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Ariss SMB, Taylor P, Fitzsimmons D, Kyeremateng S, Mawson S. Mobile technology and delegated work in specialist community services: the EnComPaSS Integration project. BMJ Support Palliat Care 2021:bmjspcare-2020-002288. [PMID: 34916238 DOI: 10.1136/bmjspcare-2020-002288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 11/22/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The current UK healthcare workforce crisis is particularly severe in community services. A key limitation with traditional service-delivery models is the reliance on practitioners with levels of training and experience to enable them to operate independently. This paper describes a real-world evaluation of the implementation of digital health technology designed to provide remote, real-time support and task delegation in community palliative care services. It explores the ability of technology to support sustainable community workforce models and reports on key indicators of quality and efficiency. METHODS The study was a mixed-methods, theory-driven evaluation, incorporating interviews, observations and analysis of routine data. The focus of this paper is the reporting of findings from pre-post implementation comparison and interrupted time series analysis. Data include community hospice service visits, hospital use by hospice patients and patient reported experiences. RESULTS The digital health intervention allowed the service to include a more junior workforce (p<0.001, Cramer's V=0.241), requiring fewer joint visits (p<0.001, Cramer's V=0.087). No negative changes in hospitalisation were observed and patient reported experiences improved (p=0.023). Changes in hospital non-emergency bed days were inconclusive. However, emergency department admissions reduced significantly (-76.9 /month at 17 months, p=0.001). The cost per hour for visits reduced from £16.71 to £16.23 and annual savings of £135 153 are estimated for reduced emergency admissions. CONCLUSIONS The evaluation demonstrates the value of digital innovation to support programmes of service redesign and begin to address the healthcare workforce crisis, while having a positive economic effect and indicating an improvement to patient experiences.
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Affiliation(s)
| | - Paul Taylor
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
- St Luke's Hospice, Sheffield, UK
| | | | | | - Susan Mawson
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
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Mawson S, Keen C, Skilbeck J, Ross H, Smith L, Dixey J, Walters SJ, Simpson R, Greenfield DM, Snowden JA. Feasibility and benefits of a structured prehabilitation programme prior to autologous stem cell transplantation (ASCT) in patients with myeloma; a prospective feasibility study. Physiotherapy 2021; 113:88-99. [PMID: 34563917 PMCID: PMC8612275 DOI: 10.1016/j.physio.2021.08.001] [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: 07/25/2019] [Revised: 06/23/2021] [Accepted: 08/01/2021] [Indexed: 12/26/2022]
Abstract
Evidence supports the benefits of exercise-based rehabilitation in promoting recovery in myeloma patients following autologous stem-cell transplantation (ASCT). However, ‘prehabilitation’ has never been evaluated prior to ASCT, despite evidence of effectiveness in other cancers. Utilising a mixed method approach the authors investigated the feasibility of a mixed strength and cardiovascular exercise intervention pre-ASCT. Quantitative data were collected to determine feasibility targets; rates of recruitment, adherence and adverse events, including 6 minute walking distance (6MWD) test and patient reported outcome measures (PROMs). Qualitative interviews were undertaken with a purposive sample of patients to capture their experiences of the study and the intervention. The authors recruited 23 patients who attended a mean percentage of 75% scheduled exercise sessions. However, retention rates were limited, with only 14/23 (62%) completing the programme. In these patients, the 6MWD increased from a mean of 346 to 451 m (i.e. by 105 m, 95% CI 62 to 148 m) with no serious adverse events. Whist participants found the exercise programme acceptable and reported improvement in their physical fitness and overall mental health and wellbeing prior to ASCT, the study identified challenges in hospital attendance for the prehabilitation schedule whilst receiving induction or re-induction chemotherapy. Evaluation of digitally-enhanced directed but remote prehabilitation models for this patient group is warranted.
Trial registration number NCT03135925
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Affiliation(s)
- Susan Mawson
- School of Health and Related Research, University of Sheffield, 30 Regent Street, Sheffield S1 4DA, UK.
| | - Carol Keen
- Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield S10 2JF, UK.
| | - Julie Skilbeck
- Department of Nursing and Midwifery, Sheffield Hallam University, Howard Street, Sheffield S1 1WB, UK.
| | - Helen Ross
- Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield S10 2JF, UK.
| | - Lauren Smith
- Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield S10 2JF, UK.
| | - Joanne Dixey
- Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield S10 2JF, UK.
| | - Stephen J Walters
- School of Health and Related Research, University of Sheffield, 30 Regent Street, Sheffield S1 4DA, UK.
| | - Rebecca Simpson
- School of Health and Related Research, University of Sheffield, 30 Regent Street, Sheffield S1 4DA, UK.
| | - Diana M Greenfield
- Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield S10 2JF, UK; Department of Oncology and Metabolism, University of Sheffield, Beech Hill Road, Sheffield S10 2RX, UK.
| | - John A Snowden
- Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield S10 2JF, UK; Department of Oncology and Metabolism, University of Sheffield, Beech Hill Road, Sheffield S10 2RX, UK.
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Tziraki C, Grimes C, Ventura F, O’Caoimh R, Santana S, Zavagli V, Varani S, Tramontano D, Apóstolo J, Geurden B, De Luca V, Tramontano G, Romano MR, Anastasaki M, Lionis C, Rodríguez-Acuña R, Capelas ML, dos Santos Afonso T, Molloy DW, Liotta G, Iaccarino G, Triassi M, Eklund P, Roller-Wirnsberger R, Illario M. Rethinking palliative care in a public health context: addressing the needs of persons with non-communicable chronic diseases. Prim Health Care Res Dev 2020; 21:e32. [PMID: 32928334 PMCID: PMC7503185 DOI: 10.1017/s1463423620000328] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/18/2020] [Accepted: 07/14/2020] [Indexed: 11/12/2022] Open
Abstract
Non-communicable chronic diseases (NCCDs) are the main cause of morbidity and mortality globally. Demographic aging has resulted in older populations with more complex healthcare needs. This necessitates a multilevel rethinking of healthcare policies, health education and community support systems with digitalization of technologies playing a central role. The European Innovation Partnership on Active and Healthy Aging (A3) working group focuses on well-being for older adults, with an emphasis on quality of life and healthy aging. A subgroup of A3, including multidisciplinary stakeholders in health care across Europe, focuses on the palliative care (PC) model as a paradigm to be modified to meet the needs of older persons with NCCDs. This development paper delineates the key parameters we identified as critical in creating a public health model of PC directed to the needs of persons with NCCDs. This paradigm shift should affect horizontal components of public health models. Furthermore, our model includes vertical components often neglected, such as nutrition, resilience, well-being and leisure activities. The main enablers identified are information and communication technologies, education and training programs, communities of compassion, twinning activities, promoting research and increasing awareness amongst policymakers. We also identified key 'bottlenecks': inequity of access, insufficient research, inadequate development of advance care planning and a lack of co-creation of relevant technologies and shared decision-making. Rethinking PC within a public health context must focus on developing policies, training and technologies to enhance person-centered quality life for those with NCCD, while ensuring that they and those important to them experience death with dignity.
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Affiliation(s)
- Chariklia Tziraki
- Israel Gerontological Data Center, Hebrew University of Jerusalem, Jerusalem, Israel
- MELABEV – Community Clubs for Elders, Jerusalem, Israel
| | | | - Filipa Ventura
- The Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal
| | - Rónán O’Caoimh
- Department of Medicine, Clinical Sciences Institute, National University of Ireland, Galway, Ireland
| | - Silvina Santana
- Department of Economics, Management, Industrial Engineering and Tourism, Institute of Electronics and Informatics Engineering of Aveiro, University of Aveiro, Aveiro, Portugal
| | | | | | - Donatella Tramontano
- Department of Molecular Medicine and Medical Biotechnology, Federico II University of Naples, Naples, Italy
| | - João Apóstolo
- Department of Nursing, Nursing School of Coimbra, Coimbra, Portugal
| | - Bart Geurden
- Nursing and Midwifery, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Vincenzo De Luca
- Research and Development Unit, Federico II University Hospital, Naples, Italy
| | - Giovanni Tramontano
- Hospital Care Division, General Directorate for Health, Campania Region, Naples, Italy
| | - Maria Rosaria Romano
- Hospital Care Division, General Directorate for Health, Campania Region, Naples, Italy
| | - Marilena Anastasaki
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Christos Lionis
- Department of Social Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | | | - Manuel Luis Capelas
- Interdisciplinary Health Research Center (CIIS), Institute of Health Sciences, Portuguese Catholic University, Lisbon, Portugal
| | - Tânia dos Santos Afonso
- Faculty of Pharmacy, Center for Pharmaceutical Studies, University of Coimbra, Coimbra, Portugal
| | - David William Molloy
- Centre for Gerontology and Rehabilitation, School of Medicine, University College of Cork, Cork, Ireland
| | - Giuseppe Liotta
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Guido Iaccarino
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Maria Triassi
- Department of Public Health, Federico II University of Naples, Naples, Italy
| | - Patrik Eklund
- Department of Computing Science, Umeå University, Umeå, Sweden
| | | | - Maddalena Illario
- Department of Public Health, Federico II University of Naples, Naples, Italy
- Health Innovation Division, General Directorate for Health, Campania Region, Naples, Italy
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Achieving Prudent Dementia Care ( Palliare): An International Policy and Practice Imperative. Int J Integr Care 2016; 16:18. [PMID: 28316557 PMCID: PMC5354215 DOI: 10.5334/ijic.2497] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This paper examines the provision of integrated advanced dementia care within seven European countries and critically reviews the potential contribution of the Prudent Healthcare perspective as a starting point for reform. Progressive efforts to innovate, promote quality and integrate care are tempered with the reality of resource constraints. Some policy makers in Europe and North America have turned their attention to the principles of Prudent Healthcare as a potential mechanism to maximise benefits for patients within available resources. As dementia progresses, living well requires increasing levels of support and care, people living with advanced dementia have complex health and social care needs, are highly dependent on others but are not yet at the terminal end stage of the condition. People with advanced dementia can benefit from a dementia specific palliative approach to care (Palliare), that helps them to live the best life possible for the months and often years they live with advanced dementia. It is also highly desirable to align policy innovations with integrated palliative care practice models and the education of the dementia workforce to accelerate informed improvements in advanced dementia care. There may be some coherence, at least superficially between Prudent Healthcare and integrated palliative care models such as Palliare. It is argued that for successful implementation, both require practitioners to be equipped with knowledge and skills and be empowered to deliver high quality care often within impoverished care environments. Adoption of the prudent perspective will however require development of a repertoire of approaches to hear the voice or proxy voice of people living with advanced dementia and to commit to the development and implementation of new evidence for advanced dementia practice. Evidence informing this policy debate draws upon contemporary literature and policy and the findings from research activities undertaken by the Palliare project supported through the Erasmus+ K2 Strategic Partnerships funding programme.
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