Implementing Foundry: A cohort study describing the regional and virtual expansion of a youth integrated service in British Columbia, Canada

AIM

Integrated youth services (IYS) have been identified as a national priority in response to the youth mental health and substance use (MHSU) crisis in Canada. In British Columbia (BC), an IYS initiative called Foundry expanded to 11 physical centres and launched a virtual service. The aim of the study was to describe the demographics of Foundry clients and patterns of service utilization during this expansion, along with the impact of the COVID-19 pandemic.

METHODS

Data were analysed for all youth (ages 12-24) accessing both in-person (April 27th, 2018-March 31st, 2021) and virtual (May 1st, 2020-March 31st, 2021) services. Cohorts containing all clients from before (April 27th, 2018-March 16th, 2020) and during (March 17th, 2020-March 31st, 2021) the COVID-19 pandemic were also examined.

RESULTS

A total of 23 749 unique youth accessed Foundry during the study period, with 110 145 services provided. Mean client age was 19.54 years (SD = 3.45) and 62% identified as female. Over 60% of youth scored 'high' or 'very high' for distress and 29% had a self-rated mental health of 'poor', with similar percentages seen for all services and virtual services. These ratings stayed consistent before and during the COVID-19 pandemic.

CONCLUSIONS

Foundry has continued to reach the target age group, with a 65% increase in number of clients during the study period compared with the pilot stage. This study highlights lessons learned and next steps to promote youth-centred data capture practices over time within an integrated youth services context.

44 Wirral's Teletriage Service

Introduction

The Wirral Teletriage Service provides non-urgent clinical support to Wirral Care Homes in order to help avoid unnecessary hospital admissions for their residents. It also aims to provide quicker access to clinical assessment than via NHS 111 and to provide this care in the patient’s residence wherever possible.

Methods

Care homes call the Teletriage service when they have concerns about the health of one of their residents. The Teletriage nurse undertakes a clinical assessment of the resident remotely via Skype. Care Homes have been provided with a secure NHS email address to facilitate secure sharing of data. They have also been provided with iPads and training for their staff. After being assessed by Teletriage, residents are signposted to the most appropriate care pathway for their needs.

Results

76 Care Homes have signed up to the service. On average, the Teletriage Service receives 300-400 calls a month. In an 18 month period, the number of calls to NHS 111 have reduced by 76%. Out of all the calls to Teletriage, 22% of patients were managed by the Teletriage team with no onward referral, 57% were managed via community services e.g GPs, Community Geriatricians, and 10% were referred to the ambulance service. Emergency Health Care Plans (EHCPs), Preferred Priorities of Care and EOL (End of Life) wishes are taken into account.

Conclusions

The Teletriage project has reduced the number of phone calls to NHS 111 and the ambulance service, and subsequently has reduced the number of patients conveyed to hospital by 12%. The Teletriage nurses work very closely with various community services as well as GPs, NWAS and Community Geriatricians. The ongoing training and education provided to the Care Home Staff means that overall there has been good engagement with the project from the majority of the Wirral Care Homes.

Citizen perspectives on the use of publicly reported primary care performance information: Results from citizen-patient dialogues in three Canadian provinces

OBJECTIVE

Performance measurement and reporting is proliferating in all sectors of the healthcare system, including primary care, despite a dearth of evidence on how the public uses reports on primary care performance. We explored how the public might use this information, to guide the development of effective reporting systems for primary care.

METHODS

We conducted six full-day deliberative dialogue sessions with a purposive sample of 56 citizen-patients across three Canadian provinces (British Columbia, Ontario and Nova Scotia). Participants identified how they would use publicly reported performance data. We conducted a thematic analysis of the data by region.

RESULTS

Common uses for primary care performance information emerged across all sessions. Participants most often discussed the utility of this information for community advocacy and participation in health system decision making. Similar barriers for using performance information to choose a primary care provider were identified in each region including the perceived lack of choice of providers and the high value placed on relationships with current providers. Finally, the value of public performance reporting in enhancing trust that people would receive good care was also a common theme.

CONCLUSIONS

Citizen-patient perspectives highlight that public reporting on primary care performance could promote the health system's responsiveness by enabling public engagement in decision making at the community level. The role of public reporting in promoting trust rather than empowering patient choice may reflect unique elements of the Canadian health system's context.

Urinary output during induced labour in normotensive women: a prospective pilot study

All fluid intake and urine output were monitored and measured in 103 consecutive women with normal blood pressure and without a history of pre-existing renal disease during induced labour for various indications. Epidural analgesia was administered in all these women and labour was augmented with oxytocin infusion. All urine specimens passed were tested for specific gravity. The temperature of the labour rooms was between 25 and 27 degrees C. Analysed results (from 50 women) shows that at a mean fluid intake of 75 ml/hour (standard deviation (SD) 21.84), oliguria (urine output <30 ml/hour) occurred in 42 (84%) of the women. There was a positive correlation between fluid intake and urinary output (r(2)=0.8515, P<0.0001). Urinary specific gravity was high (>1010) in all the specimens throughout the study. This study suggests that oliguria may be a common component of labour managed in this manner and its interpretation in pre-eclamptics in labour may be viewed in this context. Oliguria may therefore be a poor indicator of renal function or worsening pre-eclampsia during labour and its management needs to be limited to the severe and persistent variety to avoid renal complications. We believe from this study that relevant urine and blood biochemistry are better correlates of renal function in labour.

Parish registers and urban structure: the example of late-eighteenth century Liverpool

Readers of theYearbookmay readily ascertain from its register of research and bibliography that the energy applied to the urban history of Victorian England has not only been substantial but is far from expended. The attraction of huge amounts of raw material, both quantitative and literary, is difficult to resist. However, the challenge of seeking less solidly founded insights with the less abundant and more indirect sources of the eighteenth and early-nineteenth centuries has met with a far less enthusiastic response. In any case the sparseness of eighteenth-century sources is less stark than at first appears. Although by no means as reliable or as widely ramified in content as census data, Anglican parish registers offer considerable scope for anyone willful enough to resist the census honey pot. Particularly when supported by ancillary sources, such as maps and directories, they provide sufficient information for at least a tentative exploration of the beginning and unfolding of an urban process whose mature expression is revealed in the cornucopia of the middle-nineteenth century.