• The added value of user involvement during the development of a feedback system regarding physical functioning for community-dwelling elderly people

      Vermeulen, Joan; Neyens, Jacques C.L.; Spreeuwenberg, Marieke D.; van Rossum, Erik; Hewson, David; de Witte, Luc P. (Ubiquity Press, 2012-06-08)
      The number of frail elderly people is increasing. Unfortunately, the number of caregivers is not increasing at the same pace, which affects older people, caregivers and healthcare systems. Because of these developments, self-management is becoming more important in healthcare. To support community-dwelling elderly people in their self-management, a system was developed that monitors their physical functioning. This system provides feedback to elderly people and their caregivers regarding physical indicators of frailty. The feedback is provided to elderly people via the screen of a mobile phone. It is important that elderly people understand the content of the feedback and are able to use the mobile phone properly. If not, it is unlikely that the system can support self-management. Many interactive health technologies that have been developed do not fulfil their promises. An important reason for this is that human and other non-technology issues are not sufficiently taken into consideration during the development process.
    • A mixed methods evaluation of the Northwest London Integrated Care Pilot

      Harris, Matthew; Pappas, Yannis; Mastellos, Nikolas; Soljak, Michael; Gunn, Laura H.; Cecil, Elizabeth; Greaves, Felix; Car, Josip; Majeed, Azeem; Imperial College London; et al. (Ubiquity Press, 2016-12-16)
    • Social prescribing: implementation and delivery

      Pescheny, Julia Vera; Pappas, Yannis; Randhawa, Gurch; University of Bedfordshire (Ubiquity Press, 2018-10-23)
      Introduction: Social prescription is an innovative approach that aims to link patients in primary care with sources of support within the community and voluntary sector to help improve their health, wellbeing, and care experience. Social prescription provides healthcare professionals with a non-medical referral option, which can operate alongside medical treatments, to address non-clinical factors that precipitate and perpetuate ill health and often lead to frequent primary and secondary care visits. It is based on the bio-psycho-social model of health that considers physical, as well as psychological and social factors as determinants of health and wellbeing. Research on social prescription indicates that there is a potential for psychosocial benefits and health and wellbeing improvements for service users. While most attention has been paid to outcome evaluations, there is a lack of research on factors affecting the implementation process of social prescription interventions. This study aimed to explore factors facilitating and hindering the implementation and delivery of a social prescription intervention in the East of England Luton. The Luton social prescribing programme is based in primary care and involves navigators, who support and work with referred patients to identify their non-medical needs. Methods: A qualitative study was conducted including 22 semi-structured interviews with managers and policy-makers 9, GPs 3, navigators 4, and service providers in the third sector 6 involved in the Luton social prescribing programme. Thematic analysis was used to analyse the data. Results: Due to the differences in stakeholders’ experiences and views, barriers and facilitators were often two sides of the same coin e.g. good communication/ poor communication. Therefore, the identified issues are presented by theme, rather than separately for barriers and facilitators. Identified issues include the availability of resources, stakeholder involvement and engagement, information technology, organisational culture and readiness, existing infrastructures, leadership, staff turnover, support and supervision, planning, communication, and relationships between stakeholders. Discussion: This study contributes to the development of an evidence base on barriers and facilitators to the implementation and delivery of social prescribing programmes. Some of the identified barriers and facilitators seem to be similar to those of other integrated care pilots in the UK, whereas others are specific to social prescribing interventions. Thus, it is important to conduct more robust and transparent research on social prescribing, to address potential barriers to implementation. Conclusion: This study produced evidence on factors that hinder and facilitate the implementation of a social prescription programme in the East of England. Findings can contribute to the development of an evidence base for social prescription programmes in the UK, and inform practice, policy, and future research in the field.
    • Social prescribing: primary care patient and service user engagement

      Pescheny, Julia Vera; Pappas, Yannis; Randhawa, Gurch; University of Bedfordshire (Ubiquity Press, 2018-10-23)
      Introduction: Social Prescribing provides healthcare professionals with a non-medical referral option, in order to address the non-medical factors that determine patients’ health, wellbeing, and often lead to frequent primary and secondary care visits. To meet the non-medical needs of people, social prescribing links primary care patients with sources of support usually provided within the third sector. Research on social prescription indicates that there is a potential for psychosocial benefits, health, and wellbeing improvements for patients who engaged with the service. However, there is no research on factors affecting primary care patients’ decision to take part, or not to take part, in social prescribing. In addition, it is unclear why service users engage, and disengage, with the prescribed services. This study aimed to explore factors affecting the participation of primary care patients (uptake) and engagement of service users (adherence) with a social prescription intervention in the East of England (Luton). Methods: A qualitative study was conducted including 17 semi-structured interviews with GPs (3), navigators (4), and service users (10), analysed using thematic analysis. Results: Factors relating to perceived needs and benefits, the role of GPs, stigmatisation, the entrenchment in the medical model, and the nature of the social prescribing programme affected the participation of primary care patients. Changes in health and wellbeing, rewards, motivation, trust, perceived benefits, service provider-, family-, and navigator support, and the accessibility and availability of services were factors related to the engagement and disengagement of service users. Discussions: Findings of this study fill the existing knowledge gap on factors affecting primary care patients’ participation and engagement in social prescribing interventions. Identified factors can inform policy and practice and, if considered in the social prescribing pathway, potentially improve patient uptake and service user adherence in existing and future programmes. A limitation of this study is that primary care patients who refused to be referred into the social prescribing programme were not interviewed. Due to a lack of recording primary care patients who refused to be referred into the social prescribing programme, this patient group could not be identified. To gain an understanding of potential reasons for refusal, in this study GPs were asked about reasons for refusal in this patient group. However, to gain a deeper understanding of barriers to initial participation, more robust and transparent research in this field, including primary care patients who refused to get involved with social prescribing, is needed. Conclusions: This study produced evidence on factors affecting the participation of primary care patients and service user engagement in a social prescribing intervention in the UK. Findings can contribute to the development of an evidence base for social prescription programmes in the UK, and inform practice, policy, and future research in the field.
    • Working towards integration: Advancing Care Coordination & TeleHealth Deployment (ACT) Programme

      Davidson, Rosemary; Bescos, Cristina; Newman, Stanton; City University; Phillips Healthcare (Ubiquity Press, 2014-11-01)
      This poster gives a summary of the ACT Programme, the sites participating, diseases covered, numbers of patients, project timetable and the aim to provide a ‘toolbox’ of best practice. ACT programmes fall within five broad areas: CC of Management of Chronic and Multimorbid long-term conditions; Management of Chronic and Multimorbid long-term conditions with telehealth; Active patient/prevention/Education; Elderly at home; and Transitional care/post discharge. The number of patients recruited to ACT programmes varied considerably, from the small scale (e.g. Scotland’s REACT project for those over 75 and Groningen’s eDiabetes programme, both with 15-20 patients) to much larger scale (e.g. Lombardy’s Chronic patients with 37,000). Most Programmes (14 out of 17) recruit people with chronic conditions and in some cases these are specified such as Congestive Heart Failure and Diabetes. Patients in recovery or rehabilitation were the second most cited group (12 out of 17). Patients in the preventative category were least likely to enter Programmes (5 out of 17). Some Programmes accept patients at multiple key stages. For example, Groningen’s Effective Cardio Programme accepts patients at the preventative, newly diagnosed, disease management, recovery/rehabilitation, at risk, chronic and palliative stages, in addition to those on new medication. All Programmes reported clear lines of responsibility for the provision of patient care. General Practitioners/Primary Care took responsibility in nine of the 17 Programmes. Elsewhere, specialist nurses held responsibility (e.g. Groningen’s Effective Cardio) or chest physicians (e.g. Groningen’s asthma/COPD Telehealth service). Other Programmes apportioned responsibility at a broader level via a Programme Management Working Group and local managers (Basque Country’s Active Patients) for example, or with a National diabetes standard and regional guidelines (Groningen’s eDiabetes) or with defined care pathways (Scotland’s three Programmes). Further details of the Organisational aspects of the participants in the ACT programme will be presented in the Poster