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Satchell J, Craston T, Drennan VM, Billings J, Serfaty M. Psychological Distress and Interventions for Older Victims of Crime: A Systematic Review. Trauma Violence Abuse 2023; 24:3493-3512. [PMID: 36329564 PMCID: PMC10594850 DOI: 10.1177/15248380221130354] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
We aimed to conduct the first systematic narrative review and quality appraisal of existing evidence on the psychological consequences of crime in older victims in the community and psychological interventions. We searched five databases to identify all peer-reviewed literature published in English on psychological impact and/or interventions for older crime victims and quality appraised these using the Mixed-Methods Appraisal Tool, following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines (Prospero: CRD42019140137). Evidence from included studies were narratively synthesized, along with their strengths and limitations. We found 20 studies on psychological distress in older victims, four of which included interventions. From these, we identified 30 different impacts including symptoms of anxiety, depression, post-traumatic stress disorder, emotions including humiliation and self-blame, and behavioral changes. Only feasibility interventions have been published, although promising results were reported for cognitive-behavioral informed treatments for depression and anxiety. Studies were wide-ranging in aims, crimes included, and outcomes used. Recommendations for improving the evidence-base and to raise the profile of this neglected population have been provided.
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Drennan VM, Halter M, Taylor F, Gabe J, Jarman H. Non-medical practitioners in the staffing of emergency departments and urgent treatment centres in England: a mixed qualitative methods study of policy implementation. BMC Health Serv Res 2023; 23:1221. [PMID: 37936220 PMCID: PMC10631061 DOI: 10.1186/s12913-023-10220-4] [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: 07/09/2023] [Accepted: 10/26/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Patient demand, internationally, on emergency departments and urgent care treatment centres has grown. Shortages of staff, particularly of emergency medicine doctors, have compounded problems. Some countries are pursuing solutions of including non-medical practitioners e.g., nurse practitioners and physician associates/assistants in their emergency department workforces. This study investigated at the macro and meso level of the health system in England: what the rationale was and the factors influencing the current and future employment, or otherwise, of non-medical practitioners in emergency departments and urgent treatment centres. METHODS Mixed qualitative methods in the interpretative tradition were employed. We undertook, in 2021-2022, a documentary analysis of national, regional and subregional policy (2017-2021), followed by semi-structured interviews of a purposive sample (n = 18) of stakeholders from national, regional and subregional levels. The data were thematically analysed and then synthesised. RESULTS There was general national policy support for increasing the presence of non-medical practitioners as part of the solution to shortages of emergency medicine doctors. However, evidence of policy support dissipated at regional and subregional levels. There were no published numbers for non-medical practitioners in emergency departments, but stakeholders suggested they were relatively small in number, unevenly distributed and faced uncertain growth. While the experience of the COVID-19 pandemic and its aftermath were said to have made senior decision makers more receptive to workforce innovation, many factors contributed to the uncertain growth. These factors included: limited evidence on the relative advantage of including non-medical practitioners; variation in the models of service being pursued to address patient demand on emergency departments and the place of non-medical practitioners within them; the lack of a national workforce plan with clear directives; and the variation in training for non-medical practitioner roles, combined with the lack of regulation of that level of practice. CONCLUSIONS We identified many features of a system ready to introduce non-medical practitioners in emergency departments and urgent treatment centres but there were uncertainties and the potential for conflict with other professional groups. One area of uncertainty was evidence of relative advantage in including non-medical practitioners in staffing. This requires urgent attention to inform decision making for short- and long-term workforce planning. Further investigation is required to consider whether these findings are generalisable to other specialties, and to similar health systems in other countries.
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Affiliation(s)
- Vari M Drennan
- Centre for Applied Health and Social Care Research, Kingston University, Kingston Upon Thames, UK.
| | - Mary Halter
- Centre for Applied Health and Social Care Research, Kingston University, Kingston Upon Thames, UK
| | - Francesca Taylor
- Centre for Applied Health and Social Care Research, Kingston University, Kingston Upon Thames, UK
| | | | - Heather Jarman
- St George's University Hospitals NHS Foundation Trust, London, UK
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Barrado-Martín Y, Frost R, Catchpole J, Rookes T, Gibson S, Avgerinou C, Gardner B, Gould R, Chadwick P, Jowett C, Hopkins J, Kumar R, Elaswarapu R, Marston L, Kharicha K, Drennan VM, Walters K. Goal setting as part of a holistic intervention to promote independence in older people with mild frailty: a process evaluation alongside a randomised controlled trial. Lancet 2023; 402 Suppl 1:S1. [PMID: 37997048 DOI: 10.1016/s0140-6736(23)02069-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/16/2023] [Accepted: 09/22/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Frailty is a condition resulting from a decline in physiological reserves caused by an accumulation of several deficits, which progressively impairs the ability to recover from health adverse events. Following a promising feasibility study, the HomeHealth trial assessed a holistic tailored intervention for older adults with mild frailty to promote independence in their own homes, compared with usual care. We aimed to understand how goal setting worked among older people with mild frailty. METHODS This study was a process evaluation alongside the HomeHealth randomised trial in older adults with mild frailty. The intervention was delivered at participants' homes, either in person or by telephone or videoconferencing. We carried out semi-structured interviews with older participants who had received the intervention (between three and six appointments), on average 233 days (range 68-465) after their last appointment, purposively sampled according to age, gender, number of sessions attended, adverse events, ethnicity, Index of Multiple Deprivation, Montreal Cognitive Assessment (MoCA) and Barthel scores, research site, and HomeHealth worker. We also conducted interviews with HomeHealth workers who delivered the intervention (n=7). Interviews explored the experience and process of goal setting, benefits and challenges, perceived progress, and behaviour change maintenance after the service had finished. Ethics approval was obtained, and all participants gave informed consent. Interviews were thematically analysed. HomeHealth workers kept formal records of goals set and assessed progress towards goals (0-2 rating scale) during six monthly-sessions, which were descriptively summarised. FINDINGS 56 interviews were completed between July 15, 2022, and May 18, 2023. Study participants (n=49) had a mean age of 80 years (range 66-94), including 32 (65%) women and 17 (35%) men. Participants self-identified as White (n=42), Asian (n=3), Black (n=2), Mixed (n=1), and other ethnic (n=1) backgrounds. Findings suggested goal setting could be both a challenge and a motivator for older participants with mild frailty. Goal setting worked well when the older person could identify a clear need and set realistic goals linked to functioning, which led to a positive sense of achievement. Challenges occurred when older people were already accessing multiple resources and health services, or where the terminology of "goals" was off-putting due to work or school connotations. Average progress towards goals was 1·15/2. Most participants set goals around improving mobility (or a combination of mobility and another goal type such as socialising), and there was evidence of participants sustaining these behaviour changes after the intervention. INTERPRETATION Older people with mild frailty can engage well with goal setting to promote independence. The lapse between receiving the intervention and being interviewed limited recall for some participants. However, the acceptability and adherence to the intervention for older people with mild frailty, and their moderate progress towards goals, should encourage further tailored and person-centred practices to promote their independence. FUNDING National Institute for Health Research (NIHR) Health Technology Assessment.
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Affiliation(s)
- Yolanda Barrado-Martín
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK.
| | - Rachael Frost
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Jessica Catchpole
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Tasmin Rookes
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Sarah Gibson
- Academic Unit for Ageing and Stroke Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Christina Avgerinou
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | | | - Rebecca Gould
- Division of Psychiatry, University College London, London, UK
| | - Paul Chadwick
- Division of Psychology & Language Sciences, University College London, London, UK
| | - Claire Jowett
- Patient and Public Involvement Contributor, London, UK
| | - Jane Hopkins
- Patient and Public Involvement Contributor, London, UK
| | - Rashmi Kumar
- Patient and Public Involvement Contributor, London, UK
| | | | - Louise Marston
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Kalpa Kharicha
- NIHR Health & Social Care Workforce Research Unit, The Policy Institute, King's College London, London, UK
| | - Vari M Drennan
- Centre for Health and Social Care Research, Kingston University, London, UK
| | - Kate Walters
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
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Sellers C, Penfold N, Gass C, Drennan VM. The experience of working with anaesthesia associates in the United Kingdom and the impact on medical anaesthetic training. Int J Health Plann Manage 2022; 37:2767-2778. [PMID: 35690995 DOI: 10.1002/hpm.3502] [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] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 04/01/2022] [Accepted: 04/25/2022] [Indexed: 11/08/2022] Open
Abstract
Anaesthesia Associates have been established in the UK for over 10 years, but without statutory regulation. Renewed interest surfaced based on a widening gap between patient need and workforce supply in the UK and established advanced practice non-doctor roles within healthcare systems elsewhere. However, there are no robust data on their impact on patient or hospital outcomes, or training opportunities for medical anaesthetists, and perceptions of the profession within the anaesthetic community are mixed. This paper describes an investigation into the demographics and scope of practice of Anaesthesia Associates in the UK in 2017, and the experience of working together as an anaesthetic team. Through qualitative interviews, we explored the role and relationships, the impact on medical anaesthetic training and ideas about future development. The overall experience of working with Anaesthesia Associates was positive. Successful integration requires understanding of the educational needs and competencies of all. Future development relies on strong leadership and robust patient outcome and efficiency measures. Interviewees strongly supported statutory regulation, which was agreed by the government in 2019 but not yet implemented. Anaesthesia Associates were seen as a benefit to anaesthetic departments and as such may provide part of the solution to the prevailing workforce issues in UK Anaesthesia, further critically challenged by the SARS-CoV-2 pandemic.
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Affiliation(s)
- Claudie Sellers
- Anaesthesia Health Education England South London, London, UK
| | - Nigel Penfold
- Anaesthesia Related Professionals Committee, London, UK
| | | | - Vari M Drennan
- Health Care & Policy Research, Health, Social Care & Education, Kingston University & St. George's University of London, Social Care & Education, Kingston University & St. George's University, London, UK
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Frost R, Avgerinou C, Goodman C, Clegg A, Hopkins J, Gould RL, Gardner B, Marston L, Hunter R, Manthorpe J, Cooper C, Skelton DA, Drennan VM, Logan P, Walters K. Clinical and cost-effectiveness of a personalised health promotion intervention enabling independence in older people with mild frailty (‘HomeHealth’) compared to treatment as usual: study protocol for a randomised controlled trial. BMC Geriatr 2022; 22:485. [PMID: 35659196 PMCID: PMC9166243 DOI: 10.1186/s12877-022-03160-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Frailty is clinically associated with multiple adverse outcomes, including reduced quality of life and functioning, falls, hospitalisations, moves to long-term care and mortality. Health services commonly focus on the frailest, with highest levels of need. However, evidence suggests that frailty is likely to be more reversible in people who are less frail. Evidence is emerging on what interventions may help prevent or reduce frailty, such as resistance exercises and multi-component interventions, but few interventions are based on behaviour change theory. There is little evidence of cost-effectiveness.
Previously, we co-designed a new behaviour change health promotion intervention (“HomeHealth”) to support people with mild frailty. HomeHealth is delivered by trained voluntary sector support workers over six months who support older people to work on self-identified goals to maintain their independence, such as strength and balance exercises, nutrition, mood and enhancing social engagement. The service was well received in our feasibility randomised controlled trial and showed promising effects upon outcomes.
Aim
To test the clinical and cost-effectiveness of the HomeHealth intervention on maintaining independence in older people with mild frailty in comparison to treatment as usual (TAU).
Methods
Single-blind individually randomised controlled trial comparing the HomeHealth intervention to TAU. We will recruit 386 participants from general practices and the community across three English regions. Participants are included if they are community-dwelling, aged 65 + , with mild frailty according to the Clinical Frailty Scale. Participants will be randomised 1:1 to receive HomeHealth or TAU for 6 months. The primary outcome is independence in activities of daily living (modified Barthel Index) at 12 months. Secondary outcomes include instrumental activities of daily living, quality of life, frailty, wellbeing, psychological distress, loneliness, cognition, capability, falls, carer burden, service use, costs and mortality. Outcomes will be analysed using linear mixed models, controlling for baseline Barthel score and site. A health economic analysis and embedded mixed-methods process evaluation will be conducted.
Discussion
This trial will provide definitive evidence on the effectiveness and cost-effectiveness of a home-based, individualised intervention to maintain independence in older people with mild frailty in comparison to TAU, that could be implemented at scale if effective.
Trial registration
ISRCTN, ISRCTN54268283. Registered 06/04/2020.
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Cole L, Drennan VM, Manthorpe J, Hatzidimitriadou E, Iliffe S. Experiences of intimate continence care and the impact on the family dyad relationship for people living at home with dementia and their co-resident family members. Dementia (London) 2022; 21:1556-1573. [PMID: 35446139 PMCID: PMC9234771 DOI: 10.1177/14713012221076667] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The experience of providing/receiving intimate continence care between family members can be difficult and emotive. Often, for people living with dementia this seems an area of care overlooked by professionals. This study investigated the experiences of intimate continence care for people living with dementia and their family member (the family dyad), and whether they viewed this as impacting on their relationship. METHOD Face-to-face interviews were conducted at 6 monthly intervals over a 12-month period with 13 carers (all family members) and one person living with dementia (13 family dyads) in England. Interviews were recorded and transcribed. Analysis of the data was achieved using a descriptive phenomenological method. FINDINGS Carers' attitudes towards providing intimate continence care revealed a task-focused approach for some but feelings of disgust and distress for others. Four participants (including the participant living with dementia) reported that intimate continence care had strengthened their dyad relationship. However, some carers perceived the care and support received from health and social care practitioners to be insufficient, which placed extra stress on them and adversely affected their family dyad relationship. CONCLUSION Implications of the study suggest that integrated and effective continence care and support for people living with dementia and their carers could (1) maintain the quality of the family dyad relationship, (2) help keep the person living at home, delaying an unwanted move to a care home and (3) consequently improve overall quality of life for individuals in the family dyad. Assuring integrated and effective continence care should be a priority for service funders and quality assurance regulators.
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Affiliation(s)
- Laura Cole
- Geller Institute of Ageing & Memory, 7364University of West London, London, UK
| | - Vari M Drennan
- Centre for Health & Social Care Research, Kingston University & St. George's University of London, London, UK
| | - Jill Manthorpe
- NIHR Policy Research Unit in Health & Social Care Workforce, King's College London, London, UK
| | - Eleni Hatzidimitriadou
- Faculty of Medicine, Health and Social Care, 2238Canterbury Christ Church University, Kent, UK
| | - Steve Iliffe
- Department of Primary Care & Population Health, 4919University College London, London, UK
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Roberts K, Drennan VM, Watkins J. Physician associate graduates in England: a cross-sectional survey of work careers. Future Healthc J 2022; 9:5-10. [DOI: 10.7861/fhj.2021-0184] [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: 11/27/2022]
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Abstract
ABSTRACT Physician associates (PAs) have been part of the UK health workforce for almost 20 years. The profession is growing rapidly with statutory regulation, protection of the title, and career progression supported by a national-level framework all in the pipeline for the near future. This article provides a brief history of the profession in the United Kingdom and prospects for its future.
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Affiliation(s)
- Kate Straughton
- Kate Straughton is president of the Faculty of Physician Associates in the Royal College of Physicians and a senior lecturer at the University of Birmingham in the UK. Karen A. Roberts is a reader in PA education and director of the PA program at Brighton and Sussex Medical School in Falmer, UK. Jeannie Watkins is a reader in PA education and course director of the PA program at St. George's, University of London. In the Centre for Health and Social Care Research at Kingston University and St. George's University of London in the UK, Vari M. Drennan is a professor of healthcare and policy research and Mary Halter is an associate professor. Ms. Watkins discloses that she is a director of and holds a 10% share in PATH, a recruitment company for PAs, but receives no money from the organization. The authors have disclosed no other potential conflicts of interest, financial or otherwise
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Williams L, Drennan VM. Evaluating the efficacy of rapid diagnostic tests for imported malaria in high income countries: A systematic review. Int Emerg Nurs 2021; 60:101110. [PMID: 34953438 DOI: 10.1016/j.ienj.2021.101110] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 10/15/2021] [Accepted: 10/27/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Malaria is a life-threatening disease. Prior to the pandemic, over a million people annually from non-endemic, high income countries such as Europe and North America visited countries with a risk of malaria transmission. Emergency care nurses in non-endemic countries frequently encounter returning travellers, presenting with symptoms suggestive of malaria. While rapid diagnostic tests are used in countries with endemic malaria, in countries such as the United Kingdom diagnosis is undertaken by microscopy and three negative tests are required to exclude. QUESTION Are rapid diagnostic tests effective for diagnosing imported malaria in non-endemic, high income countries? METHOD A systematic review of published research (January 2009 - November 2020) comparing rapid diagnostic tests with microscopy. RESULTS Fourteen studies were included, conducted in five countries with 14 different RDTs evaluated. Mean sensitivity and specificity for Plasmodium Falciparum was 91.8% and 97.7% and Plasmodium Vivax 81.6% and 99.2%. Higher sensitivities were related to higher parasite densities. CONCLUSIONS International travel will return post-pandemic and rapid, accurate and cost-efficient tests will be required. The rapid diagnostic tests in these studies showed significant variation and were not as accurate as microscopy. Consequently, it cannot be recommended that rapid diagnostic tests replace the gold standard of microscopy. Further research is required.
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Affiliation(s)
- Lucy Williams
- Joint Faculty of Kingston University & St. George's University of London, Cranmer Terrace, London SW17 ORE, UK.
| | - Vari M Drennan
- Joint Faculty of Kingston University & St. George's University of London, Cranmer Terrace, London SW17 ORE, UK.
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Taylor F, Drennan VM, Turner ML, Jones J, Popoola J. 'It gives you the skills of how you can cope': Exploring the self-reported experience of patients receiving in-centre haemodialysis on participating in chosen art activities. Health Expect 2021; 24:1979-1987. [PMID: 34378286 PMCID: PMC8628595 DOI: 10.1111/hex.13337] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/17/2021] [Accepted: 07/01/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Increasing numbers of patients are receiving dialysis, particularly in high-income countries. Patients receiving haemodialysis often experience fatigue, anxiety, depression and boredom. It is suggested that arts activities could have a therapeutic effect. OBJECTIVE This study aimed to explore patients' perspectives of participating while on dialysis in chosen arts and creative living activities provided by tutors at the bedside. DESIGN Qualitative semi-structured interviews in the interpretive tradition were conducted, with thematic analysis. SETTING AND PARTICIPANTS Fifteen patients of different ages, genders and ethnicities who participated in an arts activity while receiving haemodialysis in an inner-city dialysis unit in England were included in this study. RESULTS Participants reported positive experiences of engaging in art activities. Their views on the value of the activities were grouped into five themes: diversion from receiving haemodialysis, a sense of achievement, contribution to a more positive self-identity, increased confidence and motivation and a therapeutic talking relationship. Participants suggested that patient peer promotion of the activities could increase uptake, with patient choice of activity seen as important. CONCLUSIONS Participation in a chosen arts activity while receiving haemodialysis was perceived by patients to have positive psychosocial effects. We theorize three potential explanatory mechanisms for these effects: That the experience of participating in the activities engendered positive psychological states of 'being in the flow'; enhanced self-esteem to add to personal coping mechanisms; and offered additional facets to the patient's identity that countered the stigmatizing effect of receiving dialysis. PATIENT OR PUBLIC CONTRIBUTION Patients and public representatives advised on the design, research methods and tools.
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Affiliation(s)
- Francesca Taylor
- Centre for Health and Social Care Research, Joint Faculty of Kingston University and St. George's University of London, London, UK
| | - Vari M Drennan
- Centre for Health and Social Care Research, Joint Faculty of Kingston University and St. George's University of London, London, UK
| | - Marie-Louise Turner
- Department of Nephrology and Transplantation, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Jeunita Jones
- Department of Nephrology and Transplantation, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Joyce Popoola
- Department of Nephrology and Transplantation, St. George's University Hospitals NHS Foundation Trust, London, UK.,Department of Biomedical Sciences and Education, St. George's University of London, London, UK
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Drennan VM, Collins L, Allan H, Brimblecombe N, Halter M, Taylor F. Are advanced clinical practice roles in England's National Health Service a remedy for workforce problems? A qualitative study of senior staff perspectives. J Health Serv Res Policy 2021; 27:96-105. [PMID: 34374583 DOI: 10.1177/13558196211036727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE A major issue facing all health systems is improving population health while at the same time responding to both growing patient numbers and needs and developing and retaining the health care workforce. One policy response to workforce shortages has been the development of advanced clinical practice roles. In the context of an English national policy promoting such roles in the health service, we explored senior managers' and senior clinicians' perceptions of factors at the organization level that support or inhibit the introduction of advanced clinical practice roles. The investigation was framed by theories of the diffusion of innovation and the system of professions. METHODS We conducted a qualitative interview study of 39 senior manager and clinicians in 19 National Health Service acute, community, mental health and ambulance organizations across a metropolitan area in 2019. RESULTS Small numbers of advanced clinical practice roles were reported, often in single services. Four main influences were identified in the development of advanced clinical practice roles: staff shortages (particularly of doctors in training grades) combined with rising patient demand, the desire to retain individual experienced staff, external commissioners or purchasers of services looking to shape services in line with national policy, and commissioner-funded new roles in new ambulatory care services and primary care. Three factors were reported as enabling the roles: finance for substantive posts, evidence of value of the posts, and structural support within the organization. Three factors were perceived as inhibiting developing the roles: confusion and lack of knowledge amongst clinicians and managers, the availability of finance for the roles, and a nervousness (sometimes resistance) to introducing the new roles. CONCLUSIONS While the national policy was to promote advanced clinical practice roles, the evidence suggested there was and would continue to be limited implementation at the operational level. Development scenarios that introduced new monies for such roles reduced some of the inhibiting factors. However, where the introduction of roles required funding to move from one part of a service to another, and potentially from one staff group to another, the growth of these roles was and is likely to be contested. In such scenarios, research and business evidence of relative advantage will be important, as too will be supporters in powerful positions. The paucity of publicly available evidence on the effectiveness of advanced clinical practice roles across the specialties and professions in different contexts requires urgent attention.
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Affiliation(s)
- Vari M Drennan
- Professor, Centre for Health & Social Care Research, Joint Faculty of Kingston University and St George's University of London, UK
| | - Linda Collins
- Associate Professor, School of Nursing, Joint Faculty of Kingston and St George's University of London, UK
| | - Helen Allan
- Professor, School of Health & Education, 4907Middlesex University, Middlesex University, UK
| | - Neil Brimblecombe
- Professor, School of Health & Social Care, London South Bank University, UK
| | - Mary Halter
- Associate Professor, Centre for Health & Social Care Research, Joint Faculty of Kingston University and St George's University of London, UK
| | - Francesca Taylor
- Research Associate, Centre for Health & Social Care Research, Joint Faculty of Kingston University and St George's University of London, UK
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Drennan VM, Calestani M, Taylor F, Halter M, Levenson R. Perceived impact on efficiency and safety of experienced American physician assistants/associates in acute hospital care in England: findings from a multi-site case organisational study. JRSM Open 2020; 11:2054270420969572. [PMID: 33294201 PMCID: PMC7705788 DOI: 10.1177/2054270420969572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Indexed: 11/17/2022] Open
Abstract
Objectives To investigate the contribution, efficiency and safety of experienced physician associates included in the staffing of medical/surgical teams in acute hospitals in England, including facilitating and hindering factors. Design Mixed methods longitudinal, multi-site evaluation of a two-year programme employing 27 American physician associates: interviews and documentary analysis. Setting Eight acute hospitals, England. Participants 36 medical directors, consultants, junior doctors, nurses and manager, 198 documents. Results Over time, the experienced physician associates became viewed as a positive asset to medical and surgical teams, even in services where high levels of scepticism were initially expressed. Their positive contribution was described as bringing continuity to the medical/surgical team which benefited patients, consultants, doctors-in-training, nurses and the overall efficiency of the service. This is the first report of the positive impact that, including physician associates in medical/surgical teams, had on achieving safe working hours for doctors in training. Many reported the lack of physician associates regulation with attendant legislated authority to prescribe medicines and order ionising radiation was a hindrance in their deployment and employment. However, by the end of the programme, seven hospitals had published plans to increase the numbers of physician associates employed and host clinical placements for student physician associates. Conclusions The programme demonstrated the types of contributions the experienced physician associates made to patient experience, junior doctor experience and acute care services with medical workforce shortages. The General Medical Council will regulate the profession in the future. Robust quantitative research is now required.
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Affiliation(s)
- Vari M Drennan
- Centre for Health & Social Care Research, Joint Faculty, Kingston University & St. George's University, London, UK
| | - Melania Calestani
- School of Allied Health, Midwifery and Social Care, Joint Faculty, Kingston and St. George's University, London, UK
| | - Francesca Taylor
- Centre for Health & Social Care Research, Joint Faculty, Kingston University & St. George's University, London, UK
| | - Mary Halter
- Centre for Health & Social Care Research, Joint Faculty, Kingston University & St. George's University, London, UK
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Taylor F, Ogidi J, Chauhan R, Ladva Z, Brearley S, Drennan VM. Introducing physician associates to hospital patients: Development and feasibility testing of a patient experience-based intervention. Health Expect 2020; 24:77-86. [PMID: 33238078 PMCID: PMC7879547 DOI: 10.1111/hex.13149] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 05/19/2020] [Revised: 10/10/2020] [Accepted: 10/15/2020] [Indexed: 01/14/2023] Open
Abstract
Background Physician associates (PAs) are one of many new mid‐level health practitioner roles being introduced worldwide. They are a recent innovation in English hospitals. Patient confusion with novel mid‐level practitioner titles and roles is well documented, alongside evidence of a positive association between patients’ ability to identify practitioners and patient satisfaction. No prior research developed an intervention to introduce PAs or any other new practitioner role to hospital patients. Objective To develop, with patient and public involvement and engagement (PPIE), an intervention for introducing the PA role to hospital patients, and to test feasibility. Methods Intervention development was underpinned by an experience‐based co‐design approach. Workshop participants generated ideas for introducing PAs, subsequently explored in semi‐structured interviews with hospital patients (n = 13). Interview findings were used by participants in a second workshop to design the intervention. Feasibility of the intervention was assessed in relation to its acceptability and efficacy using semi‐structured interviews with hospital patients (n = 20) and PAs (n = 3). Results The intervention developed was a patient information leaflet. It was considered feasible to use in the hospital setting, helpful to patients in understanding the PA role and acceptable to both patients and PAs. The intervention was also appreciated by patients for providing reassurance of care and support. Conclusions An experience‐based co‐design approach enabled development of an intervention tailored to patients’ experiential preferences. Positive evidence of feasibility and utility is encouraging, supporting future larger‐scale testing. Patient and public contribution PPIE representatives were involved in the study design, intervention development and data interpretation.
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Affiliation(s)
- Francesca Taylor
- Joint Faculty of Kingston University and St George's University of London, St George's University of London, London, UK
| | - Jonathan Ogidi
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Rakhee Chauhan
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Zeena Ladva
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Sally Brearley
- Joint Faculty of Kingston University and St George's University of London, St George's University of London, London, UK
| | - Vari M Drennan
- Joint Faculty of Kingston University and St George's University of London, St George's University of London, London, UK
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Fleming C, Drennan VM, Kerry-Barnard S, Reid F, Adams EJ, Sadiq ST, Phillips R, Majewska W, Harding-Esch EM, Cousins EC, Yoward F, Oakeshott P. Understanding the acceptability, barriers and facilitators for chlamydia and gonorrhoea screening in technical colleges: qualitative process evaluation of the "Test n Treat" trial. BMC Public Health 2020; 20:1212. [PMID: 32770977 PMCID: PMC7414554 DOI: 10.1186/s12889-020-09285-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 07/20/2020] [Indexed: 11/10/2022] Open
Abstract
Background Low uptake of sexually transmitted infection testing by sexually active young people is a worldwide public health problem. Screening in non-medical settings has been suggested as a method to improve uptake. The “Test n Treat” feasibility trial offered free, on-site rapid chlamydia/gonorrhoea tests with same day treatment for chlamydia (and gonorrhoea treatment at a local clinic,) to sexually active students (median age 17 years) at six technical colleges in London. Despite high rates of chlamydia (6% prevalence), uptake of testing was low (< 15%). In a qualitative study we explored the acceptability, including barriers and facilitators to uptake, of on-site chlamydia screening. Methods In 2016–17 we conducted a qualitative study in the interpretative tradition using face to face or telephone semi-structured interviews with students (n = 26), teaching staff (n = 3) and field researchers (n = 4). Interviews were digitally recorded, transcribed and thematically analysed. Results From the student perspective, feelings of embarrassment and the potential for stigma were deterrents to sexually transmitted infection testing. While the non-medical setting was viewed as mitigating against stigma, for some students volunteering to be screened exposed them to detrimental judgements by their peers. A small financial incentive to be screened was regarded as legitimising volunteering in a non-discrediting way. Staff and researchers confirmed these views. The very low level of knowledge about sexually transmitted infections influenced students to not view themselves as candidates for testing. There were also suggestions that some teenagers considered themselves invulnerable to sexually transmitted infections despite engaging in risky sexual behaviours. Students and researchers reported the strong influence peers had on uptake, or not, of sexually transmitted infection testing. Conclusions This study offers new insights into the acceptability of college-based sexually transmitted infection screening to young, multi-ethnic students. Future studies in similar high risk, hard to reach groups should consider linking testing with education about sexually transmitted infections, offering non stigmatising incentives and engaging peer influencers.
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Affiliation(s)
- Charlotte Fleming
- Population Health Research Institute, St George's, University of London, London, UK
| | - Vari M Drennan
- Centre for Health & Social Care Research, Kingston University & St George's, University of London, London, UK.
| | - Sarah Kerry-Barnard
- Population Health Research Institute, St George's, University of London, London, UK
| | - Fiona Reid
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | | | - S Tariq Sadiq
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Rachel Phillips
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | | | - Emma M Harding-Esch
- Institute for Infection and Immunity, St George's, University of London, London, UK.,Public Health England, London, UK
| | - Emma C Cousins
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Freya Yoward
- Population Health Research Institute, St George's, University of London, London, UK
| | - Pippa Oakeshott
- Population Health Research Institute, St George's, University of London, London, UK
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Kerry-Barnard S, Huntington S, Fleming C, Reid F, Sadiq ST, Drennan VM, Adams E, Oakeshott P. Near patient chlamydia and gonorrhoea screening and treatment in further education/technical colleges: a cost analysis of the 'Test n Treat' feasibility trial. BMC Health Serv Res 2020; 20:316. [PMID: 32299437 PMCID: PMC7160983 DOI: 10.1186/s12913-020-5062-5] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community-based screening may be one solution to increase testing and treatment of sexually transmitted infections in sexually active teenagers, but there are few data on the practicalities and cost of running such a service. We estimate the cost of running a 'Test n Treat' service providing rapid chlamydia (CT) and gonorrhoea (NG) testing and same day on-site CT treatment in technical colleges. METHODS Process data from a 2016/17 cluster randomised feasibility trial were used to estimate total costs and service uptake. Pathway mapping was used to model different uptake scenarios. Participants, from six London colleges, provided self-taken genitourinary samples in the nearest toilet. Included in the study were 509 sexually active students (mean 85/college): median age 17.9 years, 49% male, 50% black ethnicity, with a baseline CT and NG prevalence of 6 and 0.5%, respectively. All participants received information about CT and NG infections at recruitment. When the Test n Treat team visited, participants were texted/emailed invitations to attend for confidential testing. Three colleges were randomly allocated the intervention, to host (non-incentivised) Test n Treat one and four months after baseline. All six colleges hosted follow-up Test n Treat seven months after baseline when students received a £10 incentive (to participate). RESULTS The mean non-incentivised daily uptake per college was 5 students (range 1 to 17), which cost £237 (range £1082 to £88) per student screened, and £4657 (range £21,281 to £1723) per CT infection detected, or £13,970 (range £63,842 to £5169) per NG infection detected. The mean incentivised daily uptake was 19 students which cost £91 per student screened, and £1408/CT infection or £7042/NG infection detected. If daily capacity for screening were achieved (49 students/day), costs including incentives would be £47 per person screened and £925/CT infection or £2774/NG infection detected. CONCLUSIONS Delivering non-incentivised Test n Treat in technical colleges is more expensive per person screened than CT and NG screening in clinics. Targeting areas with high infection rates, combined with high, incentivised uptake could make costs comparable. TRIAL REGISTRATION ISRCTN58038795, Assigned August 2016, registered prospectively.
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Affiliation(s)
- Sarah Kerry-Barnard
- Population Health Research Institute, St George's, University of London, London, SW17 ORE, UK
| | - Susie Huntington
- Aquarius Population Health Limited, Unit 29, Tileyard Studios, Tileyard Rd, London, N7 9AH, UK.
| | - Charlotte Fleming
- Population Health Research Institute, St George's, University of London, London, SW17 ORE, UK
| | - Fiona Reid
- School of Population Health and Environmental Sciences, King's College London, London, SE1 1UL, UK
| | - S Tariq Sadiq
- Institute for Infection and Immunity, St George's, University of London, London, SW17 ORE, UK
| | - Vari M Drennan
- Centre for Health and Social Care Research, Kingston University and St George's University of London, London, SW17 ORE, UK
| | - Elisabeth Adams
- Aquarius Population Health Limited, Unit 29, Tileyard Studios, Tileyard Rd, London, N7 9AH, UK
| | - Pippa Oakeshott
- Population Health Research Institute, St George's, University of London, London, SW17 ORE, UK
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Avgerinou C, Gardner B, Kharicha K, Frost R, Liljas A, Elaswarapu R, Manthorpe J, Drennan VM, Goodman C, Iliffe S, Walters K. Health promotion for mild frailty based on behaviour change: Perceptions of older people and service providers. Health Soc Care Community 2019; 27:1333-1343. [PMID: 31148312 PMCID: PMC6771617 DOI: 10.1111/hsc.12781] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/22/2019] [Accepted: 04/26/2019] [Indexed: 06/02/2023]
Abstract
Mild frailty is common among older people, but it is potentially reversible with health promotion interventions. Behaviour change may be a key to preventing progression of frailty; however, we know little about what interventions work best and how a behaviour change approach would be perceived by this group. The aim of this study was to explore how mildly frail older people perceive health promotion based on behaviour change and what factors affect engagement with this approach. We conducted semi-structured interviews with 16 older people with mild frailty who received a pilot home-based behaviour change health promotion service, including a dyad of older person/family carer, and two service providers delivering the service in two diverse areas of South England. Interviews were audio-recorded, transcribed and thematically analysed. The concept of goal setting was acceptable to most participants, though the process of goal setting needed time and consideration. Goals on maintaining independence, monitoring of progress and receiving feedback were reported to increase motivation. Physical/mental capability and knowledge/perception of own needs were main determinants of the type of goals chosen by participants as well as the approach used by the project workers. Older people with complex needs benefited from care coordination, with a combination of goal setting and elements of social, practical and emotional support in varying proportions. Mildly frail older people responded well to a behaviour change approach to promote health and well-being. Further consideration is needed of the most effective strategies based on complexity of needs, and how to overcome barriers among people with cognitive impairment.
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Affiliation(s)
- Christina Avgerinou
- Department of Primary Care and Population HealthUniversity College LondonLondonUK
| | | | - Kalpa Kharicha
- Department of Primary Care and Population HealthUniversity College LondonLondonUK
| | - Rachael Frost
- Department of Primary Care and Population HealthUniversity College LondonLondonUK
| | - Ann Liljas
- Department of Primary Care and Population HealthUniversity College LondonLondonUK
| | - Rekha Elaswarapu
- Age UK Ealing (Patient and Public Involvement and Engagement representative)LondonUK
| | - Jill Manthorpe
- Social Care Workforce Research UnitKing’s College LondonLondonUK
| | - Vari M. Drennan
- Centre for Health and Social Care ResearchKingston University and St George’s, University of LondonLondonUK
| | - Claire Goodman
- Centre for Research in Primary and Community CareUniversity of HertfordshireHatfieldUK
| | - Steve Iliffe
- Department of Primary Care and Population HealthUniversity College LondonLondonUK
| | - Kate Walters
- Department of Primary Care and Population HealthUniversity College LondonLondonUK
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17
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Taylor F, Halter M, Drennan VM. Understanding patients' satisfaction with physician assistant/associate encounters through communication experiences: a qualitative study in acute hospitals in England. BMC Health Serv Res 2019; 19:603. [PMID: 31455342 PMCID: PMC6712610 DOI: 10.1186/s12913-019-4410-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 08/06/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Physician assistants/associates (PAs) are a recent innovation in acute hospital teams in England and many other countries worldwide. Although existing evidence indicates generally high levels of patient satisfaction with their PA hospital encounters, little is known about the factors associated with this outcome. There is a lack of evidence on the process of PA-patient communication in hospital encounters and how this might influence satisfaction. This study therefore aimed to understand patients' satisfaction with PA acute hospital encounters through PA-patient communication experiences. METHODS A qualitative study was conducted among patients and representatives of patients seen by or receiving care from one of the PAs working in acute hospital services in England. Semi-structured interviews were undertaken face-to-face with study participants in the hospital setting and shortly after their PA encounter. Data were coded and analysed using thematic analysis. The study was framed within a theoretical model of core functions of medical encounter communication. RESULTS Fifteen patients and patient representatives who had experienced a PA encounter participated in interviews, across five hospitals in England. Four interrelated communication experiences were important to participants who were satisfied with the encounter in general: feeling trust and confidence in the relationship, sharing relevant and meaningful information, experiencing emotional care and support, and sharing discussion on illness management and treatment. However, many participants misconceived PAs to be doctors, raising a potential risk of reduced trust in the PA relationship and negative implications for satisfaction with their PA encounter. Participants considered it beneficial that patients be informed about the PA role to prevent confusion. CONCLUSIONS PA encounters offer a constructive example of successful clinician-patient communication experiences in acute hospital encounters from the patient's perspective. Study participants were generally naïve to the PA role. Hospital services and organisations introducing these mid-level or advanced care practitioner roles should consider giving attention to informing patients about the roles.
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Affiliation(s)
- Francesca Taylor
- Centre for Health & Social Care Research, Joint Faculty of Kingston University & St George's University of London, St George's University of London, Cranmer Terrace, London, SW17 0RE, UK.
| | - Mary Halter
- Centre for Health & Social Care Research, Joint Faculty of Kingston University & St George's University of London, St George's University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Vari M Drennan
- Centre for Health & Social Care Research, Joint Faculty of Kingston University & St George's University of London, St George's University of London, Cranmer Terrace, London, SW17 0RE, UK
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Abstract
INTRODUCTION Nurses comprise half the global health workforce. A nine million shortage estimated in 2014 is predicted to decrease by two million by 2030 but disproportionality effect regions such as Africa. This scoping review investigated: what is known about current nurse workforces and shortages and what can be done to forestall such shortages? SOURCES OF DATA Published documents from international organisations with remits for nursing workforces, published reviews with forward citation and key author searches. AREAS OF AGREEMENT Addressing nurse shortages requires a data informed, country specific model of the routes of supply and demand. It requires evidence informed policy and resource allocation at national, subnational and organisation levels. AREAS OF CONTROVERSY The definition in law, type of education, levels and scope of practice of nurses varies between countries raising questions of factors and evidence underpinning such variation. Most policy solutions proposed by international bodies draws on data and research about the medical workforce and applies that to nurses, despite the different demographic profile, the work, the career options, the remuneration and the status. GROWING POINTS Demand for nurses is increasing in all countries. Better workforce planning in nursing is crucial to reduce health inequalities and ensure sustainable health systems. AREAS TIMELY FOR DEVELOPING RESEARCH Research is needed on: the nursing workforce in low income countries and in rural and remote areas; on the impact of scope of practice and task-shifting changes; on the impact over time of implementing system wide policies as well as raising the profile of nursing.
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Affiliation(s)
- Vari M Drennan
- Centre for Health & Social Care Research, Joint Faculty of Kingston University & St. George's University of London, St. George's University of London, Cranmer Terrace, London ,UK
| | - Fiona Ross
- Centre for Health & Social Care Research, Joint Faculty of Kingston University & St. George's University of London, St. George's University of London, Cranmer Terrace, London ,UK
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19
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Drennan VM, Halter M, Wheeler C, Nice L, Brearley S, Ennis J, Gabe J, Gage H, Levenson R, de Lusignan S, Begg P, Parle J. The role of physician associates in secondary care: the PA-SCER mixed-methods study. Health Serv Deliv Res 2019. [DOI: 10.3310/hsdr07190] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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
BackgroundIncreasing demand for hospital services and staff shortages has led NHS organisations to review workforce configurations. One solution has been to employ physician associates (PAs). PAs are trained over 2 years at postgraduate level to work to a supervising doctor. Little is currently known about the roles and impact of PAs working in hospitals in England.Objectives(1) To investigate the factors influencing the adoption and deployment of PAs within medical and surgical teams in secondary care and (2) to explore the contribution of PAs, including their impact on patient experiences, organisation of services, working practices, professional relationships and service costs, in acute hospital care.MethodsThis was a mixed-methods, multiphase study. It comprised a systematic review, a policy review, national surveys of medical directors and PAs, case studies within six hospitals utilising PAs in England and a pragmatic retrospective record review of patients in emergency departments (EDs) attended by PAs and Foundation Year 2 (FY2) doctors.ResultsThe surveys found that a small but growing number of hospitals employed PAs. From the case study element, it was found that medical and surgical teams mainly used PAs to provide continuity to the inpatient wards. Their continuous presence contributed to smoothing patient flow, accessibility for patients and nurses in communicating with doctors and releasing doctors’ (of all grades) time for more complex patients and for attending to patients in clinic and theatre settings. PAs undertook significant amounts of ward-based clinical administration related to patients’ care. The lack of authority to prescribe or order ionising radiation restricted the extent to which PAs assisted with the doctors’ workloads, although the extent of limitation varied between teams. A few consultants in high-dependency specialties considered that junior doctors fitted their team better. PAs were reported to be safe, as was also identified from the review of ED patient records. A comparison of a random sample of patient records in the ED found no difference in the rate of unplanned return for the same problem between those seen by PAs and those seen by FY2 doctors (odds ratio 1.33, 95% confidence interval 0.69 to 2.57;p = 0.40). In the ED, PAs were also valued for the continuity they brought and, as elsewhere, their input in inducting doctors in training into local clinical and hospital processes. Patients were positive about the care PAs provided, although they were not able to identify what or who a PA was; they simply saw them as part of the medical or surgical team looking after them. Although the inclusion of PAs was thought to reduce the need for more expensive locum junior doctors, the use of PAs was primarily discussed in terms of their contribution to patient safety and patient experience in contrast to utilising temporary staff.LimitationsPAs work within medical and surgical teams, such that their specific impact cannot be distinguished from that of the whole team.ConclusionsPAs can provide a flexible advanced clinical practitioner addition to the secondary care workforce without drawing from existing professions. However, their utility in the hospital setting is unlikely to be fully realised without the appropriate level of regulation and attendant authority to prescribe medicines and order ionising radiation within their scope of practice.Future researchComparative investigation is required of patient experience, outcomes and service costs in single, secondary care specialties with and without PAs and in comparison with other types of advanced clinical practitioners.Study registrationThe systematic review component of this study is registered as PROSPERO CRD42016032895.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Vari M Drennan
- Centre for Health and Social Care Research, Joint Faculty of Kingston University and St George’s, University of London, London, UK
| | - Mary Halter
- Centre for Health and Social Care Research, Joint Faculty of Kingston University and St George’s, University of London, London, UK
| | - Carly Wheeler
- Centre for Health and Social Care Research, Joint Faculty of Kingston University and St George’s, University of London, London, UK
| | - Laura Nice
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Sally Brearley
- Centre for Public Engagement, Joint Faculty of Kingston University and St George’s, University of London, London, UK
| | - James Ennis
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Jon Gabe
- Royal Holloway, University of London, Egham, UK
| | - Heather Gage
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | | | - Simon de Lusignan
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Phil Begg
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Jim Parle
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
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20
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Drennan VM, Halter M, Wheeler C, Nice L, Brearley S, Ennis J, Gabe J, Gage H, Levenson R, de Lusignan S, Begg P, Parle J. What is the contribution of physician associates in hospital care in England? A mixed methods, multiple case study. BMJ Open 2019; 9:e027012. [PMID: 30700491 PMCID: PMC6359738 DOI: 10.1136/bmjopen-2018-027012] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To investigate the deployment of physician associates (PAs); the factors supporting and inhibiting their employment and their contribution and impact on patients' experience and outcomes and the organisation of services. DESIGN Mixed methods within a case study design, using interviews, observations, work diaries and documentary analysis. SETTING Six acute care hospitals in three regions of England in 2016-2017. PARTICIPANTS 43 PAs, 77 other health professionals, 28 managers, 28 patients and relatives. RESULTS A key influencing factor supporting the employment of PAs in all settings was a shortage of doctors. PAs were found to be acceptable, appropriate and safe members of the medical/surgical teams by the majority of doctors, managers and nurses. They were mainly deployed to undertake inpatient ward work in the medical/surgical team during core weekday hours. They were reported to positively contribute to: continuity within their medical/surgical team, patient experience and flow, inducting new junior doctors, supporting the medical/surgical teams' workload, which released doctors for more complex patients and their training. The lack of regulation and attendant lack of authority to prescribe was seen as a problem in many but not all specialties. The contribution of PAs to productivity and patient outcomes was not quantifiable separately from other members of the team and wider service organisation. Patients and relatives described PAs positively but most did not understand who and what a PA was, often mistaking them for doctors. CONCLUSIONS This study offers new insights concerning the deployment and contribution of PAs in medical and surgical specialties in English hospitals. PAs provided a flexible addition to the secondary care workforce without drawing from existing professions. Their utility in the hospital setting is unlikely to be completely realised without the appropriate level of regulation and authority to prescribe medicines and order ionising radiation within their scope of practice.
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Affiliation(s)
- Vari M Drennan
- Centre for Health and Social Care Research, Joint Faculty of Kingston University and St. George's University of London, London, UK
| | - Mary Halter
- Centre for Health and Social Care Research, Joint Faculty of Kingston University and St. George's University of London, London, UK
| | - Carly Wheeler
- Centre for Health and Social Care Research, Joint Faculty of Kingston University and St. George's University of London, London, UK
| | - Laura Nice
- Institute of Clinical Sciences, University of Birmingham, London, UK
| | - Sally Brearley
- Centre for Public Engagement, Joint Faculty of Kingston University and St. George's University of London, London, UK
| | - James Ennis
- Institute of Clinical Sciences, University of Birmingham, London, UK
| | - Jonathan Gabe
- Department of Criminology and Sociology, School of Law, Royal Holloway, University of London, Egham, UK
| | - Heather Gage
- Surrey Health Economics Centre, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | | | - Simon de Lusignan
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Phil Begg
- Royal Orthopaedic Hospital, Birmingham, UK
| | - James Parle
- Institute of Clinical Sciences, University of Birmingham, London, UK
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21
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Oakeshott P, Kerry-Barnard S, Fleming C, Phillips R, Drennan VM, Adams EJ, Majewska W, Harding-Esch EM, Cousins EC, Planche T, Green A, Bartholomew RI, Sadiq ST, Reid F. 'Test n Treat' (TnT): a cluster randomized feasibility trial of on-site rapid Chlamydia trachomatis tests and treatment in ethnically diverse, sexually active teenagers attending technical colleges. Clin Microbiol Infect 2018; 25:865-871. [PMID: 30391581 DOI: 10.1016/j.cmi.2018.10.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 10/24/2018] [Accepted: 10/25/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES We conducted a cluster-randomized feasibility trial of 90-minute Chlamydia trachomatis tests and same day on-site treatment ('Test n Treat/TnT') in six technical colleges in London, England, to assess TnT uptake rates; follow-up rates; prevalence of C. trachomatis at baseline and 7 months; time to treatment; acceptability of TnT. METHODS Participants completed questionnaires and provided genitourinary samples at baseline and 7 months. Participants were informed that baseline samples would not be tested for 7 months and were advised to get screened independently. Colleges were randomly allocated 1:1 to intervention (TnT) or control (no TnT). One month and 4 months post recruitment, participants at intervention colleges were texted invitations for on-site free C. trachomatis tests. A purposive sample of students who did/did not attend for screening were interviewed (n = 26). RESULTS Five hundred and nine sexually active students were recruited: median age 17.9 years, 47% male, 50% black ethnicity, 55% reporting two or more sexual partners in the previous year. TnT uptake was 13% (33/259; 95% CI 8.9-17.4%) at 1 month and 10% (26/259; 6.7-14.4%) at 4 months with overall C. trachomatis positivity 5.1% (3/59; 1.1-14.2%). Follow-up at 7 months was 62% (317/509) for questionnaires and 52% (264/509) for samples. C. trachomatis prevalence was 6.2% (31/503) at baseline and 6.1% (16/264) at 7 months. Median time from test to treatment was 15 h. Interviews suggested low test uptake was associated with not feeling at risk, perceptions of stigma, and little knowledge of sexually transmitted infections (STIs). CONCLUSIONS Despite high C. trachomatis rates at baseline and follow-up, uptake of testing was low. Like many countries, England urgently needs better sex education, including making STI testing routine/normal. Trial registration ISRCTN58038795.
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Affiliation(s)
- P Oakeshott
- Population Health Research Institute, St George's, University of London, London UK.
| | - S Kerry-Barnard
- Population Health Research Institute, St George's, University of London, London UK
| | - C Fleming
- Population Health Research Institute, St George's, University of London, London UK
| | - R Phillips
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - V M Drennan
- Centre for Health & Social Care Research, Kingston University & St George's, University of London, London, UK
| | - E J Adams
- Aquarius Population Health Limited, London, UK
| | | | - E M Harding-Esch
- Institute for Infection and Immunity, St George's, University of London, London, UK; Public Health England, London, UK
| | - E C Cousins
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - T Planche
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - A Green
- Population Health Research Institute, St George's, University of London, London UK
| | - R I Bartholomew
- Population Health Research Institute, St George's, University of London, London UK; Institute for Infection and Immunity, St George's, University of London, London, UK
| | - S T Sadiq
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - F Reid
- School of Population Health and Environmental Sciences, King's College London, London, UK
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Abstract
OBJECTIVE To appraise and synthesise research on the impact of physician assistants/associates (PA) in secondary care, specifically acute internal medicine, care of the elderly, emergency medicine, trauma and orthopaedics, and mental health. DESIGN Systematic review. SETTING Electronic databases (Medline, Embase, ASSIA, CINAHL, SCOPUS, PsycINFO, Social Policy and Practice, EconLit and Cochrane), reference lists and related articles. INCLUDED ARTICLES Peer-reviewed articles of any study design, published in English, 1995-2017. INTERVENTIONS Blinded parallel processes were used to screen abstracts and full text, data extractions and quality assessments against published guidelines. A narrative synthesis was undertaken. OUTCOME MEASURES Impact on: patients' experiences and outcomes, service organisation, working practices, other professional groups and costs. RESULTS 5472 references were identified and 161 read in full; 16 were included-emergency medicine (7), trauma and orthopaedics (6), acute internal medicine (2), mental health (1) and care of the elderly (0). All studies were observational, with variable methodological quality. In emergency medicine and in trauma and orthopaedics, when PAs are added to teams, reduced waiting and process times, lower charges, equivalent readmission rate and good acceptability to staff and patients are reported. Analgesia prescribing, operative complications and mortality outcomes were variable. In internal medicine outcomes of care provided by PAs and doctors were equivalent. CONCLUSIONS PAs have been deployed to increase the capacity of a team, enabling gains in waiting time, throughput, continuity and medical cover. When PAs were compared with medical staff, reassuringly there was little or no negative effect on health outcomes or cost. The difficulty of attributing cause and effect in complex systems where work is organised in teams is highlighted. Further rigorous evaluation is required to address the complexity of the PA role, reporting on more than one setting, and including comparison between PAs and roles for which they are substituting. PROSPERO REGISTRATION NUMBER CRD42016032895.
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Affiliation(s)
- Mary Halter
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
| | - Carly Wheeler
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
| | - Ferruccio Pelone
- National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London, UK
| | - Heather Gage
- School of Economics, University of Surrey, Guildford, Surrey, UK
| | - Simon de Lusignan
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, Surrey, UK
| | - Jim Parle
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Robert Grant
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
| | - Jonathan Gabe
- Centre for Criminology and Sociology, School of Law, Royal Holloway, University of London, London, UK
| | - Laura Nice
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Vari M Drennan
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
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Drennan VM, Calestani M, Ross F, Saunders M, West P. Tackling the workforce crisis in district nursing: can the Dutch Buurtzorg model offer a solution and a better patient experience? A mixed methods case study. BMJ Open 2018; 8:e021931. [PMID: 29880574 PMCID: PMC6009560 DOI: 10.1136/bmjopen-2018-021931] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
UNLABELLED Despite policy intentions for more healthcare out of hospital, district nursing services face multiple funding and staffing challenges, which compromise the care delivered and policy objectives. OBJECTIVES What is the impact of the adapted Buurtzorg model on feasibility, acceptability and effective outcomes in an English district nursing service? DESIGN Mixed methods case study. SETTING Primary care. PARTICIPANTS Neighbourhood nursing team (Buurtzorg model), patients and carers, general practitioners (GPs), other health professionals, managers and conventional district nurses. RESULTS The adapted Buurtzorg model of community nursing demonstrated feasibility and acceptability to patients, carers, GPs and other health professionals. For many patients, it was preferable to previous experiences of district nursing in terms of continuity in care, improved support of multiple long-term conditions (encompassing physical, mental and social factors) and proactive care. For the neighbourhood nurses, the ability to make operational and clinical decisions at team level meant adopting practices that made the service more responsive, accessible and efficient and offered a more attractive working environment. Challenges were reported by nurses and managers in relation to the recognition and support of the concept of self-managing teams within a large bureaucratic healthcare organisation. While there were some reports of clinical effectiveness and efficiency, this was not possible to quantify, cost or compare with the standard district nursing service. CONCLUSIONS The adapted Buurtzorg model of neighbourhood nursing holds potential for addressing issues of concern to patients, carers and staff in the community. The two interacting innovations, that is, a renewed focus on patient and carer-centred care and the self-managing team, were implemented in ways that patients, carers, other health professionals and nurses could identify difference for both the nursing care and also the nurses' working lives. It now requires longer term investigation to understand both the mechanism for change and also the sustainability.
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Affiliation(s)
- Vari M Drennan
- Centre for Health and Social Care Research, Kingston University Faculty of Health Social Care and Education, London, UK
| | - Melania Calestani
- Centre for Health and Social Care Research, Kingston University Faculty of Health Social Care and Education, London, UK
| | - Fiona Ross
- Centre for Health and Social Care Research, Kingston University Faculty of Health Social Care and Education, London, UK
| | | | - Peter West
- Independent health economist, London, UK
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Kerry-Barnard S, Fleming C, Reid F, Phillips R, Drennan VM, Adams EJ, Majewska W, Balendra A, Harding-Esch E, Cousins E, Tariq Sadiq S, Oakeshott P. 'Test n Treat (TnT)'- Rapid testing and same-day, on-site treatment to reduce rates of chlamydia in sexually active further education college students: study protocol for a cluster randomised feasibility trial. Trials 2018; 19:311. [PMID: 29871673 PMCID: PMC5989383 DOI: 10.1186/s13063-018-2674-8] [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] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 05/04/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Sexually active young people attending London further education (FE) colleges have high rates of chlamydia, but screening rates are low. We will conduct a cluster randomised feasibility trial of frequent, rapid, on-site chlamydia testing and same-day treatment (Test and Treat (TnT)) in six FE colleges (with parallel qualitative and economic assessments) to assess the feasibility of conducting a future trial to investigate if TnT reduces chlamydia rates. METHODS We will recruit 80 sexually active students aged 16-24 years from public areas at each of six colleges. All participants (total n = 480) will be asked to provide samples (urine for males, self-taken vaginal swabs for females) and complete questionnaires on sexual lifestyle and healthcare use at baseline and after 7 months. Participants will be informed that baseline samples will not be tested for 7 months and be advised to get screened separately. Colleges will be randomly allocated to the intervention (TnT) or the control group (no TnT). One and 4 months after recruitment, participants at each intervention college (n = 3) will be texted and invited for on-site chlamydia tests using the 90-min Cepheid GeneXpert system. Students with positive results will be asked to see a visiting nurse health adviser for same-day treatment and partner notification, (backed by genitourinary medicine follow-up). Participants in control colleges (n = 3) will receive 'thank you' texts 1 and 4 months after recruitment. Seven months after recruitment, participants from both groups will be invited to complete questionnaires and provide samples for TnT. All samples will be tested, and same-day treatment offered to students with positive results. Acceptability of TnT will be assessed by qualitative interviews of purposively sampled students (n = 30) and college staff (n = 12). We will collect data on costs of TnT and usual healthcare. DISCUSSION Findings will provide key values to inform feasibility, sample size and timescales of a future definitive trial of TnT in FE colleges, including: Recruitment rates TnT uptake rates Follow-up rates Prevalence of chlamydia in participants at baseline and 7 months Acceptability of TnT to students and college staff Estimate of the cost per person screened/treated in TnT versus usual care TRIAL REGISTRATION: International Standard Randomised Controlled Trials Registry, ID: ISRCTN58038795 , Registered on 31 August 2016.
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Affiliation(s)
- Sarah Kerry-Barnard
- Population Health Research Institute, St George’s, University of London, London, SW17ORE UK
| | - Charlotte Fleming
- Population Health Research Institute, St George’s, University of London, London, SW17ORE UK
| | - Fiona Reid
- Department of Primary Care and Public Health Sciences, King’s College London, 4th Floor, Addison House, Guy’s Campus, London, SE1 1UL UK
| | - Rachel Phillips
- Department of Primary Care and Public Health Sciences, King’s College London, 4th Floor, Addison House, Guy’s Campus, London, SE1 1UL UK
| | - Vari M. Drennan
- Centre for Health and Social Care Research, Kingston University and St George’s University of London, London, SW17ORE UK
| | - Elisabeth J. Adams
- Aquarius Population Health Limited, 58a Highgate High Street, London, N6 5HX UK
| | - Wendy Majewska
- WEM Consultancy Ltd., 96 Tantallon Road, London, SW12 8DH UK
| | - Anjella Balendra
- Population Health Research Institute, St George’s, University of London, London, SW17ORE UK
| | - Emma Harding-Esch
- Infection and Immunity, St George’s, University of London, London, SW17ORE UK
| | - Emma Cousins
- Infection and Immunity, St George’s, University of London, London, SW17ORE UK
| | - S. Tariq Sadiq
- Infection and Immunity, St George’s, University of London, London, SW17ORE UK
| | - Pippa Oakeshott
- Population Health Research Institute, St George’s, University of London, London, SW17ORE UK
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Goodman C, Norton C, Buswell M, Russell B, Harari D, Harwood R, Roe B, Rycroft-Malone J, Drennan VM, Fader M, Maden M, Cummings K, Bunn F. Managing Faecal INcontinence in people with advanced dementia resident in Care Homes (FINCH) study: a realist synthesis of the evidence. Health Technol Assess 2018; 21:1-220. [PMID: 28805188 DOI: 10.3310/hta21420] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Eighty per cent of care home residents in the UK are living with dementia. The prevalence of faecal incontinence (FI) in care homes is estimated to range from 30% to 50%. There is limited evidence of what is effective in the reduction and management of FI in care homes. OBJECTIVE To provide a theory-driven explanation of the effectiveness of programmes that aim to improve FI in people with advanced dementia in care homes. DESIGN A realist synthesis. This was an iterative approach that involved scoping of the literature and consultation with five stakeholder groups, a systematic search and analysis of published and unpublished evidence, and a validation of programme theories with relevant stakeholders. DATA SOURCES The databases searched included PubMed, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library, Scopus, SocAbs, Applied Social Sciences Index and Abstracts, BiblioMap, Sirius, OpenGrey, Social Care Online and the National Research Register. RESULTS The scoping identified six programme theories with related context-mechanism-outcome configurations for testing. These addressed (1) clinician-led support, assessment and review, (2) the contribution of teaching and support for care home staff on how to reduce and manage FI, (3) the causes and prevention of constipation, (4) how the cognitive and physical capacity of the resident affect outcomes, (5) how the potential for recovery, reduction and management of FI is understood by those involved and (6) how the care of people living with dementia and FI is integral to the work patterns of the care home and its staff. Data extraction was completed on 62 core papers with iterative searches of linked literature. Dementia was a known risk factor for FI, but its affect on the uptake of different interventions and the dementia-specific continence and toileting skills staff required was not addressed. Most care home residents with FI will be doubly incontinent and, therefore, there is limited value in focusing solely on FI or on single causes of FI such as constipation. Clinical assessment, knowledge of the causes of FI and strategies that recognise the individuals' preferences are necessary contextual factors. Valuing the intimate and personal care work that care home staff provide to people living with dementia and addressing the dementia-related challenges when providing continence care within the daily work routines are key to helping to reduce and manage FI in this population. LIMITATIONS The synthesis was constrained by limited evidence specific to FI and people with dementia in care homes and by the lack of dementia-specific evidence on continence aids. CONCLUSIONS This realist synthesis provides a theory-driven understanding of the conditions under which improvement in care for care home residents living with dementia and FI is likely to be successful. FUTURE WORK Future multicomponent interventions need to take account of how the presence of dementia affects the behaviours and choices of those delivering and receiving continence care within a care home environment. STUDY REGISTRATION This study is registered as PROSPERO CRD42014009902. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Christine Norton
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Marina Buswell
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Bridget Russell
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Danielle Harari
- Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Division of Health and Social Care, King's College London, London, UK
| | - Rowan Harwood
- Health Care of Older People, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
| | - Brenda Roe
- Faculty of Health and Social Care, Edge Hill University, Ormskirk, UK
| | | | - Vari M Drennan
- Centre for Health and Social Care Research, Faculty of Health, Social Care and Education, Kingston and St George's, London, UK
| | - Mandy Fader
- Health Sciences, University of Southampton, Southampton, UK
| | - Michelle Maden
- School of Health Sciences, University of Liverpool, Liverpool, UK
| | | | - Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
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Drennan VM. More care out of hospital? A qualitative exploration of the factors influencing the development of the district nursing workforce in England. J Health Serv Res Policy 2018; 24:11-18. [PMID: 29754532 PMCID: PMC6304681 DOI: 10.1177/1355819618769082] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives Many countries seek to improve care for people with chronic conditions and
increase delivery of care outside of hospitals, including in the home.
Despite these policy objectives in the United Kingdom, the home visiting
nursing service workforce, known as district nursing, is declining. This
study aimed to investigate the factors influencing the development of
district nursing workforces in a metropolitan area of England. Methods A qualitative study in a metropolitan area of three million residents in
diverse socio-economic communities using semi-structured interviews with a
purposive sample of senior nurses in provider and commissioning
organizations. Thematic analysis was framed by theories of workforce
development. Findings: All participants reported that the context for the
district nursing service was one of major reorganizations in the face of
wider National Health Service changes and financial pressures. The analysis
identified five themes that can be seen to impact the ways in which the
district nursing workforce was developed. These were: the challenge of
recruitment and retention, a changing case-mix of patients and the
requirement for different clinical skills, the growth of specialist home
visiting nursing services and its impact on generalist nursing, the capacity
of the district nursing service to meet growing demand, and the influence of
the short-term service commissioning process on the need for long-term
workforce development. Conclusion There is an apparent paradox between health policies which promote more care
within and closer to home and the reported decline in district nursing
services. Using the lens of workforce development theory, an explanatory
framework was offered with factors such as the nature of the nursing labour
market, human resource practices, career advancement opportunities as well
as the contractual context and the economic environment.
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Affiliation(s)
- Vari M Drennan
- Professor of Health Care & Policy Research, Centre for Health & Social Care Research, Faculty of Health, Social Care & Education, Kingston University and St George's University of London, UK
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27
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Frost R, Kharicha K, Jovicic A, Liljas AEM, Iliffe S, Manthorpe J, Gardner B, Avgerinou C, Goodman C, Drennan VM, Walters K. Identifying acceptable components for home-based health promotion services for older people with mild frailty: A qualitative study. Health Soc Care Community 2018; 26:393-403. [PMID: 29210136 DOI: 10.1111/hsc.12526] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/06/2017] [Indexed: 06/07/2023]
Abstract
Mild frailty is common in later life, increasing the risk of hospitalisation, loss of independence and premature death. Targeted health promotion services may reduce adverse outcomes and increase quality of life; however, effective, well-developed theory-based interventions are lacking. We aimed to explore perceptions of health promotion behaviours undertaken by older people with mild frailty, barriers and facilitators to engagement, and identify potential components for new home-based health promotion services. We carried out 17 semi-structured qualitative interviews and six focus groups with 53 stakeholders, including 14 mildly frail older people, 12 family carers, 19 community health and social care professionals, and 8 homecare workers, in one urban and one semi-rural area of England. Transcripts were thematically analysed. Older people with mild frailty reported engaging in a variety of lifestyle behaviours to promote health and well-being. Key barriers or facilitators to engaging in these included transport, knowledge of local services, social support and acceptance of personal limitations. Older people, carers and professionals agreed that any new service should address social networks and mobility and tailor other content to each individual. Services should aim to increase motivation through focussing on independence and facilitate older people to continue carrying out behaviours that improve their well-being, as well as provide information, motivation, psychological support and practical support. Stakeholders agreed services should be delivered over a sustained period by trained non-specialist workers. New services including these components are likely to be acceptable to older people with mild frailty.
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Affiliation(s)
- Rachael Frost
- Department of Primary Care and Population Health, University College London, London, UK
| | - Kalpa Kharicha
- Department of Primary Care and Population Health, University College London, London, UK
| | - Ana Jovicic
- Department of Primary Care and Population Health, University College London, London, UK
| | - Ann E M Liljas
- Department of Primary Care and Population Health, University College London, London, UK
| | - Steve Iliffe
- Department of Primary Care and Population Health, University College London, London, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King's College London, London, UK
| | | | - Christina Avgerinou
- Department of Primary Care and Population Health, University College London, London, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hertfordshire, UK
| | - Vari M Drennan
- Centre for Health and Social Care Research, Kingston University & St Georges, University of London, London, UK
| | - Kate Walters
- Department of Primary Care and Population Health, University College London, London, UK
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Affiliation(s)
- Vari M Drennan
- Joint Faculty of Kingston University and St George's University of London, London SW17 0RE, UK
| | | | | | - Jon Gabe
- Royal Holloway University of London, Egham TW20 0EX, UK
| | - Mary Halter
- Joint Faculty of Kingston University and St George's University of London, London SW17 0RE, UK
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Abstract
Purpose
The purpose of this paper is to discuss the question of how to meet the needs of older people living at home with dementia who have problems with continence. The paper is focused on social care practice in community settings.
Design/methodology/approach
This paper is practice focused and draws on the authors’ research and experiences in clinical care, workforce development and service improvement.
Findings
This paper summarises research on incontinence and its negative effects on quality of life and care relationships. It describes the impact of incontinence in terms of social embarrassment, restricted social activity, extra work (such as laundry) and costs, but also distress. It links research with care practice, with a focus on people with dementia who may be at particular risk of both continence problems and of assumptions that nothing can be done to assist them.
Social implications
This paper provides questions that could be addressed in commissioning and provision of services and argues that they need to be informed by care practitioners’ experiences. It provides details of sources of support that are available at national and local levels.
Originality/value
This paper draws together research on continence and social care practice to provide a series of self-assessment questions for local services. It focuses on social care workers who are at the frontline of practice including personal assistants and carers.
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30
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Abstract
Dementia is a distressing condition in which individuals progressively require the support of others. Many people experience problems with incontinence and continence management. The presence of incontinence is influential in decisions for people with dementia to move into a care home. This study, in the interpretative tradition, investigates for the first time the person with dementia’s perspective on these problems and their strategies for managing them. We conducted semi-structured conversational interviews with seven people with mild-to-moderate dementia and analysed the transcripts thematically. Our participants described both a variety of problems with incontinence and continence management, and their embarrassment and humiliation. Strategies included managing their presentation of self to others to keep such problems hidden, although it was evident that for some their cognitive problems led to strategies that were potentially problematic for others. In addition, some described the ways in which they acted to protect others, such as spouses, from the stigmatising effect of the incontinence.
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Affiliation(s)
| | - Vari M Drennan
- Kingston University and St.George's University of London, UK
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31
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Wheeler C, Halter M, Drennan VM, de Lusignan S, Grant R, Gabe J, Gage H, Begg P, Ennis J, Parle J. Physician associates working in secondary care teams in England: Interprofessional implications from a national survey. J Interprof Care 2017; 31:774-776. [PMID: 28876145 DOI: 10.1080/13561820.2017.1341390] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Physician associates (PAs) are a new type of healthcare professional to the United Kingdom; however, they are well established in the United States (where they are known as physician assistants). PAs are viewed as one potential solution to the current medical workforce doctor shortage. This study investigated the deployment of PAs within secondary care teams in England, through the use of a cross-sectional electronic, self-report survey. The findings from 14 questions are presented. Sixty-three PAs working in a range of specialties responded. A variety of work settings were reported, most frequently inpatient wards, with work generally taking place during weekdays. Both direct and non-direct patient care activities were reported, with the type of work undertaken varying at times, depending on the presence or absence of other healthcare professionals. PAs reported working within a variety of secondary care team staffing permutations, with the majority of these being interprofessional. Line management was largely provided by consultants; however day-to-day supervision varied, often relating to different work settings. A wide variation in ongoing supervision was also reported. Further research is required to understand the nature of PAs' contribution to collaborative care within secondary care teams in England.
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Affiliation(s)
- Carly Wheeler
- a Faculty of Health, Social Care and Education , Kingston University and St George's, University of London , London , UK
| | - Mary Halter
- a Faculty of Health, Social Care and Education , Kingston University and St George's, University of London , London , UK
| | - Vari M Drennan
- a Faculty of Health, Social Care and Education , Kingston University and St George's, University of London , London , UK
| | - Simon de Lusignan
- b Department of Clinical and Experimental Medicine , University of Surrey , Guildford , UK
| | - Robert Grant
- a Faculty of Health, Social Care and Education , Kingston University and St George's, University of London , London , UK
| | - Jonathan Gabe
- c Centre for Criminology and Sociology, School of Law, Royal Holloway , University of London , London , UK
| | - Heather Gage
- d School of Economics , University of Surrey , Guildford , UK
| | - Philip Begg
- e The Royal Orthopaedic Hospital Birmingham NHS Foundation Trust , Birmingham , UK
| | - James Ennis
- f Institute of Clinical Sciences , University of Birmingham , Birmingham , UK
| | - Jim Parle
- f Institute of Clinical Sciences , University of Birmingham , Birmingham , UK
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Roe B, Goodman C, Russell B, Buswell M, Norton C, Harari D, Harwood R, Malone JR, Drennan VM, Fader M, Maden M, Bunn F. Management of Fecal Incontinence in Older People With Dementia Resident in Care Homes: A Realist Synthesis-The FINCH Study. J Am Med Dir Assoc 2017; 18:750-751. [PMID: 28739491 DOI: 10.1016/j.jamda.2017.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/01/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Brenda Roe
- Edge Hill University, Ormskirk, United Kingdom.
| | | | | | | | | | | | - Rowan Harwood
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | | | - Vari M Drennan
- St George's University of London and University of Kingston, Kingston, United Kingdom
| | - Mandy Fader
- University of Southampton, Southampton, United Kingdom
| | | | - Frances Bunn
- University of Hertfordshire, Hatfield, United Kingdom
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Buswell M, Goodman C, Roe B, Russell B, Norton C, Harwood R, Fader M, Harari D, Drennan VM, Malone JR, Madden M, Bunn F. What Works to Improve and Manage Fecal Incontinence in Care Home Residents Living With Dementia? A Realist Synthesis of the Evidence. J Am Med Dir Assoc 2017; 18:752-760.e1. [DOI: 10.1016/j.jamda.2017.05.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 05/26/2017] [Indexed: 01/06/2023]
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Frost R, Belk C, Jovicic A, Ricciardi F, Kharicha K, Gardner B, Iliffe S, Goodman C, Manthorpe J, Drennan VM, Walters K. Health promotion interventions for community-dwelling older people with mild or pre-frailty: a systematic review and meta-analysis. BMC Geriatr 2017; 17:157. [PMID: 28728570 PMCID: PMC5520298 DOI: 10.1186/s12877-017-0547-8] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [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: 02/15/2017] [Accepted: 07/11/2017] [Indexed: 12/20/2022] Open
Abstract
Background Mild or pre-frailty is common and associated with increased risks of hospitalisation, functional decline, moves to long-term care, and death. Little is known about the effectiveness of health promotion in reducing these risks. This systematic review aimed to synthesise randomised controlled trials (RCTs) evaluating home and community-based health promotion interventions for older people with mild/pre-frailty. Methods We searched 20 bibliographic databases and 3 trials registers (January 1990 – May 2016) using mild/pre-frailty and associated terms. We included randomised controlled and crossover trials of health promotion interventions for community-dwelling older people (65+ years) with mild/pre-frailty and excluded studies focussing on populations in hospital, long term care facilities or with a specific condition. Risk of bias was assessed by two reviewers using the Cochrane Risk of Bias tool. We pooled study results using standardised mean differences (SMD) where possible and used narrative synthesis where insufficient outcome data were available. Results We included 10 articles reporting on seven trials (total n = 506 participants) and included five trials in a meta-analysis. Studies were predominantly small, of limited quality and six studies tested group exercise alone. One study additionally investigated a nutrition and exercise intervention and one evaluated telemonitoring. Interventions of exercise in groups showed mixed effects on functioning (no effects on self-reported functioning SMD 0.19 (95% CI -0.57 to 0.95) n = 3 studies; positive effects on performance-based functioning SMD 0.37 (95% CI 0.07 to 0.68) n = 3 studies). No studies assessed moves to long-term care or hospitalisations. Conclusions Currently the evidence base is of insufficient size, quality and breadth to recommend specific health promotion interventions for older people with mild or pre- frailty. High quality studies of rigorously developed interventions are needed. PROSPERO registration CRD42014010370 (Review 2). Electronic supplementary material The online version of this article (doi:10.1186/s12877-017-0547-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rachael Frost
- Department of Primary Care and Population Health, University College London, London, UK
| | - Celia Belk
- Department of Primary Care and Population Health, University College London, London, UK
| | - Ana Jovicic
- Department of Primary Care and Population Health, University College London, London, UK
| | - Federico Ricciardi
- Department of Statistical Science, University College London, London, UK
| | - Kalpa Kharicha
- Department of Primary Care and Population Health, University College London, London, UK
| | | | - Steve Iliffe
- Department of Primary Care and Population Health, University College London, London, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hertfordshire, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King's College London, London, UK
| | - Vari M Drennan
- Centre for Health and Social Care Research, Kingston University & St George's, University of London, London, UK
| | - Kate Walters
- Department of Primary Care and Population Health, University College London, London, UK.
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Halter M, Drennan VM, Joly LM, Gabe J, Gage H, de Lusignan S. Patients' experiences of consultations with physician associates in primary care in England: A qualitative study. Health Expect 2017; 20:1011-1019. [PMID: 28429886 PMCID: PMC5600217 DOI: 10.1111/hex.12542] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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] [Accepted: 01/04/2017] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Physician associates are new to English general practice and set to expand in numbers. OBJECTIVE To investigate the patients' perspective on consulting with physician associates in general practice. DESIGN A qualitative study, using semi-structured interviews, with thematic analysis. SETTING AND PARTICIPANTS Thirty volunteer patients of 430 who had consulted physician associates for a same-day appointment and had returned a satisfaction survey, in six general practices employing physician associates in England. FINDINGS Some participants only consulted once with a physician associate and others more frequently. The conditions consulted for ranged from minor illnesses to those requiring immediate hospital admission. Understanding the role of the physician associate varied from 'certain and correct' to 'uncertain', to 'certain and incorrect', where the patient believed the physician associate to be a doctor. Most, but not all, reported positive experiences and outcomes of their consultation, with some choosing to consult the physician. Those with negative experiences described problems when the limits of the role were reached, requiring additional GP consultations or prescription delay. Trust and confidence in the physician associate was derived from trust in the NHS, the general practice and the individual physician associate. Willingness to consult a physician associate was contingent on the patient's assessment of the severity or complexity of the problem and the desire for provider continuity. CONCLUSION Patients saw physician associates as an appropriate general practitioner substitute. Patients' experience could inform delivery redesign.
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Affiliation(s)
- Mary Halter
- Faculty of Health, Social Care and Education, Kingston University and St George's University of London, London, UK
| | - Vari M Drennan
- Faculty of Health, Social Care and Education, Kingston University and St George's University of London, London, UK
| | - Louise M Joly
- Social Care Workforce Research Unit, King's College London, UK
| | - Jonathan Gabe
- Centre for Criminology & Sociology, School of Law, Royal Holloway, University of London, Egham, UK
| | - Heather Gage
- School of Economics, University of Surrey, Guildford, UK
| | - Simon de Lusignan
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
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Halter M, Wheeler C, Drennan VM, de Lusignan S, Grant R, Gabe J, Gage H, Ennis J, Parle J. Physician associates in England's hospitals: a survey of medical directors exploring current usage and factors affecting recruitment. Clin Med (Lond) 2017; 17:126-131. [PMID: 28365621 PMCID: PMC6297628 DOI: 10.7861/clinmedicine.17-2-126] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 11/27/2022]
Abstract
In the UK secondary care setting, the case for physician associates is based on the cover and stability they might offer to medical teams. We assessed the extent of their adoption and deployment - that is, their current usage and the factors supporting or inhibiting their inclusion in medical teams - using an electronic, self-report survey of medical directors of acute and mental health NHS trusts in England. Physician associates - employed in small numbers, in a range of specialties, in 20 of the responding trusts - were reported to have been employed to fill gaps in medical staffing and support medical specialty trainees. Inhibiting factors were commonly a shortage of physician associates to recruit and lack of authority to prescribe, as well as a lack of evidence and colleague resistance. Our data suggest there is an appetite for employment of physician associates while practical and attitudinal barriers are yet to be fully overcome.
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Affiliation(s)
- Mary Halter
- Kingston University and St George's, University of London, London, UK
| | - Carly Wheeler
- Kingston University and St George's, University of London, London, UK
| | - Vari M Drennan
- Kingston University and St George's, University of London, London, UK
| | | | - Robert Grant
- Kingston University and St George's, University of London, London, UK
| | - Jonathan Gabe
- School of Law, Royal Holloway, University of London, London, UK
| | | | - James Ennis
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Jim Parle
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
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Drennan VM, Gabe J, Halter M, de Lusignan S, Levenson R. Physician associates in primary health care in England: A challenge to professional boundaries? Soc Sci Med 2017; 181:9-16. [PMID: 28364578 DOI: 10.1016/j.socscimed.2017.03.045] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 03/17/2017] [Accepted: 03/22/2017] [Indexed: 10/19/2022]
Abstract
Like other health care systems, the National Health Service (NHS) in England has looked to new staffing configurations faced with medical staff shortages and rising costs. One solution has been to employ physician associates (PAs). PAs are trained in the medical model to assess, diagnose and commence treatment under the supervision of a physician. This paper explores the perceived effects on professional boundaries and relationships of introducing this completely new professional group. It draws on data from a study, completed in 2014, which examined the contribution of PAs working in general practice. Data were gathered at macro, meso and micro levels of the health care system. At the macro and meso level data were from policy documents, interviews with civil servants, senior members of national medical and nursing organisations, as well as regional level NHS managers (n = 25). At the micro level data came from interviews with General Practitioners, nurse practitioners and practice staff (n = 30) as well as observation of clinical and professional meetings. Analysis was both inductive and also framed by the existing theories of a dynamic system of professions. It is argued that professional boundaries become malleable and subject to negotiation at the micro level of service delivery. Stratification within professional groups created differing responses between those working at macro, meso and micro levels of the system; from acceptance to hostility in the face of a new and potentially competing, occupational group. Overarching this state agency was the requirement to underpin legislatively the shifts in jurisdictional boundaries, such as prescribing required for vertical substitution for some of the work of doctors.
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Affiliation(s)
- Vari M Drennan
- Faculty of Health, Social Care and Education, Kingston University and St. George's University of London, Cranmer Terrace, London, SW17 0RE, UK.
| | - Jonathon Gabe
- Centre for Criminology & Sociology, Royal Holloway, University of London, Egham Hill, Egham Surrey, TW20 0EX, UK.
| | - Mary Halter
- Faculty of Health, Social Care and Education, Kingston University and St. George's University of London, Cranmer Terrace, London, SW17 0RE, UK.
| | - Simon de Lusignan
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, Surrey, GU2 7PX, UK.
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Russell B, Buswell M, Norton C, Malone JR, Harari D, Harwood R, Roe B, Fader M, Drennan VM, Bunn F, Goodman C. Supporting people living with dementia and faecal incontinence. Br J Community Nurs 2017; 22:110-114. [PMID: 28252330 DOI: 10.12968/bjcn.2017.22.3.110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Bridget Russell
- Centre for Research in Primary and Community Care, University of Hertfordshire
| | - Marina Buswell
- Florence Nightingale School of Nursing & Midwifery, King's College London
| | | | - Jo Rycroft Malone
- Division of Health and Social Care, Department of Ageing and Health, Guys and St Thomas' NHS Trust, King's College London
| | - Danielle Harari
- Health Care of Older People Nottingham University Hospitals NHS Trust, University of Nottingham
| | - Rowan Harwood
- Faculty of Health and Social Care, Edge Hill University
| | - Brenda Roe
- Department of Health Sciences, University of Southampton
| | - Mandy Fader
- Faculty of Health, Social Care and Education, St Georges University of London and Kingston University
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Gardner B, Jovicic A, Belk C, Kharicha K, Iliffe S, Manthorpe J, Goodman C, Drennan VM, Walters K. Specifying the content of home-based health behaviour change interventions for older people with frailty or at risk of frailty: an exploratory systematic review. BMJ Open 2017; 7:e014127. [PMID: 28183809 PMCID: PMC5306507 DOI: 10.1136/bmjopen-2016-014127] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 11/06/2022] Open
Abstract
OBJECTIVES To identify trials of home-based health behaviour change interventions for frail older people, describe intervention content and explore its potential contribution to intervention effects. DESIGN 15 bibliographic databases, and reference lists and citations of key papers, were searched for randomised controlled trials of home-based behavioural interventions reporting behavioural or health outcomes. SETTING Participants' homes. PARTICIPANTS Community-dwelling adults aged ≥65 years with frailty or at risk of frailty. PRIMARY AND SECONDARY OUTCOME MEASURES Trials were coded for effects on thematically clustered behavioural, health and well-being outcomes. Intervention content was described using 96 behaviour change techniques, and 9 functions (eg, education, environmental restructuring). RESULTS 19 eligible trials reported 22 interventions. Physical functioning was most commonly assessed (19 interventions). Behavioural outcomes were assessed for only 4 interventions. Effectiveness on most outcomes was limited, with at most 50% of interventions showing potential positive effects on behaviour, and 42% on physical functioning. 3 techniques (instruction on how to perform behaviour, adding objects to environment, restructuring physical environment) and 2 functions (education and enablement) were more commonly found in interventions showing potential than those showing no potential to improve physical function. Intervention content was not linked to effectiveness on other outcomes. CONCLUSIONS Interventions appeared to have greatest impact on physical function where they included behavioural instructions, environmental modification and practical social support. Yet, mechanisms of effects are unclear, because impact on behavioural outcomes has rarely been considered. Moreover, the robustness of our findings is also unclear, because interventions have been poorly reported. Greater engagement with behavioural science is needed when developing and evaluating home-based health interventions. PROSPERO REGISTRATION NUMBER ID=CRD42014010370.
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Affiliation(s)
- Benjamin Gardner
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ana Jovicic
- Department of Primary Care and Population Health, University College London, Royal Free Hospital, London, UK
| | - Celia Belk
- Department of Primary Care and Population Health, University College London, Royal Free Hospital, London, UK
| | - Kalpa Kharicha
- Department of Primary Care and Population Health, University College London, Royal Free Hospital, London, UK
| | - Steve Iliffe
- Department of Primary Care and Population Health, University College London, Royal Free Hospital, London, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King's College London, London, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hertfordshire, UK
| | - Vari M Drennan
- Centre for Health and Social Care Research, Kingston University & St George's, University of London, London, UK
| | - Kate Walters
- Department of Primary Care and Population Health, University College London, Royal Free Hospital, London, UK
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de Lusignan S, McGovern AP, Tahir MA, Hassan S, Jones S, Halter M, Joly L, Drennan VM. Physician Associate and General Practitioner Consultations: A Comparative Observational Video Study. PLoS One 2016; 11:e0160902. [PMID: 27560179 PMCID: PMC4999215 DOI: 10.1371/journal.pone.0160902] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 04/07/2016] [Accepted: 06/20/2016] [Indexed: 11/18/2022] Open
Abstract
Background Physician associates, known internationally as physician assistants, are a mid-level practitioner, well established in the United States of America but new to the United Kingdom. A small number work in primary care under the supervision of general practitioners, where they most commonly see patients requesting same day appointments for new problems. As an adjunct to larger study, we investigated the quality of the patient consultation of physician associates in comparison to that of general practitioners. Method We conducted a comparative observational study using video recordings of consultations by volunteer physician associates and general practitioners with consenting patients in single surgery sessions. Recordings were assessed by experienced general practitioners, blinded to the type of the consulting practitioner, using the Leicester Assessment Package. Assessors were asked to comment on the safety of the recorded consultations and to attempt to identify the type of practitioner. Ratings were compared across practitioner type, alongside the number of presenting complaints discussed in each consultation and the number of these which were acute, minor, or regarding a chronic condition. Results We assessed 62 consultations (41 general practitioner and 21 physician associates) from five general practitioners and four physician associates. All consultations were assessed as safe; but general practitioners were rated higher than PAs in all elements of consultation. The general practitioners were more likely than physician associates to see people with multiple presenting complaints (p<0.0001) and with chronic disease related complaints (p = 0.008). Assessors correctly identified general practitioner consultations but not physician associates. The Leicester Assessment Package had limited inter-rater and intra-rater reliability. Conclusions The physician associate consultations were with a less complex patient group. They were judged as competent and safe, although general practitioner consultations, unsurprisingly, were rated as more competent. Physician associates offer a complementary addition to the medical workforce in general practice.
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Affiliation(s)
- Simon de Lusignan
- Department of Clinical and Experimental Medicine University of Surrey, Guildford, GU2 7XH, United Kingdom
- Division of Population Health Sciences and Education St. George’s University of London, London, SW17 0RE, United Kingdom
- * E-mail:
| | - Andrew P. McGovern
- Department of Clinical and Experimental Medicine University of Surrey, Guildford, GU2 7XH, United Kingdom
| | - Mohammad Aumran Tahir
- Department of Clinical and Experimental Medicine University of Surrey, Guildford, GU2 7XH, United Kingdom
- AT Medics, St. Charles Hospital, Exmoor Street, London, W10 6DZ, United Kingdom
| | - Simon Hassan
- Department of Clinical and Experimental Medicine University of Surrey, Guildford, GU2 7XH, United Kingdom
| | - Simon Jones
- Department of Clinical and Experimental Medicine University of Surrey, Guildford, GU2 7XH, United Kingdom
- Department of Population Health NYU School of Medicine, 227 East 30th Street, New York, New York, 10016, United States of America
| | - Mary Halter
- Faculty of Health, Social Care & Education, Kingston University & St. George’s University of London, London, United Kingdom
| | - Louise Joly
- Social Care Workforce Research Unit King’s College London, Strand, London, WC2R 2LS, United Kingdom
| | - Vari M. Drennan
- Faculty of Health, Social Care & Education, Kingston University & St. George’s University of London, London, United Kingdom
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Drennan VM, Halter M, Gale J, Harris R. Retaining nurses in metropolitan areas: insights from senior nurse and human resource managers. J Nurs Manag 2016; 24:1041-1048. [PMID: 27291829 DOI: 10.1111/jonm.12402] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2016] [Indexed: 11/26/2022]
Abstract
AIM To investigate the views of senior nurse and human resource managers of strategies to retain hospital nurses in a metropolitan area. BACKGROUND Against a global shortage, retaining nurses is a management imperative for the quality of hospital services. METHOD Semi-structured interviews, thematically analysed. RESULTS Metropolitan areas have many health organisations in geographical proximity, offering nurses choices in employer and employment. Senior nurse and human resource managers recognised the complexity of factors influencing nurse turnover, including those that 'pulled' nurses out of their jobs to other posts and factors that 'pushed' nurses to leave. Four themes emerged in retaining nurses: strategy and leadership, including analysis of workforce and leavers' data, remuneration, the type of nursing work and career development and the immediate work environment. CONCLUSIONS In contexts where multiple organisations compete for nurses, addressing retention through strategic leadership is likely to be important in paying due attention and apportioning resources to effective strategies. IMPLICATIONS FOR NURSING MANAGEMENT Aside from good human resource management practices for all, strategies tailored to different segments of the nursing workforce are likely to be important. This metropolitan study suggests attention should be paid to strategies that address remuneration, progressing nursing careers and the immediate work environment.
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Affiliation(s)
- Vari M Drennan
- Faculty of Health, Social Care & Education Kingston University & St George's University of London, London, UK.
| | - Mary Halter
- Faculty of Health, Social Care & Education Kingston University & St George's University of London, London, UK
| | - Julia Gale
- Faculty of Health, Social Care & Education Kingston University & St George's University of London, London, UK
| | - Ruth Harris
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, UK
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Drennan VM, Halter M, Brearley S, Carneiro W, Gabe J, Gage H, Grant R, Joly L, de Lusignan S. Corrigendum: Investigating the contribution of physician assistants to primary care in England: a mixed-methods study. Health Serv Deliv Res 2016. [DOI: 10.3310/hsdr02160-c201603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
AbstractCorrection to the table footnote in Table 28.
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Affiliation(s)
- Vari M Drennan
- Faculty of Health, Social Care and Education, Kingston University and St George’s University of London, London, UK
| | - Mary Halter
- Faculty of Health, Social Care and Education, Kingston University and St George’s University of London, London, UK
| | - Sally Brearley
- Faculty of Health, Social Care and Education, Kingston University and St George’s University of London, London, UK
| | - Wilfred Carneiro
- Directorate of Corporate Affairs, St George’s Healthcare NHS Trust, London, UK
| | - Jonathan Gabe
- Centre for Criminology and Sociology, Royal Holloway, University of London, London, UK
| | - Heather Gage
- School of Economics, University of Surrey, Guildford, UK
| | - Robert Grant
- Faculty of Health, Social Care and Education, Kingston University and St George’s University of London, London, UK
| | - Louise Joly
- Faculty of Health, Social Care and Education, Kingston University and St George’s University of London, London, UK
| | - Simon de Lusignan
- Department of Health Care Management and Policy, University of Surrey, Guildford, UK
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Bunn F, Goodman C, Pinkney E, Drennan VM. Specialist nursing and community support for the carers of people with dementia living at home: an evidence synthesis. Health Soc Care Community 2016; 24:48-67. [PMID: 25684210 DOI: 10.1111/hsc.12189] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/07/2014] [Indexed: 06/04/2023]
Abstract
Specialist nurses are one way of providing support for family carers of people with dementia, but relatively little is known about what these roles achieve, or if they are more effective than roles that do not require a clinical qualification. The aim of this review was to synthesise the literature on the scope and effectiveness of specialist nurses, known as Admiral Nurses, and set this evidence in the context of other community-based initiatives to support family carers of people with dementia. We undertook a systematic review of the literature relating to the scope and effectiveness of Admiral Nurses and a review of reviews of interventions to support the family carers of people with dementia. To identify studies, we searched electronic databases, undertook lateral searches and contacted experts. Searches were undertaken in November 2012. Results are reported narratively with key themes relating to Admiral Nurses identified using thematic synthesis. We included 33 items relating to Admiral Nurses (10 classified as research) and 11 reviews evaluating community-based support for carers of people with dementia. There has been little work to evaluate specific interventions provided by Admiral Nurses, but three overarching thematic categories were identified: (i) relational support, (ii) co-ordinating and personalising support and (iii) challenges and threats to the provision of services by Admiral Nurses. There was an absence of clearly articulated goals and service delivery was subject to needs of the host organisation and the local area. The reviews of community-based support for carers of people with dementia included 155 studies but, in general, evidence that interventions reduced caregiver depression or burden was weak, although psychosocial and educational interventions may reduce depression in carers. Community support for carers of people with dementia, such as that provided by Admiral Nurses, is valued by family carers, but the impact of such initiatives is not clearly established.
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Affiliation(s)
- Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Emma Pinkney
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Vari M Drennan
- Centre for Health and Social Care Research, Kingston University and St Georges University, London, UK
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Goodman C, Rycroft Malone J, Norton C, Harari D, Harwood R, Roe B, Russell B, Fader M, Buswell M, Drennan VM, Bunn F. Reducing and managing faecal incontinence in people with advanced dementia who are resident in care homes: protocol for a realist synthesis. BMJ Open 2015; 5:e007728. [PMID: 26163032 PMCID: PMC4499729 DOI: 10.1136/bmjopen-2015-007728] [Citation(s) in RCA: 6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Faecal incontinence (FI) is the involuntary loss of liquid or solid stool that is a social or hygienic problem. The prevalence of FI in residents of care homes is high, but it is not an inevitable consequence of old age or dementia. There is good evidence on risk factors, but few studies provide evidence about effective interventions. There is a need to understand how, why, and in what circumstances particular programmes to reduce and manage FI are effective (or not) for people with dementia. The purpose of this review is to identify which (elements of the) interventions could potentially be effective, and examine the barriers and facilitators to the acceptability, uptake and implementation of interventions designed to address FI in people with dementia who are resident in care homes. METHODS AND ANALYSIS A realist synthesis approach to review the evidence will be used which will include studies on continence, person-centred care, implementation research in care homes, workforce and research on care home culture. An iterative four-stage approach is planned. Phase 1: development of an initial programme theory or theories that will be 'tested' through a first scoping of the literature and consultation with five stakeholder groups (care home providers, user representatives, academics and practice educators, clinicians with a special interest in FI and continence specialists). Phase 2: a systematic search and analysis of published and unpublished evidence to test and develop the programme theories identified in phase 1. Phase 3: validation of programme theory/ies with a purposive sample of participants from phase 1. ETHICS AND DISSEMINATION The overall protocol does not require ethical review. The University research ethics committee will review interviews conducted as part of phase 1 and 3. The final fourth phase will synthesise and develop recommendations for practice and develop testable hypotheses for further research.
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Affiliation(s)
- Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Jo Rycroft Malone
- School of Healthcare Sciences, Bangor University School of Health Care Sciences, Bangor, UK
| | - Christine Norton
- Florence Nightingale School of Nursing & Midwifery, King's College London, London, UK
| | - Danielle Harari
- Division of Health and Social Care, Department of Ageing and Health, Guys and St Thomas’, King's College London, London, UK
| | - Rowan Harwood
- Health Care of Older People Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
| | - Brenda Roe
- Faculty of Health and Social Care, Edge Hill University of Manchester, Manchester, UK
| | - Bridget Russell
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Mandy Fader
- Department of Health Sciences, University of Southampton, Southampton, UK
| | - Marina Buswell
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Vari M Drennan
- Faculty of Health, Social Care and Education, St Georges University of London and Kingston University, UK
| | - Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
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Normansell R, Drennan VM, Oakeshott P. Exploring access and attitudes to regular sexually transmitted infection screening: the views of young, multi-ethnic, inner-city, female students. Health Expect 2015; 19:322-30. [PMID: 25703741 DOI: 10.1111/hex.12354] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2015] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Low uptake of sexually transmitted infection (STI) testing by young people is a major public health problem worldwide. The aims of this qualitative, community-based study were to explore access and attitudes to STI screening in high risk, young, ethnically diverse female students. METHODS Qualitative semi-structured interviews were conducted at an inner-London further education college with 17 women aged 16-25 years. RESULTS The women wanted convenient, regular STI testing and perceived this as responsible behaviour. However, they doubted the maturity of their peers who were unlikely to view themselves as candidates for testing, and feared the perceived stigma associated with testing. This was reflected in their preference for confidential testing. Despite attending their general practice for non-sexual health matters, most did not consider this option for STI testing. However, the long wait in specialist clinics was an important barrier. Many younger participants would not want postal STI sample kits sent to their homes. We found dissatisfaction with sexual health education. CONCLUSIONS STI screening for underserved groups such as young sexually active ethnically diverse female college students needs to be confidential, convenient, easily accessed and offered in ways that allow them to consider themselves as candidates for such screening without fear of social stigma. Family doctors should be aware that young women often do not perceive primary care to be an option for accessing STI screening, and could consider ways of advertising these services. Policymakers and commissioners should be aware that clinic waiting times and lack of education remain barriers to testing.
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Affiliation(s)
- Rebecca Normansell
- Population Health Research Institute, St George's, University of London, London, UK
| | - Vari M Drennan
- Faculty of Health, Social Care & Education, St. George's, University of London & Kingston University, London, UK
| | - Pippa Oakeshott
- Population Health Research Institute, St George's, University of London, London, UK
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McGraw C, Drennan VM. Evaluation of the suitability of root cause analysis frameworks for the investigation of community-acquired pressure ulcers: a systematic review and documentary analysis. J Clin Nurs 2014; 24:536-45. [PMID: 24963871 DOI: 10.1111/jocn.12644] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2014] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To evaluate the suitability of root cause analysis frameworks for the investigation of community-acquired pressure ulcers. The objective was to identify the extent to which these frameworks take account of the setting where the ulcer originated as being the person's home rather than a hospital setting. BACKGROUND Pressure ulcers involving full-thickness skin loss are increasingly being regarded as indicators of nursing patient safety failure, requiring investigation using root cause analysis frameworks. Evidence suggests that root cause analysis frameworks developed in hospital settings ignore the unique dimensions of risk in home healthcare settings. DESIGN AND METHODS A systematic literature review and documentary analysis of frameworks used to investigate community-acquired grade three and four pressure ulcers by home nursing services in England. RESULTS No published papers were identified for inclusion in the review. Fifteen patient safety investigative frameworks were collected and analysed. Twelve of the retrieved frameworks were intended for the investigation of community-acquired pressure ulcers; seven of which took account of the setting where the ulcer originated as being the patient's home. CONCLUSION This study provides evidence to suggest that many of the root cause analysis frameworks used to investigate community-acquired pressure ulcers in England are unsuitable for this purpose. RELEVANCE TO CLINICAL PRACTICE This study provides researchers and practitioners with evidence of the need to develop appropriate home nursing root cause analysis frameworks to investigate community-acquired pressure ulcers.
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Drennan VM, Halter M, Brearley S, Carneiro W, Gabe J, Gage H, Grant R, Joly L, de Lusignan S. Investigating the contribution of physician assistants to primary care in England: a mixed-methods study. Health Serv Deliv Res 2014. [DOI: 10.3310/hsdr02160] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [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
BackgroundPrimary health care is changing as it responds to demographic shifts, technological changes and fiscal constraints. This, and predicted pressures on medical and nursing workforces, raises questions about staffing configurations. Physician assistants (PAs) are mid-level practitioners, trained in a medical model over 2 years at postgraduate level to work under a supervising doctor. A small number of general practices in England have employed PAs.ObjectiveTo investigate the contribution of PAs to the delivery of patient care in primary care services in England.DesignA mixed-methods study conducted at macro, meso and micro organisational levels in two phases: (1) a rapid review, a scoping survey of key national and regional informants, a policy review, and a survey of PAs and (2) comparative case studies in 12 general practices (six employing PAs). The latter incorporated clinical record reviews, a patient satisfaction survey, video observations of consultations and interviews with patients and professionals.ResultsThe rapid review found 49 published studies, mainly from the USA, which showed increased numbers of PAs in general practice settings but weak evidence for impact on processes and patient outcomes. The scoping survey found mainly positive or neutral views about PAs, but there was no mention of their role in workforce policy and planning documents. The survey of PAs in primary care (n = 16) found that they were mainly deployed to provide same-day appointments. The comparative case studies found that physician assistants were consulted by a wide range of patients, but these patients tended to be younger, with less medically acute or complex problems than those consulting general practitioners (GPs). Patients reported high levels of satisfaction with both PAs and GPs. The majority were willing or very willing to consult a PA again but wanted choice in which type of professional they consulted. There was no significant difference between PAs and GPs in the primary outcome of patient reconsultation for the same problem within 2 weeks, investigations/tests ordered, referrals to secondary care or prescriptions issued. GPs, blinded to the type of clinician, judged the documented activities in the initial consultation of patients who reconsulted for the same problem to be appropriate in 80% (n = 223) PA and 50% (n = 252) GP records. PAs were judged to be competent and safe from observed consultations. The average consultation with a physician assistant is significantly longer than that with a GP: 5.8 minutes for patients of average age for this sample (38 years). Costs per consultation were £34.36 for GPs and £28.14 for PAs. Costs could not be apportioned to GPs for interruptions, supervision or training of PAs.ConclusionsPAs were found to be acceptable, effective and efficient in complementing the work of GPs. PAs can provide a flexible addition to the primary care workforce. They offer another labour pool to consider in health professional workforce and education planning at local, regional and national levels. However, in order to maximise the contribution of PAs in primary care settings, consideration needs to be given to the appropriate level of regulation and the potential for authority to prescribe medicines. Future research is required to investigate the contribution of PAs to other first contact services as well as secondary services; the contribution and impact of all types of mid-level practitioners (including nurse practitioners) in first contact services; the factors and influences on general practitioner and practice manager decision-making as to staffing and skill mix; and the reliability and validity of classification systems for both primary care patients and their presenting condition and their consequences for health resource utilisation.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Vari M Drennan
- Faculty of Health, Social Care and Education, Kingston University and St George’s University of London, London, UK
| | - Mary Halter
- Faculty of Health, Social Care and Education, Kingston University and St George’s University of London, London, UK
| | - Sally Brearley
- Faculty of Health, Social Care and Education, Kingston University and St George’s University of London, London, UK
| | - Wilfred Carneiro
- Directorate of Corporate Affairs, St George’s Healthcare NHS Trust, London, UK
| | - Jonathan Gabe
- Centre for Criminology and Sociology, Royal Holloway, University of London, London, UK
| | - Heather Gage
- School of Economics, University of Surrey, Guildford, UK
| | - Robert Grant
- Faculty of Health, Social Care and Education, Kingston University and St George’s University of London, London, UK
| | - Louise Joly
- Faculty of Health, Social Care and Education, Kingston University and St George’s University of London, London, UK
| | - Simon de Lusignan
- Department of Health Care Management and Policy, University of Surrey, Guildford, UK
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Drennan VM, Greenwood N, Cole L. Continence care for people with dementia at home. Nurs Times 2014; 110:19. [PMID: 24754106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The majority of people with dementia live in their own homes. Difficulties with using the toilet and incontinence can lead to them moving into care homes. This report summarises a systematic review by Drennan et al (2012) that investigated the evidence for conservative interventions for the prevention or management of incontinence in people with dementia living at home.
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Drennan VM, Grant RL, Harris R. Trends over time in prescribing by English primary care nurses: a secondary analysis of a national prescription database. BMC Health Serv Res 2014; 14:54. [PMID: 24499423 PMCID: PMC3922985 DOI: 10.1186/1472-6963-14-54] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 01/31/2014] [Indexed: 11/16/2022] Open
Abstract
Background A growing number of countries legislate for nurses to have medication prescribing authority although it is a contested issue. The UK is one of these countries, giving authority to nurses with additional qualifications since 1992 and incrementally widened the scope of nurse prescribing, most recently in 2006. The policy intention for primary care was to improve efficiency in service delivery through flexibility between medical and nursing roles. The extent to which this has occurred is uncertain. This study investigated nurses prescribing activities, over time, in English primary care settings. Methods A secondary data analysis of a national primary care prescription database 2006-2010 and National Health Service workforce database 2010 was undertaken. Results The numbers of nurses issuing more than one prescription annually in primary care rose from 13,391 in 2006 to 15,841 in 2010. This represented forty three percent of those with prescribing qualifications and authorisation from their employers. The number of items prescribed by nurses rose from 1.1% to 1.5% of total items prescribed in primary care. The greatest volume of items prescribed by independent nurse prescribers was in the category of penicillins, followed by dressings. However, the category where independent nurse prescribers contributed the largest proportion of all primary care prescriptions was emergency contraception (9.1%). In contrast, community practitioner nurse prescribers’ greatest volume and contribution was in the category of gel and colloid dressings (27%), medicated stockings (14.5%) and incontinence appliances (4.2%). There were slightly higher rates of nurse prescribing in areas with higher levels of socio-economic deprivation and fewer physicians per capita, but the correlations were weak and warrant further investigation. Conclusions The percentage of prescriptions written by nurses in primary care in England is very small in comparison to physicians. Our findings suggest that nurse prescribing is used where it is seen to have relative advantage by all stakeholders, in particular when it supports efficiency in nursing practice and also health promotion activities by nurses in general practice. It is in these areas that there appears to be flexibility in the prescribing role between nurses and general practitioners.
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Affiliation(s)
- Vari M Drennan
- Faculty of Health, Social Care & Education, Kingston University & St George's, University of London, London, UK.
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Drennan VM, Porter EMJ, Grant RL. Graduates from dual qualification courses, registered nurse and health visitor: a career history study. Nurse Educ Today 2013; 33:925-930. [PMID: 22939771 DOI: 10.1016/j.nedt.2012.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 06/07/2012] [Revised: 07/29/2012] [Accepted: 08/04/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Educationalists and managers internationally are challenged to find ways of preparing, recruiting early in their careers, and retaining nurses into public health roles in primary care. Public health nursing qualifications are post-initial nurse registration in the United Kingdom as in some other countries. In the mid twentieth century there were a number of innovative programmes of dual qualification: registered nurse and health visitor (the United Kingdom term for public health nurse). OBJECTIVE To investigate the career histories of graduates from courses integrating both nursing and health visitor qualifications. DESIGN An observational, survey study. SETTING The United Kingdom. PARTICIPANTS A purposive sample of graduates from integrated registered nurse and health visitor programmes, 1959-1995, from one University. METHODS Self completed, anonymous, survey sent to graduates, with contact details known to the University and through snowballing techniques, in 2011. FINDINGS Forty five women (56%), graduates in all four decades, returned the survey. A significant majority (82%) had taken up health visitor posts on completing the course. Over their careers, 42% of all jobs held were as health visitors. Only four never worked in a post that required a health visiting qualification. Most had undertaken paid work throughout their careers that focused on aspects of public health, often linked to child, maternal and/or family wellbeing. Many held teaching/lecturing and management posts at some point in their career. Those holding management posts were more likely to report leaving them as a result of organisational re-structuring or redundancy than those in non-management posts. CONCLUSIONS Courses that prepare students to be both nurses and health visitors result in a majority of graduates who take up posts as health visitors on qualification and subsequently. Nurse education planners may find this evidence of value in determining ways of providing a future workforce for public health nursing.
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Affiliation(s)
- Vari M Drennan
- St. George's University of London, United Kingdom; Kingston University, United Kingdom.
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