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Tsang JY, Sperrin M, Blakeman T, Payne RA, Ashcroft D. Defining, identifying and addressing problematic polypharmacy within multimorbidity in primary care: a scoping review. BMJ Open 2024; 14:e081698. [PMID: 38803265 PMCID: PMC11129052 DOI: 10.1136/bmjopen-2023-081698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 05/11/2024] [Indexed: 05/29/2024] Open
Abstract
INTRODUCTION Polypharmacy and multimorbidity pose escalating challenges. Despite numerous attempts, interventions have yet to show consistent improvements in health outcomes. A key factor may be varied approaches to targeting patients for intervention. OBJECTIVES To explore how patients are targeted for intervention by examining the literature with respect to: understanding how polypharmacy is defined; identifying problematic polypharmacy in practice; and addressing problematic polypharmacy through interventions. DESIGN We performed a scoping review as defined by the Joanna Briggs Institute. SETTING The focus was on primary care settings. DATA SOURCES Medline, Embase, Cumulative Index to Nursing and Allied Health Literature and Cochrane along with ClinicalTrials.gov, Science.gov and WorldCat.org were searched from January 2004 to February 2024. ELIGIBILITY CRITERIA We included all articles that had a focus on problematic polypharmacy in multimorbidity and primary care, incorporating multiple types of evidence, such as reviews, quantitative trials, qualitative studies and policy documents. Articles focussing on a single index disease or not written in English were excluded. EXTRACTION AND ANALYSIS We performed a narrative synthesis, comparing themes and findings across the collective evidence to draw contextualised insights and conclusions. RESULTS In total, 157 articles were included. Case-finding methods often rely on basic medication counts (often five or more) without considering medical history or whether individual medications are clinically appropriate. Other approaches highlight specific drug indicators and interactions as potentially inappropriate prescribing, failing to capture a proportion of patients not fitting criteria. Different potentially inappropriate prescribing criteria also show significant inconsistencies in determining the appropriateness of medications, often neglecting to consider multimorbidity and underprescribing. This may hinder the identification of the precise population requiring intervention. CONCLUSIONS Improved strategies are needed to target patients with polypharmacy, which should consider patient perspectives, individual factors and clinical appropriateness. The development of a cross-cutting measure of problematic polypharmacy that consistently incorporates adjustment for multimorbidity may be a valuable next step to address frequent confounding.
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Affiliation(s)
- Jung Yin Tsang
- Centre for Primary Care and Health Services Research, School of Health Sciences, The University of Manchester Division of Population Health Health Services Research and Primary Care, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration (GMPSRC), Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre (MAHSC), The University of Manchester, Manchester, UK
| | - Matthew Sperrin
- NIHR Greater Manchester Patient Safety Research Collaboration (GMPSRC), Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre (MAHSC), The University of Manchester, Manchester, UK
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Thomas Blakeman
- Centre for Primary Care and Health Services Research, School of Health Sciences, The University of Manchester Division of Population Health Health Services Research and Primary Care, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration (GMPSRC), Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre (MAHSC), The University of Manchester, Manchester, UK
| | - Rupert A Payne
- Department of Health and Community Sciences, University of Exeter Medical School, Exeter, UK
| | - Darren Ashcroft
- NIHR Greater Manchester Patient Safety Research Collaboration (GMPSRC), Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre (MAHSC), The University of Manchester, Manchester, UK
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
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Sumner J, Ng CWT, Teo KEL, Peh ALT, Lim YW. Co-designing care for multimorbidity: a systematic review. BMC Med 2024; 22:58. [PMID: 38321495 PMCID: PMC10848537 DOI: 10.1186/s12916-024-03263-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/18/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND The co-design of health care enables patient-centredness by partnering patients, clinicians and other stakeholders together to create services. METHODS We conducted a systematic review of co-designed health interventions for people living with multimorbidity and assessed (a) their effectiveness in improving health outcomes, (b) the co-design approaches used and (c) barriers and facilitators to the co-design process with people living with multimorbidity. We searched MEDLINE, EMBASE, CINAHL, Scopus and PsycINFO between 2000 and March 2022. Included experimental studies were quality assessed using the Cochrane risk of bias tool (ROB-2 and ROBINS-I). RESULTS We screened 14,376 reports, with 13 reports meeting the eligibility criteria. Two reported health and well-being outcomes: one randomised clinical trial (n = 134) and one controlled cohort (n = 1933). Outcome measures included quality of life, self-efficacy, well-being, anxiety, depression, functional status, healthcare utilisation and mortality. Outcomes favouring the co-design interventions compared to control were minimal, with only 4 of 17 outcomes considered beneficial. Co-design approaches included needs assessment/ideation (12 of 13), prototype (11 of 13), pilot testing (5 of 13) (i.e. focus on usability) and health and well-being evaluations (2 of 13). Common challenges to the co-design process include poor stakeholder interest, passive participation, power imbalances and a lack of representativeness in the design group. Enablers include flexibility in approach, smaller group work, advocating for stakeholders' views and commitment to the process or decisions made. CONCLUSIONS In this systematic review of co-design health interventions, we found that few projects assessed health and well-being outcomes, and the observed health and well-being benefits were minimal. The intensity and variability in the co-design approaches were substantial, and challenges were evident. Co-design aided the design of novel services and interventions for those with multimorbidity, improving their relevance, usability and acceptability. However, the clinical benefits of co-designed interventions for those with multimorbidity are unclear.
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Affiliation(s)
- Jennifer Sumner
- Alexandra Hospital, National University Health System, Singapore, Singapore.
| | | | | | - Adena Li Tyin Peh
- Alexandra Hospital, National University Health System, Singapore, Singapore
| | - Yee Wei Lim
- Alexandra Hospital, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Moser A, Korstjens I. Series: Practical guidance to qualitative research. Part 5: Co-creative qualitative approaches for emerging themes in primary care research: Experience-based co-design, user-centred design and community-based participatory research. Eur J Gen Pract 2022; 28:1-12. [PMID: 35037811 PMCID: PMC8765256 DOI: 10.1080/13814788.2021.2010700] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 11/07/2021] [Accepted: 11/16/2021] [Indexed: 11/03/2022] Open
Abstract
This article, the fifth in a series aiming to provide practical guidance for qualitative research in primary care, introduces three qualitative approaches with co-creative characteristics for addressing emerging themes in primary care research: experience-based co-design, user-centred design and community-based participatory research. Co-creation aims to define the (research) problem, develop and implement interventions and evaluate and define (research and practice) outcomes in partnership with patients, family carers, researchers, care professionals and other relevant stakeholders. Experience-based co-design seeks to understand how people experience a health care process or service. User-centred design is an approach to assess, design and develop technological and organisational systems, for example, eHealth, involving end-users in the design and decision-making processes. Community-based participatory research is a collaborative approach addressing a locally relevant health issue. It is often directed at hard-to-reach and vulnerable people. We address the context, what, why, when and how of these co-creative approaches, and their main practical and methodological challenges. We provide examples of empirical studies using these approaches and sources for further reading.
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Affiliation(s)
- Albine Moser
- Research Centre Autonomy and Participation of Chronically Ill People, Zuyd University of Applied Sciences, Heerlen, The Netherlands
- Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Irene Korstjens
- Research Centre for Midwifery Science, Zuyd University of Applied Sciences, Maastricht, The Netherlands
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Silcock J, Marques I, Olaniyan J, Raynor DK, Baxter H, Gray N, Zaidi STR, Peat G, Fylan B, Breen L, Benn J, Alldred DP. Co-designing an intervention to improve the process of deprescribing for older people living with frailty in the United Kingdom. Health Expect 2022; 26:399-408. [PMID: 36420768 PMCID: PMC9854320 DOI: 10.1111/hex.13669] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In older people living with frailty, polypharmacy can lead to preventable harm like adverse drug reactions and hospitalization. Deprescribing is a strategy to reduce problematic polypharmacy. All stakeholders should be actively involved in developing a person-centred deprescribing process that involves shared decision-making. OBJECTIVE To co-design an intervention, supported by a logic model, to increase the engagement of older people living with frailty in the process of deprescribing. DESIGN Experience-based co-design is an approach to service improvement, which uses service users and providers to identify problems and design solutions. This was used to create a person-centred intervention with the potential to improve the quality and outcomes of the deprescribing process. A 'trigger film' showing older people talking about their healthcare experiences was created and facilitated discussions about current problems in the deprescribing process. Problems were then prioritized and appropriate solutions were developed. The review located the solutions in the context of current processes and procedures. An ideal care pathway and a complex intervention to deliver better care were developed. SETTING AND PARTICIPANTS Older people living with frailty, their informal carers and professionals living and/or working in West Yorkshire, England, UK. Deprescribing was considered in the context of primary care. RESULTS The current deprescribing process differed from an ideal pathway. A complex intervention containing seven elements was required to move towards the ideal pathway. Three of these elements were prototyped and four still need development. The complex intervention responded to priorities about (a) clarity for older people about what was happening at all stages in the deprescribing process and (b) the quality of one-to-one consultations. CONCLUSIONS Priorities for improving the current deprescribing process were successfully identified. Solutions were developed and structured as a complex intervention. Further work is underway to (a) complete the prototyping of the intervention and (b) conduct feasibility testing. PATIENT OR PUBLIC CONTRIBUTION Older people living with frailty (and their informal carers) have made a central contribution, as collaborators, to ensure that a complex intervention has the greatest possible potential to enhance the experience of deprescribing medicines.
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Affiliation(s)
- Jonathan Silcock
- School of Pharmacy and Medical Sciences, Faculty of Life SciencesUniversity of BradfordBradfordUK,NIHR Yorkshire and the Humber Patient Safety Translational Research Centre, Bradford Institute for Health ResearchBradfordUK
| | - Iuri Marques
- School of Pharmacy and Medical Sciences, Faculty of Life SciencesUniversity of BradfordBradfordUK
| | - Janice Olaniyan
- School of Pharmacy and Medical Sciences, Faculty of Life SciencesUniversity of BradfordBradfordUK,NIHR Yorkshire and the Humber Patient Safety Translational Research Centre, Bradford Institute for Health ResearchBradfordUK
| | | | - Helen Baxter
- Alliance Manchester Business School, Faculty of HumanitiesUniversity of ManchesterManchesterUK
| | - Nicky Gray
- Department of Pharmacy, School of Applied SciencesUniversity of HuddersfieldHuddersfieldUK
| | | | - George Peat
- Department of Health SciencesUniversity of YorkYorkUK
| | - Beth Fylan
- School of Pharmacy and Medical Sciences, Faculty of Life SciencesUniversity of BradfordBradfordUK,NIHR Yorkshire and the Humber Patient Safety Translational Research Centre, Bradford Institute for Health ResearchBradfordUK
| | - Liz Breen
- School of Pharmacy and Medical Sciences, Faculty of Life SciencesUniversity of BradfordBradfordUK,NIHR Yorkshire and the Humber Patient Safety Translational Research Centre, Bradford Institute for Health ResearchBradfordUK
| | - Jonathan Benn
- NIHR Yorkshire and the Humber Patient Safety Translational Research Centre, Bradford Institute for Health ResearchBradfordUK,School of PsychologyUniversity of LeedsLeedsUK
| | - David P. Alldred
- NIHR Yorkshire and the Humber Patient Safety Translational Research Centre, Bradford Institute for Health ResearchBradfordUK,School of HealthcareUniversity of LeedsLeedsUK
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Turk A, Wong G, Mahtani KR, Maden M, Hill R, Ranson E, Wallace E, Krska J, Mangin D, Byng R, Lasserson D, Reeve J. Optimising a person-centred approach to stopping medicines in older people with multimorbidity and polypharmacy using the DExTruS framework: a realist review. BMC Med 2022; 20:297. [PMID: 36042454 PMCID: PMC9429627 DOI: 10.1186/s12916-022-02475-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 07/12/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Tackling problematic polypharmacy requires tailoring the use of medicines to individual circumstances and may involve the process of deprescribing. Deprescribing can cause anxiety and concern for clinicians and patients. Tailoring medication decisions often entails beyond protocol decision-making, a complex process involving emotional and cognitive work for healthcare professionals and patients. We undertook realist review to highlight and understand the interactions between different factors involved in deprescribing and to develop a final programme theory that identifies and explains components of good practice that support a person-centred approach to deprescribing in older patients with multimorbidity and polypharmacy. METHODS The realist approach involves identifying underlying causal mechanisms and exploring how, and under what conditions they work. We conducted a search of electronic databases which were supplemented by citation checking and consultation with stakeholders to identify other key documents. The review followed the key steps outlined by Pawson et al. and followed the RAMESES standards for realist syntheses. RESULTS We included 119 included documents from which data were extracted to produce context-mechanism-outcome configurations (CMOCs) and a final programme theory. Our programme theory recognises that deprescribing is a complex intervention influenced by a multitude of factors. The components of our final programme theory include the following: a supportive infrastructure that provides clear guidance around professional responsibilities and that enables multidisciplinary working and continuity of care, consistent access to high-quality relevant patient contextual data, the need to support the creation of a shared explanation and understanding of the meaning and purpose of medicines and a trial and learn approach that provides space for monitoring and continuity. These components may support the development of trust which may be key to managing the uncertainty and in turn optimise outcomes. These components are summarised in the novel DExTruS framework. CONCLUSION Our findings recognise the complex interpretive practice and decision-making involved in medication management and identify key components needed to support best practice. Our findings have implications for how we design medication review consultations, professional training and for patient records/data management. Our review also highlights the role that trust plays both as a central element of tailored prescribing and a potential outcome of good practice in this area.
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Affiliation(s)
- Amadea Turk
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, OX2 6GG, UK
| | - Geoffrey Wong
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, OX2 6GG, UK
| | - Kamal R Mahtani
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, OX2 6GG, UK
| | - Michelle Maden
- Liverpool Reviews & Implementation Group, Institute of Population Health, University of Liverpool, Liverpool, L69 3BX, UK
| | - Ruaraidh Hill
- Liverpool Reviews & Implementation Group, Institute of Population Health, University of Liverpool, Liverpool, L69 3BX, UK
| | - Ed Ranson
- Academy of Primary Care, Hull York Medical School, Allam Medical Building, University of Hull, Hull, HU6 7RX, UK
| | - Emma Wallace
- Department of General Practice RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
| | - Janet Krska
- Medway School of Pharmacy, Universities of Greenwich and Kent, Chatham Maritime, Kent, ME4 4TB, UK
| | - Dee Mangin
- Department of Family Medicine, McMaster University, Hamilton, ON, L8P 1H6, Canada
| | - Richard Byng
- Community and Primary Care Research Group, Peninsula Medical School, University of Plymouth, Plymouth, PL4 8AA, UK
| | - Daniel Lasserson
- Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Joanne Reeve
- Academy of Primary Care, Hull York Medical School, Allam Medical Building, University of Hull, Hull, HU6 7RX, UK.
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Moshe I, Terhorst Y, Paganini S, Schlicker S, Pulkki-Råback L, Baumeister H, Sander LB, Ebert DD. Predictors of Dropout in a Digital Intervention for the Prevention and Treatment of Depression in Patients With Chronic Back Pain: Secondary Analysis of Two Randomized Controlled Trials. J Med Internet Res 2022; 24:e38261. [PMID: 36040780 PMCID: PMC9472049 DOI: 10.2196/38261] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/03/2022] [Accepted: 07/15/2022] [Indexed: 11/24/2022] Open
Abstract
Background Depression is a common comorbid condition in individuals with chronic back pain (CBP), leading to poorer treatment outcomes and increased medical complications. Digital interventions have demonstrated efficacy in the prevention and treatment of depression; however, high dropout rates are a major challenge, particularly in clinical settings. Objective This study aims to identify the predictors of dropout in a digital intervention for the treatment and prevention of depression in patients with comorbid CBP. We assessed which participant characteristics may be associated with dropout and whether intervention usage data could help improve the identification of individuals at risk of dropout early on in treatment. Methods Data were collected from 2 large-scale randomized controlled trials in which 253 patients with a diagnosis of CBP and major depressive disorder or subclinical depressive symptoms received a digital intervention for depression. In the first analysis, participants’ baseline characteristics were examined as potential predictors of dropout. In the second analysis, we assessed the extent to which dropout could be predicted from a combination of participants’ baseline characteristics and intervention usage variables following the completion of the first module. Dropout was defined as completing <6 modules. Analyses were conducted using logistic regression. Results From participants’ baseline characteristics, lower level of education (odds ratio [OR] 3.33, 95% CI 1.51-7.32) and both lower and higher age (a quadratic effect; age: OR 0.62, 95% CI 0.47-0.82, and age2: OR 1.55, 95% CI 1.18-2.04) were significantly associated with a higher risk of dropout. In the analysis that aimed to predict dropout following completion of the first module, lower and higher age (age: OR 0.60, 95% CI 0.42-0.85; age2: OR 1.59, 95% CI 1.13-2.23), medium versus high social support (OR 3.03, 95% CI 1.25-7.33), and a higher number of days to module completion (OR 1.05, 95% CI 1.02-1.08) predicted a higher risk of dropout, whereas a self-reported negative event in the previous week was associated with a lower risk of dropout (OR 0.24, 95% CI 0.08-0.69). A model that combined baseline characteristics and intervention usage data generated the most accurate predictions (area under the receiver operating curve [AUC]=0.72) and was significantly more accurate than models based on baseline characteristics only (AUC=0.70) or intervention usage data only (AUC=0.61). We found no significant influence of pain, disability, or depression severity on dropout. Conclusions Dropout can be predicted by participant baseline variables, and the inclusion of intervention usage variables may improve the prediction of dropout early on in treatment. Being able to identify individuals at high risk of dropout from digital health interventions could provide intervention developers and supporting clinicians with the ability to intervene early and prevent dropout from occurring.
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Affiliation(s)
- Isaac Moshe
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Yannik Terhorst
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Sarah Paganini
- Department of Sport Psychology, Institute of Sports and Sport Science, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Sandra Schlicker
- Clinic for Psychiatry and Psychotherapy, Rhein-Erft-Kreis, Germany
| | - Laura Pulkki-Råback
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Lasse B Sander
- Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - David Daniel Ebert
- Department for Sport and Health Sciences, Chair for Psychology & Digital Mental Health Care, Technical University of Munich, Munich, Germany
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Tanay MAL, Armes J, Oakley C, Sage L, Tanner D, Roca J, Bryson L, Greenall B, Urwin L, Wyatt T, Robert G. Co-designing a cancer care intervention: reflections of participants and a doctoral researcher on roles and contributions. RESEARCH INVOLVEMENT AND ENGAGEMENT 2022; 8:36. [PMID: 35918715 PMCID: PMC9343815 DOI: 10.1186/s40900-022-00373-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Patient and Public Involvement is most usually framed in the context of designing, conducting and/or disseminating research. Participatory methods such as Experience-Based Co-Design (EBCD) further allow service users to directly engage in developing, testing and implementing interventions and services alongside healthcare staff. This paper aims to explore how participants in an EBCD project came-over time-to perceive their role and involvement in co-designing a cancer care intervention. METHODS The findings are based on our reflections, a research diary, email correspondence and fieldnotes from co-design events. Co-design participants who attended most of the ten co-design events took part through written reflections or audio-recorded video calls. Ten reflective pieces were collected from clinicians (n = 4), PPI group members/patient participants (n = 4), a doctoral researcher (n = 1) and a visual illustrator (n = 1). Inductive data analysis of participant reflections was carried out using reflexive thematic analysis. Meeting fieldnotes, email correspondence and the researcher's diary were deductively analysed using the initial themes generated from this inductive analysis. RESULTS Five main themes were identified: (1) changing perception of roles during the co-design process, (2) defining a 'co-designer', (3) engagement and ownership, (4) role of the research facilitator in maintaining momentum, and (5) perceived benefits of involvement. CONCLUSION Our findings show the changing perceptions of roles and contributions among participants over time. Patients typically described their role as co-designers in terms simply of sharing their experiences. In contrast, clinicians perceived themselves as co-designers because they were working with patients who were actively involved in decision-making. Levels of engagement were affected by several factors such as time and facilitation, but most participants came to view themselves as co-owners of the intervention. Overall, participants perceived their involvement as a positive experience with clinicians also reporting wider positive impacts on their clinical practice.
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Affiliation(s)
- Mary Anne Lagmay Tanay
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.
| | - Jo Armes
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | | | | | | | - Jose Roca
- Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | | | | | - Lauren Urwin
- Oncology and Haematology Rehabilitation Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Toni Wyatt
- Oncology and Haematology Rehabilitation Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Glenn Robert
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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The use of co-production, co-design and co-creation to mobilise knowledge in the management of health conditions: a systematic review. BMC Health Serv Res 2022; 22:877. [PMID: 35799251 PMCID: PMC9264579 DOI: 10.1186/s12913-022-08079-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/12/2022] [Indexed: 12/03/2022] Open
Abstract
Background Knowledge mobilisation is a term used in healthcare research to describe the process of generating, sharing and using evidence. ‘Co’approaches, such as co-production, co-design and co-creation, have been proposed as a way of overcoming the knowledge to practice gap. There is a need to understand why researchers choose to adopt these approaches, how they achieve knowledge mobilisation in the management of health conditions, and the extent to which knowledge mobilisation is accomplished. Methods Studies that explicitly used the terms co-production, co-design or co-creation to mobilise knowledge in the management of health conditions were included. Web of Science, EMBASE via OvidSP, MEDLINE via OvidSP and CINHAL via EBSCO databases were searched up to April 2021. Quality assessment was carried out using the Joanna Briggs Institute qualitative quality assessment checklist. Pluye and Hong’s seven steps for mixed studies reviews were followed. Data were synthesised using thematic synthesis. Results Twenty four international studies were included. These were qualitative studies, case studies and study protocols. Key aspects of ‘co’approaches were bringing people together as active and equal partners, valuing all types of knowledge, using creative approaches to understand and solve problems, and using iterative prototyping techniques. Authors articulated mechanisms of action that included developing a shared understanding, identifying and meeting needs, giving everyone a voice and sense of ownership, and creating trust and confidence. They believed these mechanisms could produce interventions that were relevant and acceptable to stakeholders, more useable and more likely to be implemented in healthcare. Varied activities were used to promote these mechanisms such as interviews and creative workshops. There appeared to be a lack of robust evaluation of the interventions produced so little evidence in this review that ‘co’approaches improved the management of health conditions. Conclusion Those using ‘co’approaches believed that they could achieve knowledge mobilisation through a number of mechanisms, but there was no evidence that these led to improved health. The framework of key aspects and mechanisms of ‘co’approaches developed here may help researchers to meet the principles of these approaches. There is a need for robust evaluation to identify whether ‘co’approaches produce improved health outcomes. Trial Registration PROSPERO CRD42020187463. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08079-y.
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Reeve J, Maden M, Hill R, Turk A, Mahtani K, Wong G, Lasserson D, Krska J, Mangin D, Byng R, Wallace E, Ranson E. Deprescribing medicines in older people living with multimorbidity and polypharmacy: the TAILOR evidence synthesis. Health Technol Assess 2022; 26:1-148. [PMID: 35894932 PMCID: PMC9376985 DOI: 10.3310/aafo2475] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Tackling problematic polypharmacy requires tailoring the use of medicines to individual needs and circumstances. This may involve stopping medicines (deprescribing) but patients and clinicians report uncertainty on how best to do this. The TAILOR medication synthesis sought to help understand how best to support deprescribing in older people living with multimorbidity and polypharmacy. OBJECTIVES We identified two research questions: (1) what evidence exists to support the safe, effective and acceptable stopping of medication in this patient group, and (2) how, for whom and in what contexts can safe and effective tailoring of clinical decisions related to medication use work to produce desired outcomes? We thus described three objectives: (1) to undertake a robust scoping review of the literature on stopping medicines in this group to describe what is being done, where and for what effect; (2) to undertake a realist synthesis review to construct a programme theory that describes 'best practice' and helps explain the heterogeneity of deprescribing approaches; and (3) to translate findings into resources to support tailored prescribing in clinical practice. DATA SOURCES Experienced information specialists conducted comprehensive searches in MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Web of Science, EMBASE, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials), Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports, Google (Google Inc., Mountain View, CA, USA) and Google Scholar (targeted searches). REVIEW METHODS The scoping review followed the five steps described by the Joanna Briggs Institute methodology for conducting a scoping review. The realist review followed the methodological and publication standards for realist reviews described by the Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) group. Patient and public involvement partners ensured that our analysis retained a patient-centred focus. RESULTS Our scoping review identified 9528 abstracts: 8847 were removed at screening and 662 were removed at full-text review. This left 20 studies (published between 2009 and 2020) that examined the effectiveness, safety and acceptability of deprescribing in adults (aged ≥ 50 years) with polypharmacy (five or more prescribed medications) and multimorbidity (two or more conditions). Our analysis revealed that deprescribing under research conditions mapped well to expert guidance on the steps needed for good clinical practice. Our findings offer evidence-informed support to clinicians regarding the safety, clinician acceptability and potential effectiveness of clinical decision-making that demonstrates a structured approach to deprescribing decisions. Our realist review identified 2602 studies with 119 included in the final analysis. The analysis outlined 34 context-mechanism-outcome configurations describing the knowledge work of tailored prescribing under eight headings related to organisational, health-care professional and patient factors, and interventions to improve deprescribing. We conclude that robust tailored deprescribing requires attention to providing an enabling infrastructure, access to data, tailored explanations and trust. LIMITATIONS Strict application of our definition of multimorbidity during the scoping review may have had an impact on the relevance of the review to clinical practice. The realist review was limited by the data (evidence) available. CONCLUSIONS Our combined reviews recognise deprescribing as a complex intervention and provide support for the safety of structured approaches to deprescribing, but also highlight the need to integrate patient-centred and contextual factors into best practice models. FUTURE WORK The TAILOR study has informed new funded research tackling deprescribing in sleep management, and professional education. Further research is being developed to implement tailored prescribing into routine primary care practice. STUDY REGISTRATION This study is registered as PROSPERO CRD42018107544 and PROSPERO CRD42018104176. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 32. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Joanne Reeve
- Academy of Primary Care, Hull York Medical School, University of Hull, Hull, UK
| | - Michelle Maden
- Liverpool Reviews and Implementation Group, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Ruaraidh Hill
- Liverpool Reviews and Implementation Group, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Amadea Turk
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kamal Mahtani
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Dan Lasserson
- Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Janet Krska
- Medway School of Pharmacy, Universities of Greenwich and Kent, Chatham, UK
| | - Dee Mangin
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Richard Byng
- Community and Primary Care Research Group, Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Emma Wallace
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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10
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Xu Y, Zhang M. The Study of the Impact of Empowering Leadership on Adaptive Performance of Faculties Based on Chain Mediating. Front Psychol 2022; 13:938951. [PMID: 35783713 PMCID: PMC9247655 DOI: 10.3389/fpsyg.2022.938951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
High-quality faculties are the fundamental guarantee to achieving the connotation development of higher education. Hence, performing university faculties determines the quality of teaching and the level of talent cultivation. Facing the change in teaching demand and environment, faculties need to change their working methods spontaneously to achieve high-level performance. Relevant empirical studies have shown that empowering leadership positively affects adaptive performance. However, some researchers have found that leadership effectiveness even has a negative effect. There may be two reasons for the inconsistency in the effectiveness of empowering leadership: (1) There is a lack of in-depth research on the effectiveness of empowering leadership and employees' performance in existing studies, and the exploration of its theoretical mechanism should be enriched. (2) The effectiveness of empowering leadership may be subject to the conditions of the individual's characteristics of the empowering. Therefore, the mechanism of empowering leadership on faculties' adaptive performance still needs to be further explored. This study explores the impact of empowering leadership on adaptive performance. Based on Social Exchange Theory and Psychology Empowerment theory, this study explores the mediating role of the leadership-member exchange relationship and psychological empowerment in the relationship between them. According to Regulatory Focus Theory, the moderating role of promotion focus and prevent focus was studied. We adopted questionnaire survey data including 292 individuals in Changchun, Shijiazhuang, and other cities; STATA 15 was conducted to test the hypotheses. The results showed that: (1) Empowering leadership was significantly and positively related to adaptive performance. (2) Leader-member exchange relationship and psychological empowerment play a mediating chain role in empowering leadership and adaptive performance; empowering leadership promotes psychology empowerment by enhancing the leadership-member exchange relationship, enhancing their adaptive performance. (3) Promotion focus positively regulates the relationship between psychological empowerment and adaptive performance. Individuals with a promotion focus have a significant positive impact on adaptive performance. Individuals with preventing focus do not weaken the positive impact of psychological empowerment on adaptive performance.
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Affiliation(s)
| | - Mengliu Zhang
- School of Business and Management, Jilin University, Changchun, China
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11
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Knowles S, Sharma V, Fortune S, Wadman R, Churchill R, Hetrick S. Adapting a codesign process with young people to prioritize outcomes for a systematic review of interventions to prevent self-harm and suicide. Health Expect 2022; 25:1393-1404. [PMID: 35521681 PMCID: PMC9327872 DOI: 10.1111/hex.13479] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/18/2022] [Accepted: 02/28/2022] [Indexed: 11/29/2022] Open
Abstract
Background Research and clinical outcomes that matter to people with lived experience can significantly differ from those outcomes studied by researchers. To inform a future Cochrane review of suicide and self‐harm prevention interventions, we aimed to work with young people with relevant lived experience to agree on priority outcomes. Design Four participatory codesign workshops were completed across two sites (New Zealand, United Kingdom) with 28 young people in total. We iteratively adapted the methods over the course of the study. Results ‘Improved coping’ and ‘safer/more accepting environment to disclose’ were the final top‐rated outcomes. ‘Reduction of self‐harm’ was considered a low priority as it could be misleading, stigmatizing and was considered a secondary consequence of other improvements. In contrast to typical research outcomes, young people emphasized the diversity of experience, the dynamic nature of improvement and holistic and asset‐based framing. Methodologically, dialogue using design materials (personas) to thematically explore outcomes was effective in overcoming the initial challenge of disparate quantitative ratings. Discussion The results will directly inform the development of a Cochrane review, enabling identification of whether and how outcomes of most importance to young people are measured in trials. Rather than producing discrete measurable outcomes that could be easily added to the systematic review, the young people challenged the academic conceptualization of outcomes, with implications for future evidence synthesis and intervention research, and for future codesign. Patient or Public Contribution Young people with lived experience were codesigners of the outcomes, and their feedback informed iterative changes to the study methods.
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Affiliation(s)
- Sarah Knowles
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Vartika Sharma
- Department of Psychological Medicine, School of Medicine, The University of Auckland, Auckland, New Zealand.,Children and Young People Satellite, Cochrane Common Mental Disorders, The University of Auckland, Auckland, New Zealand
| | - Sarah Fortune
- Department of Social and Community Health, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Ruth Wadman
- Department of Health Sciences, University of York, York, UK
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Sarah Hetrick
- Department of Psychological Medicine, School of Medicine, The University of Auckland, Auckland, New Zealand.,Children and Young People Satellite, Cochrane Common Mental Disorders, The University of Auckland, Auckland, New Zealand
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12
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Aguayo GA, Goetzinger C, Scibilia R, Fischer A, Seuring T, Tran VT, Ravaud P, Bereczky T, Huiart L, Fagherazzi G. Methods to Generate Innovative Research Ideas and Improve Patient and Public Involvement in Modern Epidemiological Research: Review, Patient Viewpoint, and Guidelines for Implementation of a Digital Cohort Study. J Med Internet Res 2021; 23:e25743. [PMID: 34941554 PMCID: PMC8738987 DOI: 10.2196/25743] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/16/2021] [Accepted: 10/08/2021] [Indexed: 01/20/2023] Open
Abstract
Background Patient and public involvement (PPI) in research aims to increase the quality and relevance of research by incorporating the perspective of those ultimately affected by the research. Despite these potential benefits, PPI is rarely included in epidemiology protocols. Objective The aim of this study is to provide an overview of methods used for PPI and offer practical recommendations for its efficient implementation in epidemiological research. Methods We conducted a review on PPI methods. We mirrored it with a patient advocate’s viewpoint about PPI. We then identified key steps to optimize PPI in epidemiological research based on our review and the viewpoint of the patient advocate, taking into account the identification of barriers to, and facilitators of, PPI. From these, we provided practical recommendations to launch a patient-centered cohort study. We used the implementation of a new digital cohort study as an exemplary use case. Results We analyzed data from 97 studies, of which 58 (60%) were performed in the United Kingdom. The most common methods were workshops (47/97, 48%); surveys (33/97, 34%); meetings, events, or conferences (28/97, 29%); focus groups (25/97, 26%); interviews (23/97, 24%); consensus techniques (8/97, 8%); James Lind Alliance consensus technique (7/97, 7%); social media analysis (6/97, 6%); and experience-based co-design (3/97, 3%). The viewpoint of a patient advocate showed a strong interest in participating in research. The most usual PPI modalities were research ideas (60/97, 62%), co-design (42/97, 43%), defining priorities (31/97, 32%), and participation in data analysis (25/97, 26%). We identified 9 general recommendations and 32 key PPI-related steps that can serve as guidelines to increase the relevance of epidemiological studies. Conclusions PPI is a project within a project that contributes to improving knowledge and increasing the relevance of research. PPI methods are mainly used for idea generation. On the basis of our review and case study, we recommend that PPI be included at an early stage and throughout the research cycle and that methods be combined for generation of new ideas. For e-cohorts, the use of digital tools is essential to scale up PPI. We encourage investigators to rely on our practical recommendations to extend PPI in future epidemiological studies.
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Affiliation(s)
- Gloria A Aguayo
- Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Catherine Goetzinger
- Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Renza Scibilia
- Diabetes Australia, Melbourne, Australia.,Diabetogenic, Melbourne, Australia
| | - Aurélie Fischer
- Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Till Seuring
- Luxembourg Institute of Socio-Economic Research, Esch/Alzette, Luxembourg
| | - Viet-Thi Tran
- Centre of Research in Epidemiology and Statistic Sorbonne Paris Cité, National Institute of Health and Medical Research (INSERM), French National Institute for Agricultural Research (INRA), Université de Paris, Paris, France.,Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Philippe Ravaud
- Centre of Research in Epidemiology and Statistic Sorbonne Paris Cité, National Institute of Health and Medical Research (INSERM), French National Institute for Agricultural Research (INRA), Université de Paris, Paris, France.,Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Tamás Bereczky
- European Patients' Academy on Therapeutic Innovation, Brussels, Belgium
| | - Laetitia Huiart
- Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Guy Fagherazzi
- Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
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13
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Newman B, Joseph K, Chauhan A, Seale H, Li J, Manias E, Walton M, Mears S, Jones B, Harrison R. Do patient engagement interventions work for all patients? A systematic review and realist synthesis of interventions to enhance patient safety. Health Expect 2021; 24:1905-1923. [PMID: 34432339 PMCID: PMC8628590 DOI: 10.1111/hex.13343] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/14/2021] [Accepted: 08/04/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Patients are increasingly being asked for feedback about their healthcare and treatment, including safety, despite little evidence to support this trend. This review identifies the strategies used to engage patients in safety during direct care, explores who is engaged and determines the mechanisms that impact effectiveness. METHODS A systematic review was performed of seven databases (CINAHL, Cochrane, Cochrane-Central, Embase, ISI Web of Science, Medline, PsycINFO) that included research published between 2010 and 2020 focused on patient engagement interventions to increase safety during direct care and reported using PRISMA. All research designs were eligible; two reviewers applied criteria independently to determine eligibility and quality. A narrative review and realist synthesis were conducted. RESULTS Twenty-six papers reporting on twenty-seven patient engagement strategies were included and classified as consultation (9), involvement (7) and partnership (11). The definitions of 'patient engagement' varied, and we found limited details about participant characteristics or interactions between people utilizing strategies. Collaborative strategy development, a user-friendly design, proactive messaging and agency sponsorship were identified as mechanisms to improve engagement about safety at the point of direct care. CONCLUSIONS Agency sponsorship of collaboration between staff and patients is essential in the development and implementation of strategies to keep patients safe during direct care. Insufficient details about participant characteristics and patient-provider interactions limit recommendations for practice change. More needs to be learned about how patients are engaged in discussions about safety, particularly minority groups unable to engage with standard information. PATIENT OR PUBLIC CONTRIBUTION Review progress was reported to the CanEngage team, including the consumer steering group, to inform project priorities (PROSPERO CRD42020196453).
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Affiliation(s)
- Bronwyn Newman
- Centre for Health Systems and Safety Research (CHSSR), Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kathryn Joseph
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Ashfaq Chauhan
- Centre for Health Systems and Safety Research (CHSSR), Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Holly Seale
- Faculty of Medicine and Health, School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jiadai Li
- Centre for Health Systems and Safety Research (CHSSR), Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Merrilyn Walton
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Stephen Mears
- Hunter New England Health Libraries, John Hunter Hospital, HRMC, Newcastle, New South Wales, Australia
| | - Benjamin Jones
- Faculty of Medicine and Health, School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Reema Harrison
- Centre for Health Systems and Safety Research (CHSSR), Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
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14
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Small N, Ong BN, Lewis A, Allen D, Bagshaw N, Nahar P, Sanders C. Co-designing new tools for collecting, analysing and presenting patient experience data in NHS services: working in partnership with patients and carers. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:85. [PMID: 34838128 PMCID: PMC8626979 DOI: 10.1186/s40900-021-00329-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/15/2021] [Indexed: 05/12/2023]
Abstract
BACKGROUND The way we collect and use patient experience data is vital to optimise the quality and safety of health services. Yet, some patients and carers do not give feedback because of the limited ways data is collected, analysed and presented. In this study, we worked together with researchers, staff, patient and carer participants, and patient and public involvement and engagement (PPIE) contributors, to co-design new tools for the collection and use of patient experience data in multiple health settings. This paper outlines how the range of PPIE and research activities enabled the co-design of new tools to collect patient experience data. METHODS Eight public contributors represented a range of relevant patient and carer experiences in specialist services with varied levels of PPIE experience, and eleven members of Patient and Participation Groups (PPGs) from two general practices formed our PPIE group at the start of the study. Slide sets were used to trigger co-design discussions with staff, patient and carer research participants, and PPIE contributors. Feedback from PPIE contributors alongside verbatim quotes from staff, patient and carer research participants is presented in relation to the themes from the research data. RESULTS PPIE insights from four themes: capturing experience data; adopting digital or non-digital tools; ensuring privacy and confidentiality; and co-design of a suite of new tools with guidance, informed joint decisions on the shaping of the tools and how these were implemented. Our PPIE contributors took different roles during co-design and testing of the new tools, which supported co-production of the study. CONCLUSIONS Our experiences of developing multiple components of PPIE work for this complex study demonstrates the importance of tailoring PPIE to suit different settings, and to maximise individual strengths and capacity. Our study shows the value of bringing diverse experiences together, putting patients and carers at the heart of improving NHS services, and a shared approach to managing involvement in co-design, with the effects shown through the research process, outcomes and the partnership. We reflect on how we worked together to create a supportive environment when unforeseen challenges emerged (such as, sudden bereavement).
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Affiliation(s)
- Nicola Small
- NIHR School for Primary Care Research, University of Manchester, Manchester, UK.
| | - Bie Nio Ong
- NIHR School for Primary Care Research, University of Manchester, Manchester, UK
| | - Annmarie Lewis
- Patient and Public Involvement and Engagement Contributor, Manchester, UK
| | - Dawn Allen
- Patient and Public Involvement and Engagement Contributor, Manchester, UK
| | - Nigel Bagshaw
- Patient and Public Involvement and Engagement Contributor, Manchester, UK
| | - Papreen Nahar
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Caroline Sanders
- NIHR School for Primary Care Research, University of Manchester, Manchester, UK
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15
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Lasser EC, Heughan JA, Lai AY, Yuan CT, Dy SM, Bittle M, Oberlander T, Pitts SI, Marsteller J, Hannum SM. Patient perceptions of safety in primary care: a qualitative study to inform care. Curr Med Res Opin 2021; 37:1991-1999. [PMID: 34490810 PMCID: PMC9721527 DOI: 10.1080/03007995.2021.1976736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Patients' perspectives on patient safety have rarely been incorporated into quality initiatives in primary care. Our objective was to understand the patient perspective on patient safety in patient-centered medical homes (PCMHs). We conducted 12 patient focus groups/interviews in nine sites with 65 patients at a geographically diverse sample of National Committee on Quality Assurance Level 3 recognized PCMHs across three states. Using a patient safety framework, we coded and analyzed interviews for overarching themes and subthemes across patient safety domains. Overarching themes focused on (1) both clear and timely communication with and between clinicians and (2) trust in the care team, including being heard, respected, and treated as a whole person. Other themes important to specific patient safety domains included sharing of and access to information, patient education and patient-centered medication reconciliation process, clear documentation for the diagnostic process, patient-centered comprehensive visits, and timeliness of care. Communication and trust are key to patient perceptions of safe primary care. Focusing on these themes across safety domains may help to make primary care both more patient-centered and safer, and should be considered in future ambulatory safety initiatives.
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Affiliation(s)
- Elyse C. Lasser
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - JaAlah-Ai Heughan
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alden Yuanhong Lai
- Department of Public Health Policy and Management, New York University School of Global Public Health, NY, USA
| | - Christina T. Yuan
- Johns Hopkins Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sydney M. Dy
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mark Bittle
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Tyler Oberlander
- National Committee for Quality Assurance (NCQA), Washington DC, USA
| | - Samantha I. Pitts
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jill Marsteller
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Susan M. Hannum
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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16
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Knowles SE, Allen D, Donnelly A, Flynn J, Gallacher K, Lewis A, McCorkle G, Mistry M, Walkington P, Brunton L. Participatory codesign of patient involvement in a Learning Health System: How can data-driven care be patient-driven care? Health Expect 2021; 25:103-115. [PMID: 34668634 DOI: 10.1111/hex.13345] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 07/21/2021] [Accepted: 08/03/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND A Learning Health System (LHS) is a model of how routinely collected health data can be used to improve care, creating 'virtuous cycles' between data and improvement. This requires the active involvement of health service stakeholders, including patients themselves. However, to date, research has explored the acceptability of being 'data donors' rather than considering patients as active contributors. The study aimed to understand how patients should be actively involved in an LHS. DESIGN Ten participatory codesign workshops were conducted with eight experienced public contributors using visual, collective and iterative methods. This led contributors to challenge and revise not only the idea of an LHS but also revise the study aims and outputs. RESULTS The contributors proposed three exemplar roles for patients in patient-driven LHS, which aligned with the idea of three forms of transparency: informational, participatory and accountability. 'Epistemic injustice' was considered a useful concept to express the risks of an LHS that did not provide active roles to patients (testimonial injustice) and that neglected their experience through collecting data that did not reflect the complexity of their lives (hermeneutic injustice). DISCUSSION Patient involvement in an LHS should be 'with and by' patients, not 'about or for'. This requires systems to actively work with and respond to patient feedback, as demonstrated within the study itself by the adaptive approach to responding to contributor questions, to work in partnership with patients to create a 'virtuous alliance' to achieve change. PATIENT OR PUBLIC CONTRIBUTION Public contributors were active partners throughout, and co-authored the paper.
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Affiliation(s)
- Sarah E Knowles
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Dawn Allen
- NIHR Collaboration for Leadership in Applied Health Research and Care Greater Manchester, University of Manchester, Manchester, UK
| | - Ailsa Donnelly
- NIHR Collaboration for Leadership in Applied Health Research and Care Greater Manchester, University of Manchester, Manchester, UK
| | - Jackie Flynn
- NIHR Collaboration for Leadership in Applied Health Research and Care Greater Manchester, University of Manchester, Manchester, UK
| | - Kay Gallacher
- NIHR Collaboration for Leadership in Applied Health Research and Care Greater Manchester, University of Manchester, Manchester, UK
| | - Annmarie Lewis
- NIHR Collaboration for Leadership in Applied Health Research and Care Greater Manchester, University of Manchester, Manchester, UK
| | - Grace McCorkle
- NIHR Collaboration for Leadership in Applied Health Research and Care Greater Manchester, University of Manchester, Manchester, UK
| | - Manoj Mistry
- NIHR Collaboration for Leadership in Applied Health Research and Care Greater Manchester, University of Manchester, Manchester, UK
| | - Pat Walkington
- NIHR Collaboration for Leadership in Applied Health Research and Care Greater Manchester, University of Manchester, Manchester, UK
| | - Lisa Brunton
- Centre for Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
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17
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Ní Shé É, Harrison R. Mitigating unintended consequences of co-design in health care. Health Expect 2021; 24:1551-1556. [PMID: 34339528 PMCID: PMC8483209 DOI: 10.1111/hex.13308] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/02/2021] [Accepted: 06/06/2021] [Indexed: 12/22/2022] Open
Abstract
Background Co‐design and associated terms are increasingly being used to facilitate values‐based approaches to health‐care improvement. It is messy and complex, involving diverse actors. Methods We explore the notion that initiatives have outcomes other than initially planned is neither new nor novel but is overlooked when thinking about co‐design. We explore some of the unintended consequences and outline some optimal conditions that can mitigate challenges. Discussion Although co‐design approaches are being applied in health care, questions remain regarding its ability to produce gains in health outcomes. Little is known about determining whether co‐design is the most suitable approach to achieve the given project goals, the levels of involvement required to realize the benefits of co‐design or the potential unintended consequences. There is a risk of further marginalizing or adding burden to under‐represented populations and/or over‐researched populations. Conclusion Undertaking a co‐design approach without the optimal conditions for inclusive involvement by all may not result in an equal partnership or improve health or care quality outcomes. Co‐design requires on‐going reflective discussions and deliberative thinking to remove any power imbalances. However, without adequate resources, a focus on implementation and support from senior leaders, it is a tough ask to achieve. Patient or Public Contribution This viewpoint article was written by two academics who have undertaken a significant amount of PPI and co‐design work with members of the public and patient's right across the health system. Our work guided the focus of this viewpoint as we reflected on our experiences.
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Affiliation(s)
- Éidín Ní Shé
- School of Population Health, University of New South Wales, Kensington, NSW, Australia
| | - Reema Harrison
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
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18
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Knowles SE, Ercia A, Caskey F, Rees M, Farrington K, Van der Veer SN. Participatory co-design and normalisation process theory with staff and patients to implement digital ways of working into routine care: the example of electronic patient-reported outcomes in UK renal services. BMC Health Serv Res 2021; 21:706. [PMID: 34273978 PMCID: PMC8286572 DOI: 10.1186/s12913-021-06702-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/31/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Successful implementation of digital health systems requires contextually sensitive solutions. Working directly with system users and drawing on implementation science frameworks are both recommended. We sought to combine Normalisation Process Theory (NPT) with participatory co-design methods, to work with healthcare stakeholders to generate implementation support recommendations for a new electronic patient reported outcome measure (ePRO) in renal services. ePROs collect data on patient-reported symptom burden and illness experience overtime, requiring sustained engagement and integration into existing systems. METHODS We identified co-design methods that could be mapped to NPT constructs to generate relevant qualitative data. Patients and staff from three renal units in England participated in empathy and process mapping activities to understand 'coherence' (why the ePRO should be completed) and 'cognitive participation' (who would be involved in collecting the ePRO). Observation of routine unit activity was completed to understand 'collective action' (how the collection of ePRO could integrate with service routines). RESULTS The mapping activities and observation enabled the research team to become more aware of the key needs of both staff and patients. Working within sites enabled us to consider local resources and barriers. This produced 'core and custom' recommendations specifying core needs that could be met with customised local solutions. We identified two over-arching themes which need to be considered when introducing new digital systems (1) That data collection is physical (electronic systems need to fit into physical spaces and routines), and (2) That data collection is intentional (system users must be convinced of the value of collecting the data). CONCLUSIONS We demonstrate that NPT constructs can be operationalised through participatory co-design to work with stakeholders and within settings to collaboratively produce implementation support recommendations. This enables production of contextually sensitive implementation recommendations, informed by qualitative evidence, theory, and stakeholder input. Further longitudinal evaluation is necessary to determine how successful the recommendations are in practice.
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Affiliation(s)
- S E Knowles
- Centre for Reviews & Dissemination, University of York, York, UK.
| | - A Ercia
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - F Caskey
- Population Health Science Institute, Bristol Medical School, University of Bristol, Bristol, UK
| | - M Rees
- School of Social, Historical and Political Studies, University of Wolverhampton, Farrington, UK
| | - K Farrington
- Renal Unit, East & North Hertfordshire NHS Trust, Stevenage, UK
| | - S N Van der Veer
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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19
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Fylan B, Tomlinson J, Raynor DK, Silcock J. Using experience-based co-design with patients, carers and healthcare professionals to develop theory-based interventions for safer medicines use. Res Social Adm Pharm 2021; 17:2127-2135. [PMID: 34187746 DOI: 10.1016/j.sapharm.2021.06.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 05/22/2021] [Accepted: 06/03/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Experience-Based Co-Design (EBCD) is a participatory design method which was originally developed and is still primarily used as a healthcare quality improvement tool. Traditionally, EBCD has been sited within single services or settings and has yielded improvements grounded in the experiences of those delivering and receiving care. METHOD In this article we present how EBCD can be adapted to develop complex interventions, underpinned by theory, to be tested more widely within the healthcare system as part of a multi-phase, multi-site research study. We begin with an outline of co-design and the stages of EBCD. We then provide an overview of how EBCD can be assimilated into an intervention development and evaluation study, giving examples of the adaptations and research tools and methods that can be deployed. We also suggest how to appraise the resulting intervention so it is realistic and tractable in multiple sites. We describe how EBCD can be combined with different behaviour change theories and methods for intervention development and finally, we make suggestions about the skills needed for successful intervention development using EBCD. CONCLUSION EBCD has been recognised as being a collaborative approach to improving healthcare services that puts patients and healthcare staff at the heart of initiatives and potential changes. We have demonstrated how EBCD can be integrated into a research project and how existing research approaches can be assimilated into EBCD stages. We have also suggested where behaviour change theories can be used to better understand intervention change mechanisms.
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Affiliation(s)
- Beth Fylan
- School of Pharmacy and Medical Sciences, University of Bradford, Richmond Road, Bradford, BD7 1DP, UK; NIHR Yorkshire and Humber Patient Safety Translational Research Centre. Bradford Institute for Health Research, Temple Bank House, Bradford, BD9 6RJ, UK.
| | - Justine Tomlinson
- School of Pharmacy and Medical Sciences, University of Bradford, Richmond Road, Bradford, BD7 1DP, UK; Medicines Management and Pharmacy Services, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, LS9 7TF, UK.
| | - David K Raynor
- School of Healthcare, University of Leeds, Leeds, LS2 9JT, UK.
| | - Jonathan Silcock
- School of Pharmacy and Medical Sciences, University of Bradford, Richmond Road, Bradford, BD7 1DP, UK.
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20
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Knowles SE, Allen D, Donnelly A, Flynn J, Gallacher K, Lewis A, McCorkle G, Mistry M, Walkington P, Drinkwater J. More than a method: trusting relationships, productive tensions, and two-way learning as mechanisms of authentic co-production. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:34. [PMID: 34059159 PMCID: PMC8165763 DOI: 10.1186/s40900-021-00262-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/18/2021] [Indexed: 05/16/2023]
Abstract
BACKGROUND Knowledge mobilisation requires the effective elicitation and blending of different types of knowledge or ways of knowing, to produce hybrid knowledge outputs that are valuable to both knowledge producers (researchers) and knowledge users (health care stakeholders). Patients and service users are a neglected user group, and there is a need for transparent reporting and critical review of methods used to co-produce knowledge with patients. This study aimed to explore the potential of participatory codesign methods as a mechanism of supporting knowledge sharing, and to evaluate this from the perspective of both researchers and patients. METHODS A knowledge mobilisation research project using participatory codesign workshops to explore patient involvement in using health data to improve services. To evaluate involvement in the project, multiple qualitative data sources were collected throughout, including a survey informed by the Generic Learning Outcomes framework, an evaluation focus group, and field notes. Analysis was a collective dialogic reflection on project processes and impacts, including comparing and contrasting the key issues from the researcher and contributor perspectives. RESULTS Authentic involvement was seen as the result of "space to talk" and "space to change". "Space to talk" refers to creating space for shared dialogue, including space for tension and disagreement, and recognising contributor and researcher expertise as equally valuable to the discussion. 'Space to change' refers to space to adapt in response to contributor feedback. These were partly facilitated by the use of codesign methods which emphasise visual and iterative working, but contributors emphasised that relational openness was more crucial, and that this needed to apply to the study overall (specifically, how contributors were reimbursed as a demonstration of how their input was valued) to build trust, not just to processes within the workshops. CONCLUSIONS Specific methods used within involvement are only one component of effective involvement practice. The relationship between researcher and contributors, and particularly researcher willingness to change their approach in response to feedback, were considered most important by contributors. Productive tension was emphasised as a key mechanism in leading to genuinely hybrid outputs that combined contributor insight and experience with academic knowledge and understanding.
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Affiliation(s)
- Sarah E Knowles
- Centre for Reviews and Dissemination, University of York, York, YO10 5DD, UK.
- Patients in the Learning Health System PPI Group, NIHR Collaboration for Leadership in Applied Health Research and Care Greater Manchester University of Manchester, Manchester, UK.
| | - Dawn Allen
- Centre for Reviews and Dissemination, University of York, York, YO10 5DD, UK
- Patients in the Learning Health System PPI Group, NIHR Collaboration for Leadership in Applied Health Research and Care Greater Manchester University of Manchester, Manchester, UK
| | - Ailsa Donnelly
- Centre for Reviews and Dissemination, University of York, York, YO10 5DD, UK
- Patients in the Learning Health System PPI Group, NIHR Collaboration for Leadership in Applied Health Research and Care Greater Manchester University of Manchester, Manchester, UK
| | - Jackie Flynn
- Centre for Reviews and Dissemination, University of York, York, YO10 5DD, UK
- Patients in the Learning Health System PPI Group, NIHR Collaboration for Leadership in Applied Health Research and Care Greater Manchester University of Manchester, Manchester, UK
| | - Kay Gallacher
- Centre for Reviews and Dissemination, University of York, York, YO10 5DD, UK
- Patients in the Learning Health System PPI Group, NIHR Collaboration for Leadership in Applied Health Research and Care Greater Manchester University of Manchester, Manchester, UK
| | - Annmarie Lewis
- Centre for Reviews and Dissemination, University of York, York, YO10 5DD, UK
- Patients in the Learning Health System PPI Group, NIHR Collaboration for Leadership in Applied Health Research and Care Greater Manchester University of Manchester, Manchester, UK
| | - Grace McCorkle
- Centre for Reviews and Dissemination, University of York, York, YO10 5DD, UK
- Patients in the Learning Health System PPI Group, NIHR Collaboration for Leadership in Applied Health Research and Care Greater Manchester University of Manchester, Manchester, UK
| | - Manoj Mistry
- Centre for Reviews and Dissemination, University of York, York, YO10 5DD, UK
- Patients in the Learning Health System PPI Group, NIHR Collaboration for Leadership in Applied Health Research and Care Greater Manchester University of Manchester, Manchester, UK
| | - Pat Walkington
- Centre for Reviews and Dissemination, University of York, York, YO10 5DD, UK
- Patients in the Learning Health System PPI Group, NIHR Collaboration for Leadership in Applied Health Research and Care Greater Manchester University of Manchester, Manchester, UK
| | - Jess Drinkwater
- Patients in the Learning Health System PPI Group, NIHR Collaboration for Leadership in Applied Health Research and Care Greater Manchester University of Manchester, Manchester, UK
- School of Medicine, Leeds Institute of Health Sciences, University of Leeds, LS2 9JT, Leeds, UK
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21
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Lawless MT, Archibald M, Pinero de Plaza MA, Drioli-Phillips P, Kitson A. Peer-to-Peer Health Communication in Older Adults' Online Communities: Protocol for a Qualitative Netnographic Study and Co-Design Approach. JMIR Res Protoc 2020; 9:e19834. [PMID: 32924960 PMCID: PMC7522734 DOI: 10.2196/19834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/02/2020] [Accepted: 07/26/2020] [Indexed: 12/22/2022] Open
Abstract
Background Online communities provide an environment in which people with similar health concerns can interact and access content that can support the self-management of long-term conditions (LTCs). Recently, the importance of online social networks as sources of health information and social support has been brought into focus with the emergence and widespread societal impacts of COVID-19. Although online communities exist for older adults, little is known about the specific health and self-care topics that older people discuss in such environments and how these relate to users’ support needs and outcomes. A better understanding of users’ needs and peer-to-peer communication in these communities is necessary to inform the design of information and communication technology (ICT) interventions that are relevant to older people and their peer supporters. Objective This study aims to use a two-phase, web-based ethnographic (netnography) and co-design approach to explore specific health care and self-care topics that older adults discuss in a UK-based online community and how peer supporters respond to these queries with informational and/or social support and engage with stakeholders to define the needs and requirements for new ICT-based interventions capable of reducing social isolation and facilitating LTC self-management support. Methods The first phase of the research will involve a qualitative netnographic analysis of posts in discussion forums in a publicly accessible online community. The second phase will involve co-design workshops with health care consumers (ie, older adults and carers) and service providers to determine the needs and requirements for new ICT-based interventions and digital innovations. Constructivist grounded theory will be used in the first phase; in the second phase, the co-design workshops will be audiorecorded and analyzed thematically. Results This research project is in progress. Permission was obtained from the website administrator to use materials from the social media forum; data collection for the first phase began in April 2020. The second phase of the study is expected to begin in late 2020. This study is due to be completed by the end of 2021. Conclusions This study is the first, to the best of our knowledge, to combine qualitative netnography with an iterative co-design framework to specify the needs and requirements for new ICT-based interventions. The findings from this study will inform the next phase of the multiphase knowledge translation project and will provide insights into the potential of online peer health communities to reduce social isolation and facilitate chronic illness self-management support and self-care. International Registered Report Identifier (IRRID) PRR1-10.2196/19834
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Affiliation(s)
- Michael Thomas Lawless
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia.,National Health and Medical Research Council Transdisciplinary Centre of Research Excellence in Frailty Research to Achieve Healthy Ageing, Adelaide, Australia
| | - Mandy Archibald
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia.,National Health and Medical Research Council Transdisciplinary Centre of Research Excellence in Frailty Research to Achieve Healthy Ageing, Adelaide, Australia.,College of Nursing, Helen Glass Centre for Nursing, University of Manitoba, Winnipeg, MB, Canada
| | - Maria Alejandra Pinero de Plaza
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia.,National Health and Medical Research Council Transdisciplinary Centre of Research Excellence in Frailty Research to Achieve Healthy Ageing, Adelaide, Australia
| | | | - Alison Kitson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia.,National Health and Medical Research Council Transdisciplinary Centre of Research Excellence in Frailty Research to Achieve Healthy Ageing, Adelaide, Australia
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22
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Tran VT, Diard E, Ravaud P. Priorities to improve the care for chronic conditions and multimorbidity: a survey of patients and stakeholders nested within the ComPaRe e-cohort. BMJ Qual Saf 2020; 30:577-587. [PMID: 32839207 PMCID: PMC8237178 DOI: 10.1136/bmjqs-2020-011219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/24/2020] [Accepted: 07/26/2020] [Indexed: 01/13/2023]
Abstract
Objective To set priorities to improve consultations, care structures and the healthcare system from the perspective of patients with chronic conditions, care professionals, hospital administrators and health policy makers. Methods Adult patients with chronic conditions recruited from the ComPaRe e-cohort in France ranked their 15 most important areas of improvement among 147 previously defined by patients. Priorities at a population level were obtained by using logit models for sets of ranked items in a data set calibrated to represent the French population of patients with chronic conditions. Care professionals, hospital managers and health policy makers rated the complexity involved in improving the areas identified. We calculated the number of patients who considered as a priority at least one of the areas considered easy to implement. Results Between September 2018 and May 2019, 3002 patients (84% women, 47% with multimorbidity) and 149 professionals (including 50 care professionals, 79 hospital directors, 11 health policy decision makers) were recruited. Patients’ top priorities were (1) Transforming care to be holistic and personalised, at a consultation level; (2) Smoothing patients' journey in the care system, increasing their knowledge of their own health and improving care coordination, at a care structure level (3) Training clinicians in better interpersonal skills and knowledge of specific conditions/treatments, reducing stigma and making care more affordable, at a healthcare system level. In total, 48%, 71% and 57% patients ranked in their top priorities one area considered easy to improve by professionals at consultation, care structure and health system levels, respectively. Conclusion This is the first comprehensive map of patients’ priorities to improve the management of chronic conditions. Implementing simple actions could benefit a large number of patients.
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Affiliation(s)
- Viet-Thi Tran
- METHODS Team, Université de Paris, CRESS, INSERM, INRA, Paris, France .,Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Elise Diard
- METHODS Team, Université de Paris, CRESS, INSERM, INRA, Paris, France.,Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Philippe Ravaud
- METHODS Team, Université de Paris, CRESS, INSERM, INRA, Paris, France.,Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique - Hôpitaux de Paris, Paris, France
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23
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Fusco F, Marsilio M, Guglielmetti C. Co-production in health policy and management: a comprehensive bibliometric review. BMC Health Serv Res 2020; 20:504. [PMID: 32503522 PMCID: PMC7275357 DOI: 10.1186/s12913-020-05241-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 04/19/2020] [Indexed: 12/25/2022] Open
Abstract
Background Due to an increasingly elderly population, a higher incidence of chronic diseases and higher expectations regarding public service provision, healthcare services are under increasing strain to cut costs while maintaining quality. The importance of promoting systems of co-produced health between stakeholders has gained considerable traction both in the literature and in public sector policy debates. This study provides a comprehensive map of the extant literature and identifies the main themes and future research needs. Methods A quantitative bibliometric analysis was carried out consisting of a performance analysis, science mapping, and a scientific collaboration analysis. Web of Science (WoS) was chosen to extract the dataset; the search was refined by language, i.e. English, and type of publication, i.e. journal academic articles and reviews. No time limitation was selected. Results The dataset is made up of 295 papers ranging from 1994 to May 2019. The analysis highlighted an annual percentage growth rate in the topic of co-production of about 25%. The articles retrieved are split between 1225 authors and 148 sources. This fragmentation was confirmed by the collaboration analysis, which revealed very few long-lasting collaborations. The scientific production is geographically polarised within the EU and Anglo-Saxon countries, with the United Kingdom playing a central role. The intellectual structure consists of three main areas: public administration and management, service management and knowledge translation literature. The co-word analysis confirms the relatively low scientific maturity of co-production applied to health services. It shows few well-developed and central terms, which refer to traditional areas of co-production (e.g. public health, social care), and some emerging themes related to social and health phenomena (e.g. the elderly and chronic diseases), the use of technologies, and the recent patient-centred approach to care (patient involvement/engagement). Conclusions The field is still far from being mature. Empirical practices, especially regarding co-delivery and co-management as well as the evaluation of their real impacts on providers and on patients are lacking and should be more widely investigated.
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Affiliation(s)
- Floriana Fusco
- Department of Economics, Management and Quantitative Methods (DEMM), Università degli Studi di Milano, via Conservatorio, 7, 20122, Milan, Italy
| | - Marta Marsilio
- Department of Economics, Management and Quantitative Methods (DEMM), Università degli Studi di Milano, via Conservatorio, 7, 20122, Milan, Italy.
| | - Chiara Guglielmetti
- Department of Economics, Management and Quantitative Methods (DEMM), Università degli Studi di Milano, via Conservatorio, 7, 20122, Milan, Italy
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24
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What Is the Co-Creation of New Knowledge? A Content Analysis and Proposed Definition for Health Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072229. [PMID: 32224998 PMCID: PMC7177645 DOI: 10.3390/ijerph17072229] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 03/18/2020] [Accepted: 03/21/2020] [Indexed: 12/13/2022]
Abstract
Co-creation of new knowledge has the potential to speed up the discovery and application of new knowledge into practice. However, the progress of co-creation is hindered by a lack of definitional clarity and inconsistent use of terminology. The aim of this paper is to propose a new standardised definition of co-creation of new knowledge for health interventions based on the existing co-creation literature. The authors completed a systematic search of electronic databases and Google Scholar using 10 of the most frequently used co-creation-related keywords to identify relevant studies. Qualitative content analysis was performed, and two reviewers independently tested the categorisation of papers. Of the 6571 papers retrieved, 42 papers met the inclusion criteria. Examination of the current literature on co-creation demonstrated how the variability of co-creation-related terms can be reduced to four collaborative processes: co-ideation, co-design, co-implementation and co-evaluation. Based on these four processes, a new definition of co-creation of new knowledge for health interventions is proposed. The analysis revealed the need to address the conceptual ambiguity of the definition of “co-creation of new knowledge”. The proposed new definition may help to resolve the current definitional issues relating to co-creation, allowing researchers and policymakers to progress the development of co-creation of new knowledge in research and practice.
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25
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Payne D. Medications at home. Br J Community Nurs 2019; 23:292-295. [PMID: 29869911 DOI: 10.12968/bjcn.2018.23.6.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article looks at practical ways to support patients with oral medication compliance in their own homes. It addresses the importance of assessing why the patient needs support, the importance of a medication review and strategies and tools to aid patient compliance, alongside instances where a nurse can aid patient's relatives and carers can provide medication instead of a nurse.
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Affiliation(s)
- Drew Payne
- Community staff nurse, Whittington Health, London
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26
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Payne D. Medications at home. Br J Community Nurs 2019; 23:240-243. [PMID: 29799779 DOI: 10.12968/bjcn.2018.23.6.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article looks at practical ways to support patients with oral medication compliance in their own homes. It addresses the importance of assessing why the patient needs support, the importance of a medication review and strategies and tools to aid patient compliance, alongside instances where a nurse can aid patient's relatives and carers can provide medication instead of a nurse.
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Affiliation(s)
- Drew Payne
- Community staff nurse, Whittington Health, London
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27
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Green T, Bonner A, Teleni L, Bradford N, Purtell L, Douglas C, Yates P, MacAndrew M, Dao HY, Chan RJ. Use and reporting of experience-based codesign studies in the healthcare setting: a systematic review. BMJ Qual Saf 2019; 29:64-76. [PMID: 31548278 DOI: 10.1136/bmjqs-2019-009570] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 08/18/2019] [Accepted: 09/10/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Experience-based codesign (EBCD) is an approach to health service design that engages patients and healthcare staff in partnership to develop and improve health services or pathways of care. The aim of this systematic review was to examine the use (structure, process and outcomes) and reporting of EBCD in health service improvement activities. METHODS Electronic databases (MEDLINE, CINAHL, PsycINFO and The Cochrane Library) were searched to identify peer-reviewed articles published from database inception to August 2018. Search terms identified peer-reviewed English language qualitative, quantitative and mixed methods studies that underwent independent screening by two authors. Full texts were independently reviewed by two reviewers and data were independently extracted by one reviewer before being checked by a second reviewer. Adherence to the 10 activities embedded within the eight-stage EBCD framework was calculated for each study. RESULTS We identified 20 studies predominantly from the UK and in acute mental health or cancer services. EBCD fidelity ranged from 40% to 100% with only three studies satisfying 100% fidelity. CONCLUSION EBCD is used predominantly for quality improvement, but has potential to be used for intervention design projects. There is variation in the use of EBCD, with many studies eliminating or modifying some EBCD stages. Moreover, there is no consistency in reporting. In order to evaluate the effect of modifying EBCD or levels of EBCD fidelity, the outcomes of each EBCD phase (ie, touchpoints and improvement activities) should be reported in a consistent manner. TRIAL REGISTRATION NUMBER CRD42018105879.
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Affiliation(s)
- Theresa Green
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Ann Bonner
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Laisa Teleni
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Natalie Bradford
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Louise Purtell
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Clint Douglas
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Patsy Yates
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Margaret MacAndrew
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Hai Yen Dao
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Raymond Javan Chan
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia .,Division of Cancer Services Princess Alexandra Hospital, Metro South Hospital and Health Service, Woolloongabba, Queensland, Australia
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28
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Tran VT, Riveros C, Péan C, Czarnobroda A, Ravaud P. Patients' perspective on how to improve the care of people with chronic conditions in France: a citizen science study within the ComPaRe e-cohort. BMJ Qual Saf 2019; 28:875-886. [PMID: 31015376 PMCID: PMC6860767 DOI: 10.1136/bmjqs-2018-008593] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 03/19/2019] [Accepted: 03/30/2019] [Indexed: 12/28/2022]
Abstract
Background This study aimed to involve patients with chronic conditions in generating ideas for improving their care. Methods We performed a citizen science study. Participants were adult patients with chronic conditions recruited in Community of Patients for Research ‘ComPaRe,’ a French e-cohort of patients with chronic conditions. Participants generated ideas to improve their care in answer to the open-ended question, ‘If you had a magic wand, what would you change in your healthcare?’ Three researchers and two patients independently extracted ideas from open-ended answers by using thematic analysis. Ideas were grouped into areas for improvement at the consultation, hospital/clinic and health system levels. Findings were validated and enriched by a second sample of participants recruited in ComPaRe. Results Between May 2017 and April 2018, a total of 1636 patients provided 3613 ideas to improve consultations (1701 ideas related to 58 areas for improvement), hospitals/clinics (928 ideas related to 41 areas for improvement) and the health system (984 ideas related to 48 areas for improvement). At the consultation level, most ideas were related to improving physician–patient discussions, informing patients about their own care, and adapting treatment to patient preferences and context. At the hospital/clinic level, most ideas aimed at improving the coordination and collaboration in care. At the health system level, most ideas were related to decreasing the administrative burden imposed on patients, improving access to care and reducing the costs of care. Conclusion Patients have many ideas to improve their care, from the content of consultations to the organisation of hospitals. Our study provides the proof of concept for a method to leverage patients’ practical knowledge of the care system to improve it.
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Affiliation(s)
- Viet-Thi Tran
- METHODS Team, Centre de Recherche Epidémiologie et Statistique Sorbonne Paris Cité (CRESS UMR 1153), INSERM, Paris, Île-de-France, France .,Centre d'Epidémiologie Clinique - Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Carolina Riveros
- Centre d'Epidémiologie Clinique - Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | | | - Philippe Ravaud
- METHODS Team, Centre de Recherche Epidémiologie et Statistique Sorbonne Paris Cité (CRESS UMR 1153), INSERM, Paris, Île-de-France, France.,Centre d'Epidémiologie Clinique - Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
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29
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Hunter H, Gorst T. Co-production with people with Parkinson's disease: making physical activity effective, meaningful and sustainable. ACTA ACUST UNITED AC 2019; 17:442-443. [PMID: 30973522 DOI: 10.11124/jbisrir-d-19-00088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Heather Hunter
- Department of Physiotherapy, School of Health Professions, University of Plymouth, Plymouth, UK The University of Plymouth Centre for Innovations in Health and Social Care: a Joanna Briggs Institute Centre of Excellence, Plymouth, UK
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Knowles S, Hays R, Senra H, Bower P, Locock L, Protheroe J, Sanders C, Daker-White G. Empowering people to help speak up about safety in primary care: Using codesign to involve patients and professionals in developing new interventions for patients with multimorbidity. Health Expect 2017; 21:539-548. [PMID: 29266797 PMCID: PMC5867321 DOI: 10.1111/hex.12648] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2017] [Indexed: 11/29/2022] Open
Abstract
Background Multimorbidity, defined as the presence of two or more long‐term conditions, is increasingly common in primary care, and patients with multimorbidity may face particular barriers to quality of care and increased safety risks due to the complexity of managing multiple conditions. Consistent with calls to directly involve service users in improving care, we aimed to use design materials to codesign new interventions to improve safety in primary care. Design We drew on two established methods—accelerated experience‐based codesign and the future workshop approach. We synthesized design materials based on research into the patient experience of safety and multimorbidity in primary care to enable both patients, service users and carers, and primary health‐care professionals to propose interventions to improve care. Results Both patients and professionals prioritized polypharmacy as a threat to safety. Their recommendations for supportive interventions were consistent with Burden of Treatment theory, emphasizing the limited capacity of patients with multimorbidity and the need for services to proactively offer support to reduce the burden of managing complex treatment regimes. Discussion & Conclusions The process was feasible and acceptable to participants, who valued the opportunity to jointly propose new interventions. The iterative workshop approach enabled the research team to better explore and refine the suggestions of attendees. Final recommendations included the need for accessible reminders to support medication adherence and medication reviews for particularly vulnerable patients conducted with pharmacists within GP practices.
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Affiliation(s)
- Sarah Knowles
- NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Greater Manchester, University of Manchester, Manchester, UK
| | - Rebecca Hays
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology Medicine and Health, NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre (Greater Manchester PSTRC), Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Hugo Senra
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Peter Bower
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Louise Locock
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Jo Protheroe
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, UK
| | - Caroline Sanders
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Gavin Daker-White
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology Medicine and Health, NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre (Greater Manchester PSTRC), Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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