people with severe mental illness remains controversial due to conflicting research evidence. Recently, there have been challenges to the conventional view that trial-based evidence should take precedence. This paper adds to these challenges in three ways. First, it emphasizes the need for critiques of trials to engage with conceptual and not just technical issues. Second, it develops a critique of trials centred on both how we can have knowledge and what it is we can have knowledge of. Third, it uses this critique to develop a research strategy that capitalizes on the information in large-scale datasets.
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Affiliation(s)
- Craig Duncan
- Department of Geography, University of Portsmouth, Portsmouth, UK
| | - Scott Weich
- School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Graham Moon
- School of Geography and Environmental Science, University ofSouthampton, Southampton, UK
| | - Liz Twigg
- Department of Geography, University of Portsmouth, Portsmouth, UK
| | - Sarah-Jane Fenton
- Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Kamaldeep Bhui
- Centre for Psychiatry, Queen Mary University of London, London, UK
| | | | | | - Patrick Keown
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Jason Madan
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Orla McBride
- School of Psychology, Ulster University, Coleraine, UK
| | - Helen Parsons
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Swaran Singh
- Warwick Medical School, University of Warwick, Coventry, UK
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11
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McGregor G, Bruce J, Ennis S, Mason J, Lall R, Ji C, Sandhu H, Seers K, Banerjee P, Canaway A, Booth K, Taylor SJC, Robertson E, Pincus T, Singh S, Fitzmaurice D, Bowater S, Clift P, Underwood M. Supervised pulmonary hypertension exercise rehabilitation (SPHERe): study protocol for a multi-centre randomised controlled trial. BMC Pulm Med 2020; 20:143. [PMID: 32429969 PMCID: PMC7236437 DOI: 10.1186/s12890-020-01182-y] [Citation(s) in RCA: 1] [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: 04/08/2020] [Accepted: 05/11/2020] [Indexed: 12/21/2022] Open
Abstract
Background Supervised cardio-pulmonary rehabilitation may be safe and beneficial for people with pulmonary hypertension (PH) in groups 1 (pulmonary arterial hypertension) and 4 (chronic thromboembolic disease), particularly as a hospital in-patient. It has not been tested in the most common PH groups; 2 (left heart disease), 3 (lung disease), or 5 (other disorders). Further it has not been evaluated in the UK National Health Service (NHS) out-patient setting, or with long-term follow-up. The aim of this randomised controlled trial (RCT) is to test the clinical and cost-effectiveness of a supervised exercise rehabilitation intervention with psychosocial support compared to best practice usual care for people with PH in the community/outpatient setting. Methods This multi-centre, pragmatic, two-arm RCT with embedded process evaluation aims to recruit 352 clinically stable adults with PH (groups 1–5) and WHO functional class II-IV. Participants will be randomised to either the Supervised Pulmonary Hypertension Exercise Rehabilitation (SPHERe) intervention or control. The SPHERe intervention consists of 1) individual assessment and familiarisation sessions; 2) 8-week, twice-weekly, supervised out-patient exercise training; 3) psychosocial/motivational support and education; 4) guided home exercise plan. The control intervention consists of best practice usual care with a single one-to-one practitioner appointment, and general advice on physical activity. Outcomes will be measured at baseline, 4 months (post-intervention) and 12 months by researchers blinded to treatment allocation. The primary outcome is the incremental shuttle walk test at 4 months. Secondary outcomes include health-related quality of life (HRQoL), time to clinical worsening and health and social care use. A purposive sample of participants (n = 20 intervention and n = 20 control) and practitioners (n = 20) will be interviewed to explore experiences of the trial, outcomes and interventions. Discussion The SPHERe study is the first multi-centre clinical RCT to assess the clinical and cost effectiveness of a supervised exercise rehabilitation intervention compared to usual care, delivered in the UK NHS, for people in all PH groups. Results will inform clinicians and commissioners as to whether or not supervised exercise rehabilitation is effective and should be routinely provided for people with PH. Trial registration ISRCTN no. 10608766, prospectively registered on 18th March 2019.
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Affiliation(s)
- Gordon McGregor
- Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK. .,Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK. .,Centre for Sport Exercise & Life Sciences, Coventry University, Coventry, UK.
| | - Julie Bruce
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Stuart Ennis
- Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK.,Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - James Mason
- Centre for Health Economics at Warwick, Warwick Medical School, University of Warwick, Coventry, UK
| | - Ranjit Lall
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Chen Ji
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Harbinder Sandhu
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Kate Seers
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Prithwish Banerjee
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK.,Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Alastair Canaway
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Katie Booth
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Stephanie J C Taylor
- Institute of Population Health Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Tamar Pincus
- Department of Psychology, Royal Holloway University of London, London, UK
| | - Sally Singh
- Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - David Fitzmaurice
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sarah Bowater
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Paul Clift
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
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12
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Weich S, Fenton SJ, Staniszewska S, Canaway A, Crepaz-Keay D, Larkin M, Madan J, Mockford C, Bhui K, Newton E, Croft C, Foye U, Cairns A, Ormerod E, Jeffreys S, Griffiths F. Using patient experience data to support improvements in inpatient mental health care: the EURIPIDES multimethod study. Health Serv Deliv Res 2020. [DOI: 10.3310/hsdr08210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
All NHS providers collect data on patient experience, although there is limited evidence about what to measure or how to collect and use data to improve services. We studied inpatient mental health services, as these are important, costly and often unpopular services within which serious incidents occur.
Aims
To identify which approaches to collecting and using patient experience data are most useful for supporting improvements in inpatient mental health care.
Design
The study comprised five work packages: a systematic review to identify evidence-based patient experience themes relevant to inpatient mental health care (work package 1); a survey of patient experience leads in NHS mental health trusts in England to describe current approaches to collecting and using patient experience data in inpatient mental health services, and to populate the sampling frame for work package 3 (work package 2); in-depth case studies at sites selected using the work package 2 findings, analysed using a realist approach (work package 3); a consensus conference to agree on recommendations about best practice (work package 4); and health economic modelling to estimate resource requirements and potential benefits arising from the adoption of best practice (work package 5). Using a realist methodology, we analysed and presented our findings using a framework based on four stages of the patient experience data pathway, for which we coined the term CRAICh (collecting and giving, receiving and listening, analysing, and quality improvement and change). The project was supported by a patient and public involvement team that contributed to work package 1 and the development of programme theories (work package 3). Two employed survivor researchers worked on work packages 2, 3 and 4.
Setting
The study was conducted in 57 NHS providers of inpatient mental health care in England.
Participants
In work package 2, 47 NHS patient experience leads took part and, in work package 3, 62 service users, 19 carers and 101 NHS staff participated, across six trusts. Forty-four individuals attended the work package 4 consensus conference.
Results
The patient experience feedback cycle was rarely completed and, even when improvements were implemented, these tended to be environmental rather than cultural. There were few examples of triangulation with patient safety or outcomes data. We identified 18 rules for best practice in collecting and using inpatient mental health experience data, and 154 realist context–mechanism–outcome configurations that underpin and explain these.
Limitations
The study was cross-sectional in design and we relied on examples of historical service improvement. Our health economic models (in work package 5) were therefore limited in the estimation and modelling of prospective benefits associated with the collection and use of patient experience data.
Conclusions
Patient experience work is insufficiently embedded in most mental health trusts. More attention to analysis and interpretation of patient experience data is needed, particularly to ways of triangulating these with outcomes and safety data.
Future work
Further evaluative research is needed to develop and evaluate a locally adapted intervention based on the 18 rules for best practice.
Study registration
The systematic review (work package 1) is registered as PROSPERO CRD42016033556.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 21. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Scott Weich
- Warwick Medical School, University of Warwick, Coventry, UK
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Sarah-Jane Fenton
- Warwick Medical School, University of Warwick, Coventry, UK
- Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Sophie Staniszewska
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry, UK
| | | | | | - Michael Larkin
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Jason Madan
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Kamaldeep Bhui
- Centre for Psychiatry, Wolfson Institute of Preventative Medicine – Barts and The London, Queen Mary University of London, London, UK
| | | | - Charlotte Croft
- Warwick Business School, University of Warwick, Coventry, UK
| | - Una Foye
- Centre for Psychiatry, Wolfson Institute of Preventative Medicine – Barts and The London, Queen Mary University of London, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Aimee Cairns
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Stephen Jeffreys
- Mental Health Foundation, London, UK
- National Survivor User Network, London, UK
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13
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Bruce J, Mazuquin B, Mistry P, Williamson E, Lall R, Vidya R, Withers E, Rees S, Canaway A, Petrou S, Lamb SE, Thompson AM. Abstract P1-13-04: Prevention of shoulder problems trial (UK-PROSPER): Exercise to prevent shoulder problems in patients undergoing breast cancer treatment. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p1-13-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Aim: To investigate the clinical and cost-effectiveness of early structured exercise on functional and health-related outcomes in women at high risk of developing shoulder problems after breast cancer treatment. Methods: The UK-PROSPER was a pragmatic, multicentre, randomised controlled trial comparing a structured exercise programme with best practice usual care (information leaflet). Women at high-risk (planned axillary node clearance, planned radiotherapy to the axilla and/or supraclavicular area, existing shoulder problems and BMI >30) of postoperative shoulder problems with a confirmed invasive or non-invasive primary breast cancer scheduled for surgery were included. We aimed to randomise 350 women from 17 centres across England, with postoperative follow-up at 6 weeks, 6 and 12 months post-randomisation. The PROSPER exercise intervention was developed from evidence, clinical experts and patients; the final intervention consisted of exercise, behavioural strategies and physical activity. Women were offered a minimum of three face-to-face appointments with a physiotherapist, starting 7 to 10 days postoperatively with three optional appointments. The control group received written leaflets containing information on exercises after surgery. The primary outcome was the Disabilities of the Arm Shoulder and Hand (DASH) score at 12 months. Secondary outcomes included DASH subscales, postoperative pain, complications and health-related quality of life. Results: 392 women were recruited, 196 randomised to each treatment arm. Mean age was 58.1 years, mean BMI was 30.2. Groups were similar for socioeconomic characteristics at baseline. Of 191 women allocated to exercise intervention, 142/191 (74%) received three or more PT sessions, 38/191 (20%) received up to three sessions and 11/191 (6%) no treatment. Those randomised to exercise had better arm, shoulder and hand function compared to usual care at 12 months (mean DASH score 16.4 versus 23.9 respectively; adjusted mean difference (MD) -7.42; 95% CI -12.34 to -2.50; p=0.003). DASH subscales for activity limitations, participation restriction and impairment improved over time in women receiving exercise compared to usual care. A lower rate of neuropathic pain at 12 months was reported by treatment arm (23% control vs 16% exercise). Conclusions: Early structured postoperative exercise was beneficial on functional and other health-related outcomes at 12 months in women undergoing surgery for breast cancer treatment. Early postoperative exercise was safe and did not increase risk of postoperative adverse events.
Citation Format: Julie Bruce, Bruno Mazuquin, Pankaj Mistry, Esther Williamson, Ranjit Lall, Raghavan Vidya, Emma Withers, Sophie Rees, Alastair Canaway, Stavros Petrou, Sarah E Lamb, Alastair M Thompson. Prevention of shoulder problems trial (UK-PROSPER): Exercise to prevent shoulder problems in patients undergoing breast cancer treatment [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-13-04.
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Affiliation(s)
- Julie Bruce
- 1University of Warwick, Coventry, United Kingdom
| | | | | | | | - Ranjit Lall
- 1University of Warwick, Coventry, United Kingdom
| | - Raghavan Vidya
- 3Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - Emma Withers
- 1University of Warwick, Coventry, United Kingdom
| | - Sophie Rees
- 1University of Warwick, Coventry, United Kingdom
| | | | | | - Sarah E Lamb
- 1University of Warwick, Coventry, United Kingdom
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14
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Weich S, Duncan C, Twigg L, McBride O, Parsons H, Moon G, Canaway A, Madan J, Crepaz-Keay D, Keown P, Singh S, Bhui K. Use of community treatment orders and their outcomes: an observational study. Health Serv Deliv Res 2020. [DOI: 10.3310/hsdr08090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Community treatment orders are widely used in England. It is unclear whether their use varies between patients, places and services, or if they are associated with better patient outcomes.
Objectives
To examine variation in the use of community treatment orders and their associations with patient outcomes and health-care costs.
Design
Secondary analysis using multilevel statistical modelling.
Setting
England, including 61 NHS mental health provider trusts.
Participants
A total of 69,832 patients eligible to be subject to a community treatment order.
Main outcome measures
Use of community treatment orders and time subject to community treatment order; re-admission and total time in hospital after the start of a community treatment order; and mortality.
Data sources
The primary data source was the Mental Health Services Data Set. Mental Health Services Data Set data were linked to mortality records and local area deprivation statistics for England.
Results
There was significant variation in community treatment order use between patients, provider trusts and local areas. Most variation arose from substantially different practice in a small number of providers. Community treatment order patients were more likely to be in the ‘severe psychotic’ care cluster grouping, male or black. There was also significant variation between service providers and local areas in the time patients remained on community treatment orders. Although slightly more community treatment order patients were re-admitted than non-community treatment order patients during the study period (36.9% vs. 35.6%), there was no significant difference in time to first re-admission (around 32 months on average for both). There was some evidence that the rate of re-admission differed between community treatment order and non-community treatment order patients according to care cluster grouping. Community treatment order patients spent 7.5 days longer, on average, in admission than non-community treatment order patients over the study period. This difference remained when other patient and local area characteristics were taken into account. There was no evidence of significant variation between service providers in the effect of community treatment order on total time in admission. Community treatment order patients were less likely to die than non-community treatment order patients, after taking account of other patient and local area characteristics (odds ratio 0.69, 95% credible interval 0.60 to 0.81).
Limitations
Confounding by indication and potential bias arising from missing data within the Mental Health Services Data Set. Data quality issues precluded inclusion of patients who were subject to community treatment orders more than once.
Conclusions
Community treatment order use varied between patients, provider trusts and local areas. Community treatment order use was not associated with shorter time to re-admission or reduced time in hospital to a statistically significant degree. We found no evidence that the effectiveness of community treatment orders varied to a significant degree between provider trusts, nor that community treatment orders were associated with reduced mental health treatment costs. Our findings support the view that community treatment orders in England are not effective in reducing future admissions or time spent in hospital. We provide preliminary evidence of an association between community treatment order use and reduced rate of death.
Future work
These findings need to be replicated among patients who are subject to community treatment order more than once. The association between community treatment order use and reduced mortality requires further investigation.
Study registration
The study was approved by the University of Warwick’s Biomedical and Scientific Research Ethics Committee (REGO-2015-1623).
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 9. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Scott Weich
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Craig Duncan
- Department of Geography, University of Portsmouth, Portsmouth, UK
| | - Liz Twigg
- Department of Geography, University of Portsmouth, Portsmouth, UK
| | - Orla McBride
- School of Psychology, Ulster University, Londonderry, UK
| | - Helen Parsons
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Graham Moon
- School of Geography and Environmental Science, University of Southampton, Southampton, UK
| | | | - Jason Madan
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Patrick Keown
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Swaran Singh
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Kamaldeep Bhui
- Centre for Psychiatry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Lamb D, Davidson M, Lloyd-Evans B, Johnson S, Heinkel S, Steare T, Pinfold V, Weich S, Morant N, Kirkbride J, Marston L, Canaway A, Madan J, Osborn D. Adult mental health provision in England: a national survey of acute day units. BMC Health Serv Res 2019; 19:866. [PMID: 31752861 PMCID: PMC6868849 DOI: 10.1186/s12913-019-4687-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 03/06/2019] [Accepted: 10/28/2019] [Indexed: 11/10/2022] Open
Abstract
Background Acute Day Units (ADUs) exist in some English NHS Trusts as an alternative to psychiatric inpatient admission. However, there is a lack of information about the number, configuration, and functioning of such units, and about the extent to which additional units might reduce admissions. This cross-sectional survey and cluster analysis of ADUs aimed to identify, categorise, and describe Acute Day Units (ADUs) in England. Methods English NHS Mental Health Trusts with ADUs were identified in a mapping exercise, and a questionnaire was distributed to ADU managers. Cluster analysis was used to identify distinct models of service, and descriptive statistics are given to summarise the results of the survey questions. Results Two types of service were identified by the cluster analysis: NHS (n = 27; and voluntary sector services (n = 18). Under a third of NHS Trusts have access to ADUs. NHS services typically have multi-disciplinary staff teams, operate during office hours, offer a range of interventions (medication, physical checks, psychological interventions, group sessions, peer support), and had a median treatment period of 30 days. Voluntary sector services had mostly non-clinically qualified staff, and typically offered supportive listening on a one-off, drop-in basis. Nearly all services aim to prevent or reduce inpatient admissions. Voluntary sector services had more involvement by service users and carers in management and running of the service than NHS services. Conclusions The majority of NHS Trusts do not provide ADUs, despite their potential to reduce inpatient admissions. Further research of ADUs is required to establish their effectiveness and acceptability to service users, carers, and staff.
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16
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Canaway A, Frew E, Lancashire E, Pallan M, Hemming K, Adab P. Economic evaluation of a childhood obesity prevention programme for children: Results from the WAVES cluster randomised controlled trial conducted in schools. PLoS One 2019; 14:e0219500. [PMID: 31291330 PMCID: PMC6619792 DOI: 10.1371/journal.pone.0219500] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 06/21/2019] [Indexed: 01/22/2023] Open
Abstract
Background Childhood obesity is a serious public health challenge and schools have been identified as an ideal place to implement prevention interventions. The aim of this study was to measure the cost-effectiveness of a multi-faceted school-based obesity prevention intervention targeting children aged 6–7 years when compared to ‘usual activities’. Methods A cluster randomised controlled trial in 54 schools across the West Midlands (UK) was conducted. The 12-month intervention aimed to increase physical activity by 30 minutes per day and encourage healthy eating. Costs were captured from a public sector perspective and utility-based health related outcomes measured using the CHU-9D. Multiple imputation using chained equations was used to address missing data. The cost effectiveness was measured at 30 months from baseline using a hierarchical net-benefit regression framework, that controlled for clustering and prespecified covariates. Any uncertainty in the results was characterised using cost-effectiveness acceptability curves. Results At 30 months, the total adjusted incremental mean cost of the intervention was £155 (95% confidence interval [CI]: £139, £171), and the incremental mean QALYs gained was 0.006 (95% CI: -0.024, 0.036), per child. The incremental cost-effectiveness at 30 months was £26,815 per QALY and using a standard willingness to pay threshold of £30,000 per QALY, there was a 52% chance that the intervention was cost-effective. Conclusions The cost-effectiveness of the school-based WAVES intervention was subject to substantial uncertainty. We therefore recommend more research to explore obesity prevention within schools as part of a wider systems approach to obesity prevention. Trial registration This paper uses data collected by the WAVES trial: Controlled trials ISRCTN97000586 (registered May 2010).
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Affiliation(s)
- Alastair Canaway
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Emma Frew
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- * E-mail:
| | - Emma Lancashire
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Miranda Pallan
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Karla Hemming
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Peymane Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
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17
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Adab P, Barrett T, Bhopal R, Cade JE, Canaway A, Cheng KK, Clarke J, Daley A, Deeks J, Duda J, Ekelund U, Frew E, Gill P, Griffin T, Hemming K, Hurley K, Lancashire ER, Martin J, McGee E, Pallan MJ, Parry J, Passmore S. The West Midlands ActiVe lifestyle and healthy Eating in School children (WAVES) study: a cluster randomised controlled trial testing the clinical effectiveness and cost-effectiveness of a multifaceted obesity prevention intervention programme targeted at children aged 6-7 years. Health Technol Assess 2019; 22:1-608. [PMID: 29436364 DOI: 10.3310/hta22080] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Systematic reviews suggest that school-based interventions can be effective in preventing childhood obesity, but better-designed trials are needed that consider costs, process, equity, potential harms and longer-term outcomes. OBJECTIVE To assess the clinical effectiveness and cost-effectiveness of the WAVES (West Midlands ActiVe lifestyle and healthy Eating in School children) study intervention, compared with usual practice, in preventing obesity among primary school children. DESIGN A cluster randomised controlled trial, split across two groups, which were randomised using a blocked balancing algorithm. Schools/participants could not be blinded to trial arm. Measurement staff were blind to allocation arm as far as possible. SETTING Primary schools, West Midlands, UK. PARTICIPANTS Schools within a 35-mile radius of the study centre and all year 1 pupils (aged 5-6 years) were eligible. Schools with a higher proportion of pupils from minority ethnic populations were oversampled to enable subgroup analyses. INTERVENTIONS The 12-month intervention encouraged healthy eating/physical activity (PA) by (1) helping teachers to provide 30 minutes of additional daily PA, (2) promoting 'Villa Vitality' (interactive healthy lifestyles learning, in an inspirational setting), (3) running school-based healthy cooking skills/education workshops for parents and children and (4) highlighting information to families with regard to local PA opportunities. MAIN OUTCOME MEASURES The primary outcomes were the difference in body mass index z-scores (BMI-zs) between arms (adjusted for baseline body mass index) at 3 and 18 months post intervention (clinical outcome), and cost per quality-adjusted life-year (QALY) (cost-effectiveness outcome). The secondary outcomes were further anthropometric, dietary, PA and psychological measurements, and the difference in BMI-z between arms at 27 months post intervention in a subset of schools. RESULTS Two groups of schools were randomised: 27 in 2011 (n = 650 pupils) [group 1 (G1)] and another 27 in 2012 (n = 817 pupils) [group 2 (G2)]. Primary outcome data were available at first follow-up (n = 1249 pupils) and second follow-up (n = 1145 pupils) from 53 schools. The mean difference (MD) in BMI-z between the control and intervention arms was -0.075 [95% confidence interval (CI) -0.183 to 0.033] and -0.027 (95% CI -0.137 to 0.083) at 3 and 18 months post intervention, respectively. The main analyses showed no evidence of between-arm differences for any secondary outcomes. Third follow-up included data on 467 pupils from 27 G1 schools, and showed a statistically significant difference in BMI-z (MD -0.20, 95% CI -0.40 to -0.01). The mean cost of the intervention was £266.35 per consented child (£155.53 per child receiving the intervention). The incremental cost-effectiveness ratio associated with the base case was £46,083 per QALY (best case £26,804 per QALY), suggesting that the intervention was not cost-effective. LIMITATIONS The presence of baseline primary outcome imbalance between the arms, and interschool variation in fidelity of intervention delivery. CONCLUSIONS The primary analyses show no evidence of clinical effectiveness or cost-effectiveness of the WAVES study intervention. A post hoc analysis, driven by findings at third follow-up, suggests a possible intervention effect, which could have been attenuated by baseline imbalances. There was no evidence of an intervention effect on measures of diet or PA and no evidence of harm. FUTURE WORK A realist evidence synthesis could provide insights into contextual factors and strategies for future interventions. School-based interventions need to be integrated within a wider societal framework and supported by upstream interventions. TRIAL REGISTRATION Current Controlled Trials ISRCTN97000586. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 8. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Peymane Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Timothy Barrett
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Raj Bhopal
- Edinburgh Migration, Ethnicity and Health Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Janet E Cade
- Faculty of Mathematics and Physical Sciences, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | | | - Kar Keung Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Joanne Clarke
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Amanda Daley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jonathan Deeks
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Joan Duda
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Ulf Ekelund
- Medical Research Council (MRC) Epidemiology Unit, Cambridge, UK.,Norwegian School of Sport Sciences, Oslo, Norway
| | - Emma Frew
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Paramjit Gill
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Tania Griffin
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Karla Hemming
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kiya Hurley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Emma R Lancashire
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - James Martin
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Eleanor McGee
- Birmingham Community Healthcare NHS Trust, Birmingham, UK
| | - Miranda J Pallan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jayne Parry
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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18
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Canaway A, Al-Janabi H, Kinghorn P, Bailey C, Coast J. Close-Person Spill-Overs in End-of-Life Care: Using Hierarchical Mapping to Identify Whose Outcomes to Include in Economic Evaluations. Pharmacoeconomics 2019; 37:573-583. [PMID: 30877637 DOI: 10.1007/s40273-019-00786-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Guidelines for economic evaluations often request that costs and outcomes beyond the patient are captured; this can include carers and also other affected parties. End-of-life care is one context where impacts of care spill over onto those other than patients, but there is little evidence about who should be included within economic evaluations. OBJECTIVE The purpose of this article was to examine (1) how many people are close to those at the end of life (2); their characteristics; and (3) what influences the network size at the end of life. METHODS In-depth interviews were conducted with 23 participants who were either recently bereaved or had somebody close to them currently receiving end-of-life care. Interviews were used in conjunction with hierarchical mapping to explore the network size and composition and influences upon these networks. Interviews were transcribed verbatim. Descriptive statistics were used to analyse the hierarchical maps and this information was combined with a constant comparative analysis of the qualitative data. RESULTS On average, close-person networks at the end of life contained eight individuals, three of whom were rated as being 'closest'. These were typically family members, although in a small number of cases non-family members were included amongst the closest individuals. There was variation in terms of network composition. Qualitative analyses revealed two key influences on network size: death trajectory (those with cognitive problems/diseases towards the end of life had smaller networks) and family size (larger families had larger networks). CONCLUSIONS The findings of this article have important implications for researchers wishing to include those affected by end-of-life care in an economic evaluation. Focussing on the three closest individuals would be a key starting point for economists seeking to capture spill-overs, whilst a truly societal perspective would require looking beyond proximal family members. This article further discusses the implications of including close persons in economic evaluations for decision makers.
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Affiliation(s)
- Alastair Canaway
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK.
| | | | - Philip Kinghorn
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Cara Bailey
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Joanna Coast
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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19
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Weich S, Duncan C, Bhui K, Canaway A, Crepaz-Keay D, Keown P, Madan J, McBride O, Moon G, Parsons H, Singh S, Twigg L. Evaluating the effects of community treatment orders (CTOs) in England using the Mental Health Services Dataset (MHSDS): protocol for a national, population-based study. BMJ Open 2018; 8:e024193. [PMID: 30341141 PMCID: PMC6196959 DOI: 10.1136/bmjopen-2018-024193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 11/28/2022] Open
Abstract
INTRODUCTION Supervised community treatment (SCT) for people with serious mental disorders has become accepted practice in many countries around the world. In England, SCT was adopted in 2008 in the form of community treatment orders (CTOs). CTOs have been used more than expected, with significant variations between people and places. There is conflicting evidence about the effectiveness of SCT; studies based on randomised controlled trials (RCTs) have suggested few positive impacts, while those employing observational designs have been more favourable. Robust population-based studies are needed, because of the ethical challenges of undertaking further RCTs and because variation across previous studies may reflect the effects of sociospatial context on SCT outcomes. We aim to examine spatial and temporal variation in the use, effectiveness and cost of CTOs in England through the analysis of routine administrative data. METHODS AND ANALYSIS Four years of data from the Mental Health Services Dataset (MHSDS) will be analysed using multilevel models. Models based on all patients eligible for CTOs will be used to explore variation in their use. A subset of CTO-eligible patients comprising a treatment group (CTO patients) and a matched control group (non-CTO patients) will be used to examine variation in the association between CTO use and study outcomes. Primary outcome will be total time in hospital. Secondary outcomes will include time to first readmission and mortality. Outputs from these models will be used to populate predictive models of healthcare resource use. ETHICS AND DISSEMINATION Ethical approval has been granted by the National Health Service Data Access and Advisory Group and Warwick University. To ensure patient confidentiality and to meet data governance requirements, analyses will be carried out in a secure microdata laboratory using de-identified data. Study findings will be disseminated through academic channels and shared with mental health policy-makers and other stakeholders.
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Affiliation(s)
- Scott Weich
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Craig Duncan
- Department of Geography, University of Portsmouth, Portsmouth, UK
| | - Kamaldeep Bhui
- Centre for Psychiatry, Barts and The London School of Medicine & Dentist, University of London, London, UK
| | | | | | - Patrick Keown
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Jason Madan
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Orla McBride
- School of Psychology, Ulster University, Londonderry, UK
| | - Graham Moon
- Geography and Environment, Ulster University, Southampton, UK
| | - Helen Parsons
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Swaran Singh
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Liz Twigg
- Department of Geography, University of Portsmouth, Portsmouth, UK
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20
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Weich S, Fenton SJH, Bhui K, Staniszewska S, Madan J, Larkin M, Newton E, Crepaz-Keay D, Canaway A, Croft C, Griffiths F. Realist Evaluation of the Use of Patient Experience Data to Improve the Quality of Inpatient Mental Health Care (EURIPIDES) in England: study protocol. BMJ Open 2018; 8:e021013. [PMID: 29903792 PMCID: PMC6009616 DOI: 10.1136/bmjopen-2017-021013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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] [Received: 12/12/2017] [Revised: 02/22/2018] [Accepted: 04/19/2018] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Inpatient mental healthcare continues to be an area of high risk and where patients report negative experiences. To ensure the patient voice is heard, National Health Service (NHS) Trusts are required to collect feedback from patients routinely. We do not know what kinds of feedback are most important or what management processes are needed to translate this into effective action plans. Further, we do not know if this makes any difference to the patients themselves. This study seeks to explore which of the many different approaches to collecting and using patient experience data are the most useful for supporting improvements in inpatient mental healthcare. The overarching aim of the study is to arrive at recommendations for best practice in the collection and use of patient experience data in NHS England adult inpatient mental health settings. We present the protocol for Realist Evaluation of the Use of Patient Experience Data to Improve the Quality of Inpatient Mental Health Care study (EURIPIDES). METHODS AND ANALYSIS The study is composed of five work packages (WPs), including a systematic review of patient experiences (WP1); a telephone survey to assist the selection of case sites (WP2); six indepth case studies involving interviews with service users, carers and staff to enable a realist evaluation of the use of patient experience to improve quality in adult inpatient mental health services (WP3); an economic evaluation of patient experience feedback activity (WP5); and a consensus conference (WP4). We discuss the methodological rationale for the five WPs. ETHICS AND DISSEMINATION This study has received approval from West Midlands/South Birmingham NHS Research Ethics Committee. The outcome of the consensus conference meeting (WP4) will form the basis of the outputs to be disseminated to NHS providers. Dissemination will also take place through publications and presentations at relevant conferences.
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Affiliation(s)
- Scott Weich
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Kamaldeep Bhui
- Barts & the London Medical School, Queen Mary University, London, UK
| | | | - Jason Madan
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Michael Larkin
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | | | - David Crepaz-Keay
- Empowerment and Social Inclusion, Mental Health Foundation, London, UK
| | | | - Charlotte Croft
- Entrepreneurship & Innovation, Organising Healthcare Research Network, Warwick Business School, Coventry, UK
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21
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Canaway A, Pincus T, Underwood M, Shapiro Y, Chodick G, Ben-Ami N. Is an enhanced behaviour change intervention cost-effective compared with physiotherapy for patients with chronic low back pain? Results from a multicentre trial in Israel. BMJ Open 2018; 8:e019928. [PMID: 29643158 PMCID: PMC5898302 DOI: 10.1136/bmjopen-2017-019928] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 11/21/2022] Open
Abstract
OBJECTIVE To assess the cost-effectiveness of an enhanced transtheoretical model of behaviour change in conjunction with physiotherapy compared with standard care (physiotherapy) in patients with chronic lower back pain (CLBP). DESIGN Cost-utility and cost-effectiveness analyses alongside a multicentre controlled trial from a healthcare perspective with a 1-year time horizon. SETTING The trial was conducted in eight centres within the Sharon district in Israel. PARTICIPANTS 220 participants aged between 25 and 55 years who suffered from CLBP for a minimum of 3 months were recruited. INTERVENTIONS The intervention used a model of behaviour change that sought to increase the adherence and implementation of physical activity in conjunction with physiotherapy. The control arm received standard care in the form of physiotherapy. PRIMARY AND SECONDARY MEASURES The primary outcome was the incremental cost per quality-adjusted life year (QALY) of the intervention arm compared with standard care. The secondary outcome was the incremental cost per Roland-Morris Disability Questionnaire point. RESULTS The cost per QALY point estimate was 10 645 New Israeli shekels (NIS) (£1737.11). There was an 88% chance the intervention was cost-effective at NIS50 000 per QALY threshold. Excluding training costs, the intervention dominated the control arm, resulting in fewer physiotherapy and physician visits while improving outcomes. CONCLUSIONS The enhanced transtheoretical model intervention appears to be a very cost-effective intervention leading to improved outcomes for low cost. Given limitations within this study, there is justification for examining the intervention within a larger, long-term randomised controlled trial. TRIAL REGISTRATION NUMBER NCT01631344; Pre-results.
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Affiliation(s)
- Alastair Canaway
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Tamar Pincus
- Department of Psychology, Royal Holloway University of London, London, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Yair Shapiro
- Faculty of Health Sciences, Ariel University, Ariel, Israel
| | - Gabriel Chodick
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Noa Ben-Ami
- Faculty of Health Sciences, Ariel University, Ariel, Israel
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22
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Adab P, Pallan MJ, Lancashire ER, Hemming K, Frew E, Barrett T, Bhopal R, Cade JE, Canaway A, Clarke JL, Daley A, Deeks JJ, Duda JL, Ekelund U, Gill P, Griffin T, McGee E, Hurley K, Martin J, Parry J, Passmore S, Cheng KK. Effectiveness of a childhood obesity prevention programme delivered through schools, targeting 6 and 7 year olds: cluster randomised controlled trial (WAVES study). BMJ 2018; 360:k211. [PMID: 29437667 PMCID: PMC5792961 DOI: 10.1136/bmj.k211] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess the effectiveness of a school and family based healthy lifestyle programme (WAVES intervention) compared with usual practice, in preventing childhood obesity. DESIGN Cluster randomised controlled trial. SETTING UK primary schools from the West Midlands. PARTICIPANTS 200 schools were randomly selected from all state run primary schools within 35 miles of the study centre (n=980), oversampling those with high minority ethnic populations. These schools were randomly ordered and sequentially invited to participate. 144 eligible schools were approached to achieve the target recruitment of 54 schools. After baseline measurements 1467 year 1 pupils aged 5 and 6 years (control: 28 schools, 778 pupils) were randomised, using a blocked balancing algorithm. 53 schools remained in the trial and data on 1287 (87.7%) and 1169 (79.7%) pupils were available at first follow-up (15 month) and second follow-up (30 month), respectively. INTERVENTIONS The 12 month intervention encouraged healthy eating and physical activity, including a daily additional 30 minute school time physical activity opportunity, a six week interactive skill based programme in conjunction with Aston Villa football club, signposting of local family physical activity opportunities through mail-outs every six months, and termly school led family workshops on healthy cooking skills. MAIN OUTCOME MEASURES The protocol defined primary outcomes, assessed blind to allocation, were between arm difference in body mass index (BMI) z score at 15 and 30 months. Secondary outcomes were further anthropometric, dietary, physical activity, and psychological measurements, and difference in BMI z score at 39 months in a subset. RESULTS Data for primary outcome analyses were: baseline, 54 schools: 1392 pupils (732 controls); first follow-up (15 months post-baseline), 53 schools: 1249 pupils (675 controls); second follow-up (30 months post-baseline), 53 schools: 1145 pupils (621 controls). The mean BMI z score was non-significantly lower in the intervention arm compared with the control arm at 15 months (mean difference -0.075 (95% confidence interval -0.183 to 0.033, P=0.18) in the baseline adjusted models. At 30 months the mean difference was -0.027 (-0.137 to 0.083, P=0.63). There was no statistically significant difference between groups for other anthropometric, dietary, physical activity, or psychological measurements (including assessment of harm). CONCLUSIONS The primary analyses suggest that this experiential focused intervention had no statistically significant effect on BMI z score or on preventing childhood obesity. Schools are unlikely to impact on the childhood obesity epidemic by incorporating such interventions without wider support across multiple sectors and environments. TRIAL REGISTRATION Current Controlled Trials ISRCTN97000586.
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Affiliation(s)
- Peymane Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Miranda J Pallan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Emma R Lancashire
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Karla Hemming
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Emma Frew
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Tim Barrett
- School of Clinical and Experimental Medicine, University of Birmingham; Birmingham, UK
| | - Raj Bhopal
- Edinburgh Migration, Ethnicity and Health Research Group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, UK
| | - Janet E Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | | | - Joanne L Clarke
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Amanda Daley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jonathan J Deeks
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Joan L Duda
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Ulf Ekelund
- Cambridge MRC Epidemiology Unit, Cambridge, UK
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Paramjit Gill
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Tania Griffin
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Eleanor McGee
- Birmingham Community Healthcare NHS Trust, Birmingham, UK
| | - Kiya Hurley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - James Martin
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jayne Parry
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - K K Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Singh SP, Tuomainen H, Girolamo GD, Maras A, Santosh P, McNicholas F, Schulze U, Purper-Ouakil D, Tremmery S, Franić T, Madan J, Paul M, Verhulst FC, Dieleman GC, Warwick J, Wolke D, Street C, Daffern C, Tah P, Griffin J, Canaway A, Signorini G, Gerritsen S, Adams L, O'Hara L, Aslan S, Russet F, Davidović N, Tuffrey A, Wilson A, Gatherer C, Walker L. Protocol for a cohort study of adolescent mental health service users with a nested cluster randomised controlled trial to assess the clinical and cost-effectiveness of managed transition in improving transitions from child to adult mental health services (the MILESTONE study). BMJ Open 2017; 7:e016055. [PMID: 29042376 PMCID: PMC5652531 DOI: 10.1136/bmjopen-2017-016055] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 08/18/2017] [Accepted: 08/25/2017] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Disruption of care during transition from child and adolescent mental health services (CAMHS) to adult mental health services may adversely affect the health and well-being of service users. The MILESTONE (Managing the Link and Strengthening Transition from Child to Adult Mental Healthcare) study evaluates the longitudinal course and outcomes of adolescents approaching the transition boundary (TB) of their CAMHS and determines the effectiveness of the model of managed transition in improving outcomes, compared with usual care. METHODS AND ANALYSIS This is a cohort study with a nested cluster randomised controlled trial. Recruited CAMHS have been randomised to provide either (1) managed transition using the Transition Readiness and Appropriateness Measure score summary as a decision aid, or (2) usual care for young people reaching the TB. Participants are young people within 1 year of reaching the TB of their CAMHS in eight European countries; one parent/carer and a CAMHS clinician for each recruited young person; and adult mental health clinician or other community-based care provider, if young person transitions. The primary outcome is Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA) measuring health and social functioning at 15 months postintervention. The secondary outcomes include mental health, quality of life, transition experience and healthcare usage assessed at 9, 15 and 24 months postintervention. With a mean cluster size of 21, a total of 840 participants randomised in a 1:2 intervention to control are required, providing 89% power to detect a difference in HoNOSCA score of 0.30 SD. The addition of 210 recruits for the cohort study ensures sufficient power for studying predictors, resulting in 1050 participants and an approximate 1:3 randomisation. ETHICS AND DISSEMINATION The study protocol was approved by the UK National Research Ethics Service (15/WM/0052) and equivalent ethics boards in participating countries. Results will be reported at conferences, in peer-reviewed publications and to all relevant stakeholder groups. TRIAL REGISTRATION NUMBER ISRCTN83240263; NCT03013595 (pre-results).
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Affiliation(s)
- Swaran P Singh
- Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School, Universityof Warwick, Coventry, UK
| | - Helena Tuomainen
- Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School, Universityof Warwick, Coventry, UK
| | - Giovanni de Girolamo
- Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Center, Brescia, Italy
| | - Athanasios Maras
- Yulius Academy, Rotterdam, The Netherlands
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Paramala Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD), National and Specialist Child and Adolescent Mental Health Services, MaudsleyHospital, London, UK
- HealthTracker Ltd, Gillingham, UK
| | - Fiona McNicholas
- Department of Child and Adolescent Psychiatry, University College Dublin School of Medicine and Medical Science, Dublin, Republic of Ireland
- Geary Institute, University College Dublin, Dublin, Republic of Ireland
- Department of Child Psychiatry, Our Lady's Hospital for Sick Children, Dublin, Republic of Ireland
- Lucena Clinic, SJOG, Dublin, Republic of Ireland
| | - Ulrike Schulze
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | | | - Sabine Tremmery
- Departmentof Neurosciences, Child & Adolescent Psychiatry, University of Leuven, Leuven, Belgium
- Department of Child & Adolescent Psychiatry, University Hospitals Leuven, Leuven, Belgium
| | - Tomislav Franić
- Department of Psychiatry, Clinical Hospital Center Split, Split, Croatia
| | - Jason Madan
- Warwick Clinical Trials Unit, Warwick Medical School, Warwick Medical School, Coventry, UK
| | - Moli Paul
- Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School, Universityof Warwick, Coventry, UK
- Coventry and Warwickshire Partnership NHS Trust, UK
| | - Frank C Verhulst
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Gwen C Dieleman
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jane Warwick
- Warwick Clinical Trials Unit, Warwick Medical School, Warwick Medical School, Coventry, UK
| | - Dieter Wolke
- Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School, Universityof Warwick, Coventry, UK
- Departmentof Psychology, Universityof Warwick, Coventry, UK
| | - Cathy Street
- Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School, Universityof Warwick, Coventry, UK
| | - Claire Daffern
- Warwick Clinical Trials Unit, Warwick Medical School, Warwick Medical School, Coventry, UK
| | - Priya Tah
- Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School, Universityof Warwick, Coventry, UK
| | - James Griffin
- Warwick Clinical Trials Unit, Warwick Medical School, Warwick Medical School, Coventry, UK
| | - Alastair Canaway
- Warwick Clinical Trials Unit, Warwick Medical School, Warwick Medical School, Coventry, UK
| | - Giulia Signorini
- Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Center, Brescia, Italy
| | - Suzanne Gerritsen
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Laura Adams
- School of Psychology, Plymouth University, UK
| | - Lesley O'Hara
- SJOG Research Foundation, Dublin, Republic of Ireland
| | - Sonja Aslan
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - Frédérick Russet
- Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Nikolina Davidović
- Department of Psychiatry, Clinical Hospital Center Split, Split, Croatia
| | - Amanda Tuffrey
- Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School, Universityof Warwick, Coventry, UK
| | - Anna Wilson
- Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School, Universityof Warwick, Coventry, UK
| | - Charlotte Gatherer
- Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School, Universityof Warwick, Coventry, UK
| | - Leanne Walker
- Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School, Universityof Warwick, Coventry, UK
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Canaway A, Al-Janabi H, Kinghorn P, Bailey C, Coast J. Development of a measure (ICECAP-Close Person Measure) through qualitative methods to capture the benefits of end-of-life care to those close to the dying for use in economic evaluation. Palliat Med 2017; 31:53-62. [PMID: 27260168 DOI: 10.1177/0269216316650616] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND End-of-life care affects both the patient and those close to them. Typically, those close to the patient are not considered within economic evaluation, which may lead to the omission of important benefits resulting from end-of-life care. AIM To develop an outcome measure suitable for use in economic evaluation that captures the benefits of end-of-life care to those close to the dying. DESIGN To develop the descriptive system for the outcome measure, in-depth qualitative interviews were conducted with the participants and constant comparative analysis methods were used to develop a descriptive system for the measure. PARTICIPANTS Twenty-seven individuals bereaved within the last 2 years or with a close-person currently receiving end-of-life care were purposively recruited into the study. Participants were recruited through newsletters, adverts, snowball sampling and a local hospice. RESULTS Twenty-seven individuals were recruited. A measure of capability with six attributes, each with five levels, was developed based on themes arising from the analysis. Attributes comprise the following: good communication with services, privacy and space to be with the loved one, emotional support, practical support, being able to prepare and cope and being free from emotional distress related to the condition of the decedent. CONCLUSION This measure is designed to capture the benefits of end-of-life care to close-persons for use in economic evaluation. Further research should value the measure and develop methods for incorporating outcomes for close-persons into economic evaluation.
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Affiliation(s)
- Alastair Canaway
- 1 Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Hareth Al-Janabi
- 2 Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Philip Kinghorn
- 2 Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Cara Bailey
- 2 Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Joanna Coast
- 3 School of Social and Community Medicine, University of Bristol, Bristol, UK
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25
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Canaway A, Coast J, Al-janabi H, Kinghorn P, Bailey C. HIERARCHICAL MAPPING AS A TOOL TO EXAMINE THE NETWORKS OF THOSE AT END OF LIFE. BMJ Support Palliat Care 2015. [DOI: 10.1136/bmjspcare-2014-000838.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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