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Tsimpida D, Rajasingam S, Panagioti M, Henshaw H. The leaky pipeline of hearing care: primary to secondary care evidence from the English Longitudinal Study of Ageing (ELSA). Int J Audiol 2024; 63:349-357. [PMID: 36951175 DOI: 10.1080/14992027.2023.2186814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/28/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVE The proportions of older adults' transitions through acknowledging their hearing loss to getting access to treatment are unknown. This was examined using data from a nationally representative cohort in England. DESIGN Patient and healthcare factors associated with referrals were examined cross-sectionally, through primary to secondary care. Non-report predictors identified using multiple logistic regression models. STUDY SAMPLE 8529 adults with hearing data in the English Longitudinal Study of Ageing Wave 7. RESULTS Nearly 40% of those with acknowledged hearing loss did not tell a doctor or nurse (n = 857/2249). Women (OR 2.68, 95% CI 2.14-2.98), retirees (OR 1.30, 95% CI 1.17-1.44), those with foreign education (OR 2.74, 95% CI 2.47-3.04), lower education (OR 2.86, 95% CI 2.58-3.18), smokers (OR 4.39, 95% CI 3.95-4.87), and heavy drinkers (OR 1.67, 95% CI 1.58-1.85) were more likely to not report hearing loss. Of those who acknowledged and reported hearing difficulties, willingness to try hearing aid(s) was high (78.9%). CONCLUSIONS Unacknowledged, or acknowledged but not reported hearing loss by individuals, and non-referrals by primary healthcare professionals, are barriers to accessing hearing healthcare. Future research should report hearing aid use as the proportion of individuals who acknowledge their hearing loss, to avoid an overestimation of the non-use of hearing aids within study samples.
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Affiliation(s)
- Dialechti Tsimpida
- Department of Public Health, Policy & Systems, Institute of Population Health, The University of Liverpool, Liverpool, UK
| | - Saima Rajasingam
- School of Psychology & Sport Sciences (Vision & Hearing) Cambridge Campus, Anglia Ruskin University, Cambridge, UK
| | - Maria Panagioti
- NIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC), School of Health Sciences, The University of Manchester, Manchester, UK
| | - Helen Henshaw
- NIHR Nottingham Biomedical Research Centre (BRC), School of Medicine, University of Nottingham, Nottingham, UK
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Abudoush AN, Poliakoff E, Panagioti M, Hodkinson A, Husain N. Investigating attention toward pain-related cues in an Arabic-speaking population with and without chronic pain. Exp Brain Res 2024:10.1007/s00221-024-06789-9. [PMID: 38424370 DOI: 10.1007/s00221-024-06789-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/22/2024] [Indexed: 03/02/2024]
Abstract
There is some evidence for attentional biases in individuals with chronic pain (CP). Cultural and linguistic differences might affect the manifestation of these processes across populations. However, such attentional biases have not been explored in the Arabic-speaking population. The current study investigated these attentional biases and possible associations with resilience. Two matched groups of Arabic-speaking participants with (58) and without (58) CP were recruited from Jordan and the United Kingdom. They completed emotionally modified versions of the Posner cueing and Stroop tasks, alongside questionnaires. Significant group differences were found for the Posner task, with the CP group exhibiting disengagement revealed by the inhibition of return (IOR) effect for sensory pain-related cues compared to delayed disengagement for the other cue types. The control group showed IOR across cue types. No group differences were found on the Stroop task. The CP group had lower resilience scores than healthy controls, and resilience moderated performance on the Posner task. The study provides preliminary evidence about the attentional processes in the Arabic population; the speed of disengagement is affected in the CP group with early disengagement for sensory pain-related information compared to affect pain and neutral stimuli. Furthermore, resilience levels in the CP and control group moderated the performance on the Posner task, suggesting that it influences attentional allocation. This study can help in understanding how the phenomenon of attention bias intertwines with the cultural and linguistic factors. Future research should further explore attentional dynamics across different time points in this population and the modulatory effect of resilience.
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Affiliation(s)
- Ahmad N Abudoush
- Department of Psychology, Faculty of Arts, School of Arts, The University of Jordan, Amman, Jordan.
- School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK.
| | - Ellen Poliakoff
- School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Maria Panagioti
- School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Alexander Hodkinson
- School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Nusrat Husain
- School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
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3
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Kuhlmann E, Falkenbach M, Brînzac MG, Correia T, Panagioti M, Ungureanu MI. The mental health needs of healthcare workers: When evidence does not guide policy. A comparative assessment of selected European countries. Int J Health Plann Manage 2024. [PMID: 38193752 DOI: 10.1002/hpm.3752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 12/15/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND The healthcare workforce (HCWF) globally is facing high stress levels and deteriorating mental health due to workplace, labour market and policy deficiencies that further exacerbate the existing crisis. However, comprehensive and effective action is missing. AIMS We adopt a health system and governance perspective to address the mental health needs of healthcare workers (HCWs), considering the nature of interventions and the levels and actors involved in governance. The aim is to move the debate forward by identifying governance gaps hampering the implementation of health workforce policies and exploring strategies to effectively increase mental health support. MATERIAL AND METHODS A qualitative comparative methodology is applied based on a case study design utilising a multi-level intersectoral governance matrix. We conducted a rapid assessment of HCWF developments in the European context (Germany, Portugal, Romania, Switzerland and the United Kingdom), drawing on secondary sources and country experts. RESULTS AND DISCUSSION Awareness of mental health threats among HCWs increased, but policy discourse is driven by service delivery and labour market demands. The attention to HCWs' needs is stronger on the international level and weakest at national/regional levels. Although organisations and professions demonstrate varying degrees of activity, their efforts are scattered and lack sustainability. Similar challenges were identified across healthcare systems, including limited action, disconnected actors, missing coordination, and a lack of attention to governance gaps and system weaknesses. CONCLUSION Adopting a health system approach is important but not sufficient. Successful mental health policy implementation needs multi-level governance and coherent coordination mechanisms.
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Affiliation(s)
- Ellen Kuhlmann
- Institute for Economics, Labour and Culture, Goethe-University Frankfurt, Frankfurt, Germany
- WHO Collaborating Center for Health Workforce Policies and Planning, Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Lisbon, Portugal
| | - Michelle Falkenbach
- European Observatory on Health Systems and Policies, Brussels, Belgium
- Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan, USA
| | - Monica-Georgiana Brînzac
- Faculty of Political, Administrative and Communication Sciences, Department of Public Health, Babeș-Bolyai University, Cluj-Napoca, Romania
- Faculty of Political, Administrative and Communication Sciences, Center for Health Workforce Research and Policy, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Tiago Correia
- WHO Collaborating Center for Health Workforce Policies and Planning, Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Lisbon, Portugal
- Global Health and Tropical Medicine, Associate Laboratory in Translation and Innovation Towards Global Health, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Maria Panagioti
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Marius-Ionut Ungureanu
- WHO Collaborating Center for Health Workforce Policies and Planning, Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Lisbon, Portugal
- Faculty of Political, Administrative and Communication Sciences, Department of Public Health, Babeș-Bolyai University, Cluj-Napoca, Romania
- Faculty of Political, Administrative and Communication Sciences, Center for Health Workforce Research and Policy, Babeș-Bolyai University, Cluj-Napoca, Romania
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Galimzhanov A, Istanbuly S, Tun HN, Ozbay B, Alasnag M, Ky B, Lyon AR, Kayikcioglu M, Tenekecioglu E, Panagioti M, Kontopantelis E, Abdel-Qadir H, Mamas MA. Cardiovascular outcomes in breast cancer survivors: a systematic review and meta-analysis. Eur J Prev Cardiol 2023; 30:2018-2031. [PMID: 37499186 DOI: 10.1093/eurjpc/zwad243] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 06/19/2023] [Accepted: 07/21/2023] [Indexed: 07/29/2023]
Abstract
AIMS It is unclear whether the future risk of cardiovascular events in breast cancer (Bc) survivors is greater than in the general population. This meta-analysis quantifies the risk of cardiovascular disease development in Bc patients, compared to the risk in a general matched cancer-free population, and reports the incidence of cardiovascular events in patients with Bc. METHODS AND RESULTS We searched PubMed, Scopus, and Web of Science databases (up to 23 March 2022) for observational studies and post hoc analyses of randomized controlled trials. Cardiovascular death, heart failure (HF), atrial fibrillation (AF), coronary artery disease (CAD), myocardial infarction (MI), and stroke were the individual endpoints for our meta-analysis. We pooled incidence rates (IRs) and risk in hazard ratios (HRs), using random-effects meta-analyses. Heterogeneity was reported through the I2 statistic, and publication bias was examined using funnel plots and Egger's test in the meta-analysis of risk. One hundred and forty-two studies were identified in total, 26 (836 301 patients) relevant to the relative risk and 116 (2 111 882 patients) relevant to IRs. Compared to matched cancer-free controls, Bc patients had higher risk for cardiovascular death within 5 years of cancer diagnosis [HR = 1.09; 95% confidence interval (CI): 1.07, 1.11], HF within 10 years (HR = 1.21; 95% CI: 1.1, 1.33), and AF within 3 years (HR = 1.13; 95% CI: 1.05, 1.21). The pooled IR for cardiovascular death was 1.73 (95% CI 1.18, 2.53), 4.44 (95% CI 3.33, 5.92) for HF, 4.29 (95% CI 3.09, 5.94) for CAD, 1.98 (95% CI 1.24, 3.16) for MI, 4.33 (95% CI 2.97, 6.30) for stroke of any type, and 2.64 (95% CI 2.97, 6.30) for ischaemic stroke. CONCLUSION Breast cancer exposure was associated with the increased risk for cardiovascular death, HF, and AF. The pooled incidence for cardiovascular endpoints varied depending on population characteristics and endpoint studied. REGISTRATION CRD42022298741.
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Affiliation(s)
- Akhmetzhan Galimzhanov
- Department of Propedeutics of Internal Disease, Semey Medical University, Semey, Kazakhstan
- Keele Cardiovascular Research Group, Center for Prognosis Research, Keele University, Stoke on Trent, Keele, UK
| | - Sedralmontaha Istanbuly
- Keele Cardiovascular Research Group, Center for Prognosis Research, Keele University, Stoke on Trent, Keele, UK
- Faculty of Medicine, University of Aleppo, Aleppo, Syrian Arab Republic
| | - Han Naung Tun
- Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Benay Ozbay
- Basaksehir Cam and Sakura State Hospital Department of Cardiology, Istanbul, Turkey
- Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Bonnie Ky
- Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Alexander R Lyon
- Cardio-Oncology Service, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK
| | - Meral Kayikcioglu
- Department of Cardiology, Faculty of Medicine, 60521 Ege University, Izmir, Turkey
| | - Erhan Tenekecioglu
- Department of Cardiology, Bursa Yuksek İhtisas Training and Research Hospital, Health Sciences University, Bursa, Turkey
- Department of Cardiology, Erasmus MC, Thorax Center, Erasmus University, Rotterdam, The Netherlands
| | - Maria Panagioti
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, National Institute for Health Research School for Primary Care Research, University of Manchester, Manchester, UK
| | - Evangelos Kontopantelis
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, National Institute for Health Research School for Primary Care Research, University of Manchester, Manchester, UK
| | - Husam Abdel-Qadir
- Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Center for Prognosis Research, Keele University, Stoke on Trent, Keele, UK
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Johnson R, Kovalenko AG, Blakeman T, Panagioti M, Lawton M, Dawson S, Duncan P, Fraser SD, Valderas JM, Chilcott S, Goulding R, Salisbury C. Treatment burden in multiple long-term conditions: a mixed-methods study protocol. BJGP Open 2023; 7:BJGPO.2023.0097. [PMID: 37295796 DOI: 10.3399/bjgpo.2023.0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Treatment burden represents the work patients undertake because of their health care, and the impact of that effort on the patient. Most research has focused on older adults (aged >65 years) with multiple long-term conditions (multimorbidity) (MLTC-M), but there are now more younger adults (aged 18-65 years) living with MLTC-M and they may experience treatment burden differently. Understanding experiences of treatment burden, and identifying those most at risk of high treatment burden, are important for designing primary care services to meet their needs. AIM To understand the treatment burden associated with MLTC-M, for people aged 18-65 years, and how primary care services affect this burden. DESIGN & SETTING Mixed-methods study in up to 33 primary care practices in two UK regions. METHOD The following two approaches will be used: (i) in-depth qualitative interviews with adults living with MLTC-M (approximately 40 participants) to understand their experiences of treatment burden and the impact of primary care, with a think-aloud aspect to explore face validity of a novel short treatment burden questionnaire (STBQ) for routine clinical use in the initial 15 interviews; (ii) cross-sectional patient survey (approximately 1000 participants), with linked routine medical record data to examine the factors associated with treatment burden for people living with MLTC-M, and to test the validity of STBQ. CONCLUSION This study will generate in-depth understanding of the treatment burden experienced by people aged 18-65 years living with MLTC-M, and how primary care services affect this burden. This will inform further development and testing of interventions to reduce treatment burden, and potentially influence MLTC-M trajectories and improve health outcomes.
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Affiliation(s)
- Rachel Johnson
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Anastasiia G Kovalenko
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Thomas Blakeman
- Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
| | - Maria Panagioti
- Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
| | - Michael Lawton
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Shoba Dawson
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Polly Duncan
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Simon Ds Fraser
- School of Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Jose M Valderas
- Centre for Research in Health Systems Performance (CRiHSP) and Division of Family Medicine, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Queenstown, Singapore
| | | | - Rebecca Goulding
- Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
| | - Chris Salisbury
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
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Shield T, Bayliss K, Hodkinson A, Panagioti M, Wearden A, Flynn J, Rowland C, Bee P, Farquhar M, Harris D, Grande G. What factors are associated with informal carers' psychological morbidity during end-of-life home care? A systematic review and thematic synthesis of observational quantitative studies. Health Soc Care Deliv Res 2023:1-58. [PMID: 37991230 DOI: 10.3310/htjy8442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
Background Family carers are central in supporting patients nearing end of life. As a consequence, they often suffer detrimental impacts on their own mental health. Understanding what factors may affect carers' mental health is important in developing strategies to maintain their psychological well-being during caregiving. Aim To conduct a systematic review and thematic evidence synthesis of factors related to carers' mental health during end-of-life caregiving. Method Searches of MEDLINE, CINAHL, PsychINFO, Social Sciences Citation Index, EMBASE, Cochrane Central Register of Controlled Trials and Database of Abstracts of Reviews of Effects 1 January 2009-24 November 2019. We included observational quantitative studies focusing on adult informal/family carers for adult patients at end of life cared for at home considering any factor related to carer mental health (anxiety, depression, distress and quality of life) pre-bereavement. Newcastle-Ottawa Quality Assessment Scale was used. Thematic analysis with box score presentation, and meta-analysis were done where data permitted. Results Findings from 63 included studies underpinned seven emergent themes. Patient condition (31 studies): worse patient psychological symptoms and quality of life were generally associated with worse carer mental health. Patient depression was associated with higher depression in carers (standardised mean difference = 0.59, 95% confidence interval 0.32 to 0.87, I2 = 77%). Patients' other symptoms and functional impairment may relate to carer mental health, but findings were unclear. Impact of caring responsibilities (14 studies): impact on carers' lives, task difficulty and general burden had clear associations with worse carer mental health. Relationships (8 studies): family dynamics and the quality of the carer-patient relationship may be important for carer mental health and are worthy of further investigation. Finance (6 studies): insufficient resources may relate to carers' mental health and warrant further study. Carers' psychological processes (13 studies): self-efficacy and preparedness were related to better mental health. However, findings regarding coping strategies were mixed. Support (18 studies): informal support given by family and friends may relate to better carer mental health, but evidence on formal support is limited. Having unmet needs was related to worse mental health, while satisfaction with care was related to better mental health. Contextual factors (16 studies): older age was generally associated with better carer mental health and being female was associated with worse mental health. Limitations Studies were mainly cross-sectional (56) rather than longitudinal (7) which raises questions about the likely causal direction of relationships. One-third of studies had samples < 100, so many had limited statistical power to identify existing relationships. Conclusions and future work Future work must adopt a comprehensive approach to improving carers' mental health because factors relating to carer mental health cover a broad spectrum. The literature on this topic is diverse and difficult to summarise, and the field would benefit from a clearer direction of enquiry guided by explanatory models. Future research should (1) further investigate quality of relationships and finances; (2) better define factors under investigation; (3) establish, through quantitative causal analyses, why factors might relate to mental health; and (4) utilise longitudinal designs more to aid understanding of likely causal direction of associations. Study registration This study is registered as PROSPERO registration 2019 CRD42019130279 at https://www.crd.york.ac.uk/prospero/. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme HSDR 18/01/01 and is published in full in Health and Social Care Delivery Research. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Tracey Shield
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Kerin Bayliss
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Alexander Hodkinson
- NIHR Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Maria Panagioti
- NIHR Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Alison Wearden
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Jackie Flynn
- Public and Community Involvement and Engagement (PCIE) Panel, NIHR Applied Research Collaboration (ARC) Greater Manchester, Manchester, UK
| | - Christine Rowland
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Penny Bee
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Morag Farquhar
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Danielle Harris
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
- NIHR Applied Research Collaboration (ARC) Greater Manchester, Manchester, UK
| | - Gunn Grande
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
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Tyler N, Hodkinson A, Planner C, Angelakis I, Keyworth C, Hall A, Jones PP, Wright OG, Keers R, Blakeman T, Panagioti M. Transitional Care Interventions From Hospital to Community to Reduce Health Care Use and Improve Patient Outcomes: A Systematic Review and Network Meta-Analysis. JAMA Netw Open 2023; 6:e2344825. [PMID: 38032642 PMCID: PMC10690480 DOI: 10.1001/jamanetworkopen.2023.44825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/03/2023] [Indexed: 12/01/2023] Open
Abstract
Importance Discharge from the hospital to the community has been associated with serious patient risks and excess service costs. Objective To evaluate the comparative effectiveness associated with transitional care interventions with different complexity levels at improving health care utilization and patient outcomes in the transition from the hospital to the community. Data Sources CENTRAL, Embase, MEDLINE, and PsycINFO were searched from inception until August 2022. Study Selection Randomized clinical trials evaluating transitional care interventions from hospitals to the community were identified. Data Extraction and Synthesis At least 2 reviewers were involved in all data screening and extraction. Random-effects network meta-analyses and meta-regressions were applied. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. Main Outcomes and Measures The primary outcomes were readmission at 30, 90, and 180 days after discharge. Secondary outcomes included emergency department visits, mortality, quality of life, patient satisfaction, medication adherence, length of stay, primary care and outpatient visits, and intervention uptake. Results Overall, 126 trials with 97 408 participants were included, 86 (68%) of which were of low risk of bias. Low-complexity interventions were associated with the most efficacy for reducing hospital readmissions at 30 days (odds ratio [OR], 0.78; 95% CI, 0.66 to 0.92) and 180 days (OR, 0.45; 95% CI, 0.30 to 0.66) and emergency department visits (OR, 0.68; 95% CI, 0.48 to 0.96). Medium-complexity interventions were associated with the most efficacy at reducing hospital readmissions at 90 days (OR, 0.64; 95% CI, 0.45 to 0.92), reducing adverse events (OR, 0.42; 95% CI, 0.24 to 0.75), and improving medication adherence (standardized mean difference [SMD], 0.49; 95% CI, 0.30 to 0.67) but were associated with less efficacy than low-complexity interventions for reducing readmissions at 30 and 180 days. High-complexity interventions were most effective for reducing length of hospital stay (SMD, -0.20; 95% CI, -0.38 to -0.03) and increasing patient satisfaction (SMD, 0.52; 95% CI, 0.22 to 0.82) but were least effective for reducing readmissions at all time periods. None of the interventions were associated with improved uptake, quality of life (general, mental, or physical), or primary care and outpatient visits. Conclusions and Relevance These findings suggest that low- and medium-complexity transitional care interventions were associated with reducing health care utilization for patients transitioning from hospitals to the community. Comprehensive and consistent outcome measures are needed to capture the patient benefits of transitional care interventions.
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Affiliation(s)
- Natasha Tyler
- National Institute for Health Research School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - Alexander Hodkinson
- National Institute for Health Research School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - Claire Planner
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - Ioannis Angelakis
- National Institute for Health Research School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- Institute of Population Health, Department of Primary Care & Mental Health, University of Liverpool, Liverpool, United Kingdom
| | | | - Alex Hall
- Division of Nursing, Midwifery & Social Work, University of Manchester, Manchester, United Kingdom
| | | | | | - Richard Keers
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
- Pharmacy Department, Pennine Care NHS Foundation Trust, Aston-Under-Lyne, United Kingdom
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Tom Blakeman
- National Institute for Health Research School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - Maria Panagioti
- National Institute for Health Research School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
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Grande G, Bayliss K, Shield T, Flynn J, Rowland C, Harris D, Wearden A, Farquhar M, Panagioti M, Hodkinson A, Booth M, Cotterill D, Goodburn L, Knipe C, Bee P. Involving carer advisors in evidence synthesis to improve carers' mental health during end-of-life home care: co-production during COVID-19 remote working. Health Soc Care Deliv Res 2023:1-34. [PMID: 37902597 DOI: 10.3310/tghh6428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Background Family carers play a central role in supporting people at the end of life, but often suffer detrimental impacts on their own mental health as a result. This project conducted evidence synthesis of research into factors that may affect carers' mental health to help identify ways of maintaining their mental health. It worked closely with a carer Review Advisory Panel to help ensure the findings made sense and were communicated meaningfully from the carers' perspective. Aim To present: (1) principles and components that facilitated successful patient and public involvement in an evidence synthesis project to help inform patient and public involvement in similar projects; (2) recommendations for carer support that were instigated and produced by the Review Advisory Panel. Process and principles Nine Review Advisory Panel meetings including four to five carers, a lay Chair and three researchers were held. Solid 'groundwork' was invested in recruitment and relationship-building prior to meetings, and it was ensured that there was agreement of how to work together and clarification of expectations at the first meeting. Key meeting principles were: having a majority of carers, and a Chair with both carer and patient and public involvement experience, to ensure carer voices remained at the fore substantial researcher representation, including the project lead, to highlight the value placed on Review Advisory Panel meetings flexibility to follow carers' agendas, enabling 'space to talk' and 'space to change' appropriate and prompt carer payment, again emphasising patient and public involvement value to the project. Added general principles were: ongoing training, ample funded time for Review Advisory Panel preparation and ongoing communication outside meetings. COVID moved all meetings online after the first meeting, but the principles were maintained. Outputs The project saw an evolution from patient and public involvement consultation to co-production. The main patient and public involvement output was recommendations for supporting carers based on project findings, instigated and produced by the Review Advisory Panel. Reflection on successful components and challenges Five carers (including the Chair) and six researchers responded to questions by e-mail. Analysis by one researcher, aided by two other researchers, was then reviewed by all participants and revised. Both carers and researchers felt the components that made the patient and public involvement work were: (1) a shared sense of purpose of and gains from the Review Advisory Panel; (2) personal gains; (3) mutual commitment and respect; and (4) bridging between academic and lay perspectives, through investment in training, ensuring carers were able to meaningfully comment, and continuous negotiation and compromise. Challenges were that the COVID-induced move from face-to-face to online meetings reduced informality, flexibility, personal connection and non-verbal communication. However, earlier groundwork facilitated group resilience to these challenges. Patient and public involvement representation on the wider Research Management Group proved less successful, flagging the importance of negotiating and defining patient and public involvement roles at all project levels. Conclusion The patient and public involvement principles employed, including meeting composition and chairing, and flexibility to follow carers' agendas, appeared to facilitate the evolution from consultation to co-production of carer recommendations, but require further testing. Preconditions for successful remote working should be further investigated, as the different advantages of face-to-face and virtual meetings may be combined through hybrid working. The iterative and responsive working required for genuine co-production may require more flexible patient and public involvement funding models. Study registration This study is registered as PROSPERO registration 2019 CRD42019130279 at https://www.crd.york.ac.uk/prospero/. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (grant 18/01/01) and will be published in full in Health and Social Care Delivery Research. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Gunn Grande
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Kerin Bayliss
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Tracey Shield
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Jackie Flynn
- Public and Community Involvement and Engagement (PCIE) Panel, NIHR Applied Research Collaboration (ARC) Greater Manchester, Manchester, UK
| | - Christine Rowland
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Danielle Harris
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Alison Wearden
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Morag Farquhar
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Maria Panagioti
- NIHR Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Alexander Hodkinson
- NIHR Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Margaret Booth
- Carer Review Advisory Panel, NIHR HSDR project 18/01/01, University of Manchester, Manchester, UK
| | - David Cotterill
- Carer Review Advisory Panel, NIHR HSDR project 18/01/01, University of Manchester, Manchester, UK
| | - Lesley Goodburn
- Carer Review Advisory Panel, NIHR HSDR project 18/01/01, University of Manchester, Manchester, UK
| | - Cedric Knipe
- Carer Review Advisory Panel, NIHR HSDR project 18/01/01, University of Manchester, Manchester, UK
| | - Penny Bee
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
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Khoso AB, Noureen A, Un Nisa Z, Hodkinson A, Elahi A, Arshad U, Naz A, Bhatti MM, Asif M, Husain MO, Husain MI, Chaudhry N, Husain N, Chaudhry IB, Panagioti M. Prevalence of suicidal ideation and suicide attempts in individuals with psychosis and bipolar disorder in South Asia: systematic review and meta-analysis. BJPsych Open 2023; 9:e179. [PMID: 37814419 PMCID: PMC10594255 DOI: 10.1192/bjo.2023.570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 08/01/2023] [Accepted: 08/17/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Suicidal ideation and attempts are growing public health concerns globally. Evidence from high-income countries suggests that individuals with psychosis and bipolar disorder are at increased risk of suicidal ideation and attempts, but there is a scarcity of evidence from South Asia. AIMS To estimate the prevalence of suicidal ideation and attempts in individuals with psychosis and bipolar disorder in South Asia. METHOD In this systematic review and meta-analysis, four databases (PsycINFO, Web of Science, EMBASE and Medline) were searched until December 2022. Pooled prevalence was estimated with random-effects models. Heterogeneity was quantified with the I2-statistic. RESULTS The pooled sample size across the 21 studies was 3745 participants, 1941 (51.8%) of which were male. The pooled prevalence of suicide attempts in South Asian people with either psychosis or bipolar disorder was 22% (95% CI 17-27; n = 15). The pooled prevalence of suicidal ideation with psychosis or bipolar disorder combined was 38% (95% CI 27-51; n = 10). Meta-regression, subgroup and sensitivity analysis showed that the pooled prevalence estimates for both suicide attempt and ideation remained unaffected by variations in critical appraisal ratings and study designs. Only one study reported data on suicide-related deaths. CONCLUSIONS One in four individuals diagnosed with psychosis or bipolar disorder have reported suicide attempts, whereas up to one in three have experienced suicidal ideation. These findings underscore the urgent need for clinicians to regularly assess and monitor suicidal ideation and attempts among individuals with these disorders in South Asia.
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Affiliation(s)
- Ameer B. Khoso
- Division of At-Risk Mental State, Schizophrenia Spectrum, and other Psychotic Disorders, Pakistan Institute of Living and Learning, Karachi, Pakistan; and Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Amna Noureen
- Division of Child and Adolescent Mental Health, Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Zaib Un Nisa
- Division of At-Risk Mental State, Schizophrenia Spectrum, and other Psychotic Disorders, Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Alexander Hodkinson
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, UK; and National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, University of Manchester, UK
| | - Anam Elahi
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, UK
| | - Usman Arshad
- Division of Child and Adolescent Mental Health, Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Anum Naz
- Division of At-Risk Mental State, Schizophrenia Spectrum, and other Psychotic Disorders, Pakistan Institute of Living and Learning, Karachi, Pakistan
| | | | - Muqaddas Asif
- Division of Substance-Related and Addiction Disorders, Pakistan Institute of Living and Learning, Lahore, Pakistan; and Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Muhammad Omair Husain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; and Department of Psychiatry, University of Toronto, Canada
| | - Muhammad Ishrat Husain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; and Department of Psychiatry, University of Toronto, Canada
| | - Nasim Chaudhry
- Division of Neurodevelopmental Disorders, Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Nusrat Husain
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK; and Mersey Care NHS Foundation Trust, Prescot, UK
| | - Imran B. Chaudhry
- Division of At-Risk Mental State, Schizophrenia Spectrum, and other Psychotic Disorders, Pakistan Institute of Living and Learning, Karachi, Pakistan; Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK; and Department of Psychiatry, Ziauddin University, Karachi, Pakistan
| | - Maria Panagioti
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, UK; and National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, University of Manchester, UK
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10
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Abudoush AN, Ali K, Kiran T, Panagioti M, Poliakoff E, Mo Hom N, Husain N. Exploring chronic pain related attentional experiences, distress and coping strategies among Arabic-speaking individuals in Jordan and the United Kingdom. Front Psychol 2023; 14:1268179. [PMID: 37849474 PMCID: PMC10577280 DOI: 10.3389/fpsyg.2023.1268179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/15/2023] [Indexed: 10/19/2023] Open
Abstract
Introduction The lived experiences of chronic pain (CP) among Arabic-speaking populations remain underexplored. A better understanding of these experiences and their associations with attention difficulties, coping mechanisms, and treatment options could lead to improved support for this group. Methods This qualitative study utilised a descriptive design and involved one-to-one interviews with 51 participants with CP who had just completed two attention tasks. Interviews were conducted using a semi-structured topic guide, transcribed verbatim and translated from Arabic to English before agreeing on the coding framework. Themes and subthemes were extracted using a framework analysis approach. Results The study identified six main themes: Factors contributing towards developing or exacerbating CP, the impact of CP on psychosocial functions, including attention, the perceived role of social support, coping strategies for managing CP, perceptions about available treatments and recommendations for interventions. Discussion CP significantly impacts individuals' physical and psychosocial functions, and it is reciprocally associated with attentional difficulties. Despite using various approaches to manage their CP, none of the participants used psychological interventions or counselling. Understanding the diverse impacts of CP and the coping strategies employed to develop culturally sensitive interventions, review current related policies, and improve healthcare services is crucial to managing CP among this population.
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Affiliation(s)
- Ahmad N. Abudoush
- School of Health Sciences, The University of Manchester, Manchester, United Kingdom
- Department of Psychology, The University of Jordan, Amman, Jordan
| | - Khalifa Ali
- School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Tayyeba Kiran
- Department of Research and Development, Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Maria Panagioti
- School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Ellen Poliakoff
- School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Nang Mo Hom
- Research Capacity and Capability Program, Ethnic Health Forum, Manchester, United Kingdom
| | - Nusrat Husain
- School of Health Sciences, The University of Manchester, Manchester, United Kingdom
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McMullen S, Panagioti M, Planner C, Giles S, Angelakis I, Keers RN, Robinson C, Fu Y, Johnson J, Tyler N. Supporting carers to improve patient safety and maintain their well-being in transitions from mental health hospitals to the community: A prioritisation nominal group technique. Health Expect 2023; 26:2064-2074. [PMID: 37421272 PMCID: PMC10485304 DOI: 10.1111/hex.13813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/10/2023] Open
Abstract
INTRODUCTION Carers of people with mental illness may face distinct challenges, including navigating fragmented health and social services during discharge from mental health hospitals. Currently, limited examples of interventions that support carers of people with mental illness in improving patient safety during transitions of care exist. We aimed to identify problems and solutions to inform future carer-led discharge interventions, which is imperative for ensuring patient safety and the well-being of carers. METHODS The nominal group technique was used which combines both qualitative and quantitative data collection methods in four distinct phases: (1) problem identification, (2) solution generation, (3) decision making and (4) prioritisation. The aim was to combine expertise from different stakeholder groups (patients, carers and academics with expertise in primary/secondary care, social care or public health) to identify problems and generate solutions. RESULTS Twenty-eight participants generated potential solutions that were grouped into four themes. The most acceptable solution for each was as follows: (1) 'Carer Involvement and Improving Carer Experience' a dedicated family liaison worker, (2) 'Patient Wellness and Education' adapting and implementing existing approaches to help implement the patient care plan, (3) 'Carer Wellness and Education' peer/social support interventions for carers and (4) 'Policy and System Improvements' understanding the co-ordination of care. CONCLUSION The stakeholder group concurred that the transition from mental health hospitals to the community is a distressing period, where patients and carers are particularly vulnerable to safety and well-being risks. We identified numerous feasible/acceptable solutions to enable carers to improve patient safety and maintain their own mental wellbeing. PATIENT AND PUBLIC CONTRIBUTION Patient and public contributors were represented in the workshop and the focus of the workshop was to identify the problems they faced and co-design potential solutions. Patient and public contributors were involved in the funding application and study design.
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Affiliation(s)
- Sarah McMullen
- Centre for Primary Care and Health Services Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and HealthThe University of ManchesterManchesterUK
| | - Maria Panagioti
- NIHR Greater Manchester Patient Safety Translational Research CentreThe University of ManchesterManchesterUK
- NIHR School for Primary Care ResearchThe University of ManchesterManchesterUK
| | - Claire Planner
- NIHR Greater Manchester Patient Safety Translational Research CentreThe University of ManchesterManchesterUK
| | - Sally Giles
- NIHR Greater Manchester Patient Safety Translational Research CentreThe University of ManchesterManchesterUK
| | - Ioannis Angelakis
- Department of Primary Care and Mental HealthThe University of LiverpoolLiverpoolUK
| | - Richard N. Keers
- Division of Pharmacy and Optometry, Centre for Pharmacoepidemiology and Drug SafetyThe University of ManchesterManchesterUK
- NIHR Greater Manchester Patient Safety Translational Research CentreManchester Academic Health Science NetworkManchesterUK
- Suicide, Risk and Safety Research UnitGreater Manchester Mental Health NHS Foundation TrustManchesterUK
| | - Catherine Robinson
- Social Care and Society, School of Health SciencesThe University of ManchesterManchesterUK
| | - Yu Fu
- Population Health Sciences InstituteNewcastle UniversityNewcastleUK
| | | | - Natasha Tyler
- NIHR Greater Manchester Patient Safety Translational Research CentreThe University of ManchesterManchesterUK
- NIHR School for Primary Care ResearchThe University of ManchesterManchesterUK
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12
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Bayliss K, Shield T, Wearden A, Flynn J, Rowland C, Bee P, Farquhar M, Harris D, Hodkinson A, Panagioti M, Booth M, Cotterill D, Goodburn L, Knipe C, Grande G. Understanding what affects psychological morbidity in informal carers when providing care at home for patients at the end of life: a systematic qualitative evidence synthesis. Health Soc Care Deliv Res 2023:1-53. [PMID: 37843444 DOI: 10.3310/pytr4127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Background Informal carers are central in supporting patients at the end of life, but this has substantial negative impacts on carers' own mental health. When carers are unable to cope, this may affect their ability to support the patient and increase the likelihood of patient hospital admissions. Further, demographic changes mean demands for care at and before end of life are increasing and existing services will struggle to meet these demands. It is important to recognise carers as a vital resource and prevent adverse health outcomes from caregiving (and thereby limit their consequences). Large individual variation in the level of psychological morbidity from end-of-life caregiving suggests there is scope for interventions to improve carer mental health if we can understand the underlying factors. Objectives This meta-synthesis of qualitative studies aims to identify factors reported by carers as important to their mental health. Data sources Searches of MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Social Science Citation Index, EMBASE, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, and Cochrane Qualitative Reviews 1 January 2009 to 24 November 2019 for empirical publications from Organization for Economic Cooperation and Development countries in English/Scandinavian on factors affecting adult carer mental health during end-of-life caregiving in home settings. Review methods Systematic qualitative meta-synthesis in collaboration with a Public Patient Involvement carer Review Advisory Panel, included thematic synthesis, followed by a best-fit framework synthesis, informed by principles of meta-ethnography. Critical Appraisal Skills Programme Qualitative Studies Checklist was used. Results Thirty-three eligible studies identified six themes encompassing factors perceived by carers to affect their mental health during end-of-life caregiving. These were: (1) the patient condition (including patient decline); (2) impact of caring responsibilities (including exhaustion, lack of time for own needs, isolation); (3) relationships (including quality of the patient-carer relationship); (4) finances (including financial concerns, impact on work); (5) carers' internal processes (including loss of autonomy, lack of confidence, coping strategies); and (6) support (including lack of informal support, inadequacies in formal support information and care provision, limited collaboration, disjointed care). Reported strategies to improve mental health were linked to the final two themes, with suggestions on how to manage carers' internal processes and build appropriate support. Findings correspond with literature 1998-2008, indicating consistency in factors affecting carers and adding validity to findings. Limitations The review was limited to caregiving in the home setting and studies from Organization for Economic Cooperation and Development countries published in English and Scandinavian. Identified papers predominantly considered carers of people with cancer, with little research into ethnic-minority perspectives. The review may therefore not fully encompass factors affecting carers of people with longer-term conditions, or those within other care settings, countries and population groups. Conclusions and future work A wide range of both internal and contextual factors may lead to psychological morbidity when caring for someone at the end of life. Future work within practice therefore requires a broad-based rather than narrow approach to sustaining and improving carer mental health. Future work within research requires collaboration between researchers and stakeholders within policy, commissioning, practice and carer organisations to develop solutions and assess their effectiveness. Further, researchers need to develop better models for factors affecting carer mental health and their interaction, to build a stronger evidence base and better guide interventions. Study registration This study is registered as PROSPERO CRD42019130279. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number HSDR 18/01/01 and will be published in full in Health and Social Care Delivery Research. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kerin Bayliss
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, UK
| | - Tracey Shield
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, UK
| | - Alison Wearden
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK
| | - Jackie Flynn
- Public and Community Involvement and Engagement Panel, NIHR Applied Research Collaboration Greater Manchester, UK
| | - Christine Rowland
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK
| | - Penny Bee
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, UK
| | - Morag Farquhar
- School of Health Sciences, University of East Anglia, UK
| | - Danielle Harris
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, UK
| | - Alexander Hodkinson
- NIHR Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, UK
| | - Maria Panagioti
- NIHR Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, UK
| | - Margaret Booth
- Carer Review Advisory Panel, NIHR HS&DR Project 18/01/01, University of Manchester, UK
| | - David Cotterill
- Carer Review Advisory Panel, NIHR HS&DR Project 18/01/01, University of Manchester, UK
| | - Lesley Goodburn
- Carer Review Advisory Panel, NIHR HS&DR Project 18/01/01, University of Manchester, UK
| | - Cedric Knipe
- Carer Review Advisory Panel, NIHR HS&DR Project 18/01/01, University of Manchester, UK
| | - Gunn Grande
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, UK
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Özen-Dursun B, Panagioti M, Alharbi R, Giles S, Husain N. A qualitative study on lived experience of self-harm in South Asians in the UK: From reasons to recovery. Clin Psychol Psychother 2023; 30:1179-1189. [PMID: 37337356 DOI: 10.1002/cpp.2875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/17/2023] [Accepted: 05/22/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVES Self-harm rates and clinical presentations differ by ethnicity. South Asian women are at risk of self-harm. Previous research suggested investigating individuals' experiences with self-harm with qualitative studies in developing self-harm prevention strategies. This research aims to explore self-harm experiences among South Asians in the United Kingdom. DESIGN Qualitative study. METHODS Participants were recruited via third-sector organizations and online platforms. Semi-structured interviews were conducted with 11 South Asian individuals with a history of self-harm living in the United Kingdom. The data were analysed based on a reflective thematic analysis approach. RESULTS Results revealed four main themes: (1) reasons for self-harm; (2) recovery journey; (3) culture and mental health; and (4) the transition to suicidal thoughts and behaviours. Reasons for self-harm included negative life circumstances, social life difficulties, challenges faced during COVID-19 and mental health problems. Participants described their recovery journey by acknowledging the role of professional help, self-care, psychoeducation and personal growth, improving social relationships, and faith and spirituality. Cultural factors included generational differences and stigma. Culturally adapted psychological interventions were perceived as promising. The reported transition from self-harm to suicidal behaviours was linked to experiencing major stressful life events and the use of severe methods of self-harm. CONCLUSIONS The findings suggest that socio-cultural factors impact mental health and recovery processes among South Asians. Mental health services should consider improving culturally sensitive clinical practices in responding to self-harm among South Asian communities.
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Affiliation(s)
- Büşra Özen-Dursun
- School of Health Sciences, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Maria Panagioti
- Division of Population Health, Health Services Research and Primary Care, National Institute of Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, National Institute for Health and Care Research School for Primary Care Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Reem Alharbi
- School of Health Sciences, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Sally Giles
- Division of Population Health, Health Services Research and Primary Care, National Institute of Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Nusrat Husain
- School of Health Sciences, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Mersey Care NHS Foundation Trust, Prescot, UK
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14
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Husain N, Kiran T, Chaudhry IB, Williams C, Emsley R, Arshad U, Ansari MA, Bassett P, Bee P, Bhatia MR, Chew-Graham C, Husain MO, Irfan M, Khaliq A, Minhas FA, Naeem F, Naqvi H, Nizami AT, Noureen A, Panagioti M, Rasool G, Saeed S, Bukhari SQ, Tofique S, Zadeh ZF, Zafar SN, Chaudhry N. A culturally adapted manual-assisted problem-solving intervention (CMAP) for adults with a history of self-harm: a multi-centre randomised controlled trial. BMC Med 2023; 21:282. [PMID: 37525207 PMCID: PMC10391745 DOI: 10.1186/s12916-023-02983-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 07/18/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Self-harm is an important predictor of a suicide death. Culturally appropriate strategies for the prevention of self-harm and suicide are needed but the evidence is very limited from low- and middle-income countries (LMICs). This study aims to investigate the effectiveness of a culturally adapted manual-assisted problem-solving intervention (CMAP) for patients presenting after self-harm. METHODS This was a rater-blind, multicenter randomised controlled trial. The study sites were all participating emergency departments, medical wards of general hospitals and primary care centres in Karachi, Lahore, Rawalpindi, Peshawar, and Quetta, Pakistan. Patients presenting after a self-harm episode (n = 901) to participating recruitment sites were assessed and randomised (1:1) to one of the two arms; CMAP with enhanced treatment as usual (E-TAU) or E-TAU. The intervention (CMAP) is a manual-assisted, cognitive behaviour therapy (CBT)-informed problem-focused therapy, comprising six one-to-one sessions delivered over three months. Repetition of self-harm at 12-month post-randomisation was the primary outcome and secondary outcomes included suicidal ideation, hopelessness, depression, health-related quality of life (QoL), coping resources, and level of satisfaction with service received, assessed at baseline, 3-, 6-, 9-, and 12-month post-randomisation. The trial is registered on ClinicalTrials.gov. NCT02742922 (April 2016). RESULTS We screened 3786 patients for eligibility and 901 eligible, consented patients were randomly assigned to the CMAP plus E-TAU arm (n = 440) and E-TAU arm (N = 461). The number of self-harm repetitions for CMAP plus E-TAU was lower (n = 17) compared to the E-TAU arm (n = 23) at 12-month post-randomisation, but the difference was not statistically significant (p = 0.407). There was a statistically and clinically significant reduction in other outcomes including suicidal ideation (- 3.6 (- 4.9, - 2.4)), depression (- 7.1 (- 8.7, - 5.4)), hopelessness (- 2.6 (- 3.4, - 1.8), and improvement in health-related QoL and coping resources after completion of the intervention in the CMAP plus E-TAU arm compared to the E-TAU arm. The effect was sustained at 12-month follow-up for all the outcomes except for suicidal ideation and hopelessness. On suicidal ideation and hopelessness, participants in the intervention arm scored lower compared to the E-TAU arm but the difference was not statistically significant, though the participants in both arms were in low-risk category at 12-month follow-up. The improvement in both arms is explained by the established role of enhanced care in suicide prevention. CONCLUSIONS Suicidal ideation is considered an important target for the prevention of suicide, therefore, CMAP intervention should be considered for inclusion in the self-harm and suicide prevention guidelines. Given the improvement in the E-TAU arm, the potential use of brief interventions such as regular contact requires further exploration.
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Affiliation(s)
- Nusrat Husain
- Division of Psychology and Mental Health, University of Manchester, Oxford Rd, Manchester, M13 9PL, England, UK
- Mersey Care NHS Foundation Trust, Kings Business Park, Trust Offices/V7 Buildings, Prescot, L34 1PJ, England, UK
| | - Tayyeba Kiran
- Pakistan Institute of Living and Learning, Suite No. 201, 2nd Floor, The Plaza, Do-Talwar, Khayaban-E-Iqbal, Clifton, Karachi, Pakistan.
| | - Imran Bashir Chaudhry
- Division of Psychology and Mental Health, University of Manchester, Oxford Rd, Manchester, M13 9PL, England, UK
- Department of Psychiatry, Ziauddin University and Hospital, 4/B Shahrah-E-Ghalib Rd, Block 6 Clifton, Karachi, Pakistan
| | - Christopher Williams
- Institute of Health and Well Being, University of Glasgow, Glasgow, G12 8QQ, Scotland, UK
| | - Richard Emsley
- Medical Statistics & Trials Methodology, Institute of Psychiatry, Kings College London, Strand, London, WC2R 2LS, England, UK
| | - Usman Arshad
- Pakistan Institute of Living and Learning, Suite No. 201, 2nd Floor, The Plaza, Do-Talwar, Khayaban-E-Iqbal, Clifton, Karachi, Pakistan
| | - Moin Ahmed Ansari
- Liaquat University of Medical and Health Sciences, C7PC+337, Hyderabad, Jamshoro, Pakistan
| | - Paul Bassett
- Statistical Consultancy, Hemel Hempstead, England, UK
| | - Penny Bee
- Division of Nursing, Midwifery and Social Work, University of Manchester, Oxford Rd, Manchester, M13 9PL, England, UK
| | - Moti Ram Bhatia
- Peoples University of Medical & Health Science for Women Nawabshah, 6CV3+7HW, Hospital Road, Shaheed Benazirabad, Nawabshah, Pakistan
| | | | - Muhammad Omair Husain
- Department of Psychiatry, University of Toronto, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada
| | - Muhammad Irfan
- Department of Mental Health, Psychiatry and Behavioural Sciences, Peshawar Medical College, Riphah International University, Islamabad, Pakistan
| | - Ayesha Khaliq
- Pakistan Institute of Living and Learning, Suite No. 201, 2nd Floor, The Plaza, Do-Talwar, Khayaban-E-Iqbal, Clifton, Karachi, Pakistan
| | | | - Farooq Naeem
- CAMH, University of Toronto, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada
| | - Haider Naqvi
- Department of Psychiatry, Dow University of Health Sciences, Mission Rd, New Labour Colony Nanakwara, Karachi, Pakistan
| | - Asad Tamizuddin Nizami
- Institute of Psychiatry, Benazir Bhutto Hospital, Near Chandni Chowk, Murree Rd, Chah Sultan, Rawalpindi, Pakistan
| | - Amna Noureen
- Pakistan Institute of Living and Learning, Suite No. 201, 2nd Floor, The Plaza, Do-Talwar, Khayaban-E-Iqbal, Clifton, Karachi, Pakistan
| | - Maria Panagioti
- Division of Population Health, Health Services Research & Primary Care, Institute for Health Policy and Organisation/Alliance Manchester Business School, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
| | - Ghulam Rasool
- Balochistan Institute of Psychiatry & Behavioural Sciences, Bolan Medical College, 5XRG+VGC, Brewery Rd, Quetta, Pakistan
| | - Sofiya Saeed
- Pakistan Institute of Living and Learning, Suite No. 201, 2nd Floor, The Plaza, Do-Talwar, Khayaban-E-Iqbal, Clifton, Karachi, Pakistan
| | - Sumira Qambar Bukhari
- Department of Psychiatry, Services Institute of Medical Sciences, G8QM+JWR, Jail Rd, Shadman 1 Shadman, Lahore, Pakistan
| | - Sehrish Tofique
- Pakistan Institute of Living and Learning, Suite No. 201, 2nd Floor, The Plaza, Do-Talwar, Khayaban-E-Iqbal, Clifton, Karachi, Pakistan
| | - Zainab F Zadeh
- Pakistan Institute of Living and Learning, Suite No. 201, 2nd Floor, The Plaza, Do-Talwar, Khayaban-E-Iqbal, Clifton, Karachi, Pakistan
| | - Shehla Naeem Zafar
- Institute of Nursing, Iqra University, G-16/1 Allama Rasheed Turabi Rd, Block-B Block B, North Nazimabad Town, Karachi, Pakistan
| | - Nasim Chaudhry
- Pakistan Institute of Living and Learning, Suite No. 201, 2nd Floor, The Plaza, Do-Talwar, Khayaban-E-Iqbal, Clifton, Karachi, Pakistan
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McFadzean IJ, Davies K, Purchase T, Edwards A, Hellard S, Ashcroft DM, Avery AJ, Flynn S, Hewson T, Jordan M, Keers R, Panagioti M, Wainwright V, Walter F, Shaw J, Carson-Stevens A. Patient safety in prisons: a multi-method analysis of reported incidents in England. J R Soc Med 2023:1410768231166138. [PMID: 37196674 PMCID: PMC10387805 DOI: 10.1177/01410768231166138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
OBJECTIVES Prisoners use healthcare services three times more frequently than the general population with poorer health outcomes. Their distinct healthcare needs often pose challenges to safe healthcare provision. This study aimed to characterise patient safety incidents reported in prisons to guide practice improvement and identify health policy priorities.Design: We carried out an exploratory multi-method analysis of anonymised safety incidents from prisons. SETTING Safety incidents had been reported to the National Reporting and Learning System by prisons in England between April 2018 and March 2019. PARTICIPANTS Reports were reviewed to identify any unintended or unexpected incident(s) which could have, or did, lead to harm for prisoners receiving healthcare. MAIN OUTCOME MEASURES Free-text descriptions were examined to identify the type and nature of safety incidents, their outcomes and harm severity. Analysis was contextualised with subject experts through structured workshops to explain relationships between the most common incidents and contributory factors. RESULTS Of 4112 reports, the most frequently observed incidents were medication-related (n = 1167, 33%), specifically whilst administering medications (n = 626, 54%). Next, were access-related (n = 559,15%), inclusive of delays in patients accessing healthcare professionals (n = 236, 42%) and managing medical appointments (n = 171, 31%). The workshops contextualised incidents involving contributing factors (n = 1529, 28%) into three key themes, namely healthcare access, continuity of care and the balance between prison and healthcare priorities. CONCLUSIONS This study highlights the importance of improving medication safety and access to healthcare services for prisoners. We recommend staffing level reviews to ensure healthcare appointments are attended, and to review procedures for handling missed appointments, communication during patient transfers and medication prescribing.
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Affiliation(s)
- Isobel J McFadzean
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4YU, UK
| | - Kate Davies
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4YU, UK
| | - Thomas Purchase
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4YU, UK
| | - Adrian Edwards
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4YU, UK
| | - Stuart Hellard
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4YU, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, M13 9PL, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC), University of Manchester, Manchester, M13 9PL, UK
| | - Anthony J Avery
- NIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC), University of Manchester, Manchester, M13 9PL, UK
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Sandra Flynn
- Faculty of Biology, Medicine and Health, Centre for Mental Health and Safety, University of Manchester, Manchester, M13 9PL, UK
| | - Tom Hewson
- Faculty of Biology, Medicine and Health, Centre for Mental Health and Safety, University of Manchester, Manchester, M13 9PL, UK
| | - Melanie Jordan
- School of Sociology & Social Policy, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Richard Keers
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, M13 9PL, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC), University of Manchester, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust (GMMH), Manchester, M25 3BL, UK
| | - Maria Panagioti
- NIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC), University of Manchester, Manchester, M13 9PL, UK
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, M13 9NT, UK
| | - Verity Wainwright
- Faculty of Biology, Medicine and Health, Centre for Mental Health and Safety, University of Manchester, Manchester, M13 9PL, UK
| | - Florian Walter
- Faculty of Biology, Medicine and Health, Centre for Mental Health and Safety, University of Manchester, Manchester, M13 9PL, UK
| | - Jenny Shaw
- Faculty of Biology, Medicine and Health, Centre for Mental Health and Safety, University of Manchester, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust (GMMH), Manchester, M25 3BL, UK
- Independent Advisory Panel on Deaths in Custody, London, SW1H 9AJ, UK
| | - Andrew Carson-Stevens
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4YU, UK
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Özen-Dursun B, Kaptan SK, Giles S, Husain N, Panagioti M. Understanding self-harm and suicidal behaviours in South Asian communities in the UK: systematic review and meta-synthesis. BJPsych Open 2023; 9:e82. [PMID: 37183676 DOI: 10.1192/bjo.2023.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Previous findings have indicated that self-harm and suicide are associated with different rates, and different risk and protective factors in South Asian people compared with White people in the UK. Substantial qualitative research has explored experiences of self-harm and suicide in South Asian people. AIMS The study aims to review the existing qualitative evidence on self-harm and suicidal behaviours in South Asian communities in the UK. METHOD Systematic searches were conducted on Medline, EMBASE, PsycINFO, CINAHL, Open Dissertations and the British Library Ethos databases. We selected qualitative studies from both journals and grey literature that included South Asian participants who were resident in the UK and presented perceptions or experiences of self-harm and/or suicidal behaviour. Analysis was undertaken based on the meta-ethnographic approach. RESULTS Fifteen studies were included in the analysis. Experience of self-harm was discussed based on three aspects: behind self-harm, functions of self-harm and recovery from self-harm. 'Behind self-harm' refers to factors associated with self-harm and suicide. 'Functions of self-harm' captures the meaning attributed to self-harm and suicide. 'Recovery from self-harm' encapsulates personal and professional help, and practical suggestions for the improvement of mental health services. CONCLUSIONS Although some similarities with the majority White population were present, there were also crucial differences that need consideration when shaping health policies, improving access to health services and developing culturally sensitive psychosocial interventions for self-harm and suicide specific to South Asian communities in the UK.
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Affiliation(s)
- Büşra Özen-Dursun
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK
| | - Safa Kemal Kaptan
- Global Mental Health and Cultural Psychiatry Research Group, University of Manchester, UK; and Department of Psychology, Boğaziçi University, Türkiye
| | - Sally Giles
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Nusrat Husain
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK; and Mersey Care NHS Foundation Trust, Prescot, UK
| | - Maria Panagioti
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, UK; and Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, National Institute for Health and Care Research School for Primary Care Research, Faculty of Biology, Medicine and Health, University of Manchester, UK
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17
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Abudoush AN, Noureen A, Panagioti M, Poliakoff E, Van Ryckeghem DML, Hodkinson A, Husain N. What can we learn about selective attention processes in individuals with chronic pain using reaction time tasks? A systematic review and meta-analysis. Pain 2023:00006396-990000000-00285. [PMID: 37043743 DOI: 10.1097/j.pain.0000000000002885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/31/2023] [Indexed: 04/14/2023]
Abstract
ABSTRACT Information-processing biases such as attentional, interpretation, and memory biases are believed to play a role in exacerbating and maintaining chronic pain (CP). Evidence suggests that individuals with CP show attentional bias toward pain-related information. However, the selective attentional processes that underpin this bias are not always well outlined in the literature. To improve current understanding, a systematic review was performed using a descriptive synthesis of reaction time-based studies. A random-effects meta-analysis was added to explore whether the results of previous meta-analyses would be confirmed using studies with a larger sample size. For this review, 2008 studies were screened from 4 databases, of which 34 (participant n = 3154) were included in the review and a subset of 15 (participant n = 1339) were included in the meta-analysis. Review results were summarised by producing a descriptive synthesis for all studies. Meta-analysis results indicated a mild significant attentional bias toward sensory pain-related information (k = 15, g = 0.28, 95% CI [0.16, 0.39], I2 = 43.2%, P = 0.038), and preliminary evidence of significant moderate bias towards affective pain-related information (k = 3, g = 0.48, 95% CI [0.23, 0.72], I2 = 7.1%, P = 0.341) for CP groups compared with control groups. We explored the main tasks, stimuli, and CP subtypes used to address attentional biases and related processes. However, variation across studies did not allow for a decisive conclusion about the role of stimulus, task type, or related attentional processes. In addition, a table of CP attention-related models was produced and tested for reliability. Finally, other results and recommendations are discussed.
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Affiliation(s)
- Ahmad N Abudoush
- School of Health Sciences, Faculty of Biology Medicine and Health Sciences, The University of Manchester, Manchester, United Kingdom
- Department of Psychology, School of Arts, The University of Jordan, Amman, Jordan
| | - Amna Noureen
- Department of Applied Psychology, National University of Modern Languages, Islamabad, Pakistan
| | - Maria Panagioti
- School of Health Sciences, Faculty of Biology Medicine and Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Ellen Poliakoff
- School of Health Sciences, Faculty of Biology Medicine and Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Dimitri M L Van Ryckeghem
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
- Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Alexander Hodkinson
- School of Health Sciences, Faculty of Biology Medicine and Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Nusrat Husain
- School of Health Sciences, Faculty of Biology Medicine and Health Sciences, The University of Manchester, Manchester, United Kingdom
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18
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Tyler N, Angelakis I, Keers RN, Planner C, Hodkinson A, Giles SJ, Grundy A, Kapur N, Armitage C, Blakeman T, Campbell SM, Robinson C, Leather J, Panagioti M. Evaluating a co-designed care bundle to improve patient safety at discharge from adult and adolescent mental health services (SAFER-MH and SAFER-YMH): protocol for a non-randomised feasibility study. BMJ Open 2023; 13:e069216. [PMID: 37041053 PMCID: PMC10106061 DOI: 10.1136/bmjopen-2022-069216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
INTRODUCTION Patients being discharged from inpatient mental wards often describe safety risks in terms of inadequate information sharing and involvement in discharge decisions. Through stakeholder engagement, we co-designed, developed and adapted two versions of a care bundle intervention, the SAFER Mental Health care bundle for adult and youth inpatient mental health settings (SAFER-MH and SAFER-YMH, respectively), that look to address these concerns through the introduction of new or improved processes of care. METHODS AND ANALYSIS Two uncontrolled before-and-after feasibility studies, where all participants will receive the intervention. We will examine the feasibility and acceptability of the SAFER-MH in inpatient mental health settings in patients aged 18 years or older who are being discharged and the feasibility and acceptability of the SAFER-YMH intervention in inpatient mental health settings in patients aged between 14 and 18 years who are being discharged. The baseline period and intervention periods are both 6 weeks. SAFER-MH will be implemented in three wards and SAFER-YMH in one or two wards, ideally across different trusts within England. We will use quantitative (eg, questionnaires, completion forms) and qualitative (eg, interviews, process evaluation) methods to assess the acceptability and feasibility of the two versions of the intervention. The findings will inform whether a main effectiveness trial is feasible and, if so, how it should be designed, and how many patients/wards should be included. ETHICS AND DISSEMINATION Ethical approval was obtained from the National Health Service Cornwall and Plymouth Research Ethics Committee and Surrey Research Ethics Committee (reference: 22/SW/0096 and 22/LO/0404). Research findings will be disseminated with participating sites and shared in various ways to engage different audiences. We will present findings at international and national conferences, and publish in open-access, peer-reviewed journals.
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Affiliation(s)
- Natasha Tyler
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
- NIHR School for Primary Care Research, University of Manchester, Manchester, UK
| | - Ioannis Angelakis
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Richard Neil Keers
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
- Centre for Pharmacoepidemiology and Drug Safety Research, University of Manchester, Manchester, UK
| | - Claire Planner
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | | | - Sally J Giles
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Andrew Grundy
- Division of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK
| | - Navneet Kapur
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
- Centre for Suicide Prevention, University of Manchester, Manchester, UK
| | - Chris Armitage
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Tom Blakeman
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
- NIHR School for Primary Care Research, University of Manchester, Manchester, UK
| | - Stephen M Campbell
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Catherine Robinson
- Division of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK
| | - Jessica Leather
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Maria Panagioti
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
- NIHR School for Primary Care Research, University of Manchester, Manchester, UK
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19
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Panagioti M, Hondkinson A. Adverse professional life experiences may affect mental health among cardiologists. Nat Rev Cardiol 2023; 20:287-288. [PMID: 36869095 DOI: 10.1038/s41569-023-00850-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Affiliation(s)
- Maria Panagioti
- NIHR School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK. .,NIHR Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
| | - Alexander Hondkinson
- NIHR School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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20
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Tyler N, Planner C, Shears B, Hernan A, Panagioti M, Giles S. Developing the Resident Measure of Safety in Care Homes (RMOS): A Delphi and Think Aloud Study. Health Expect 2023; 26:1149-1158. [PMID: 36797827 PMCID: PMC10154851 DOI: 10.1111/hex.13730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 01/26/2023] [Accepted: 02/05/2023] [Indexed: 02/18/2023] Open
Abstract
OBJECTIVE This study aimed to develop a measure of contributory factors to safety incidents in care homes to be completed by residents and/or their unpaid carers. INTRODUCTION Care home residents are particularly vulnerable to patient safety incidents, due to higher likelihood of frailty, multimorbidity and cognitive decline. However, despite residents and their carers wanting to be involved in safety initiatives, there are few mechanisms for them to contribute and make meaningful safety improvements to practice. METHODS We developed 73 evidence-based items from synthesis and existing measures, which we presented to a panel of stakeholders (residents/carers, health/social care professionals and researchers). We used two online rounds of Delphi to generate consensus (80%) on items important to include in the Resident Measure of Safety in Care Homes (RMOS); a consensus meeting was later held. The draft RMOS developed through the Delphi was presented to participants during 'Think Aloud' interviews using cognitive testing techniques. RESULTS The 29-item RMOS was developed. Forty-three participants completed Delphi round 1, and 27 participants completed round 2, 11 participants attended the consensus meeting and 12 'Think Aloud' interviews were conducted. Of the 73 original items, 42 items that did not meet consensus in Delphi round 1 were presented in round 2. After the consensus meeting, it was agreed that 35 items would comprise the RMOS questionnaire and were presented in the 'Think Aloud' interviews. Participants suggested numerous changes to items mostly to improve comprehension and ability to answer. CONCLUSION We have a developed an evidence-based RMOS, with good face validity, to assess contributory factors to safety in care homes from a resident/carer perspective. Future work will involve psychometrically testing the items in a pilot and developing a complementary simplified, dementia-friendly version to promote inclusivity. PATIENT OR PUBLIC INVOLVEMENT Four patient and public contributors worked with researchers to develop the online questionnaires. Patients (residents) and carers participated on the consensus panel. One member of the research team is an expert by lived experience and was involved in design and analysis decisions. The item list and instructions for the questionnaires were reviewed for face validity, understanding and acceptability by a patient and public involvement group and modified.
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Affiliation(s)
- Natasha Tyler
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,National Institute for Health and Care Research School for Primary Care Research, University of Manchester, Manchester, UK
| | - Claire Planner
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Bethany Shears
- Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
| | - Andrea Hernan
- Faculty of Health, Deakin University, Warrnambool, Australia
| | - Maria Panagioti
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,National Institute for Health and Care Research School for Primary Care Research, University of Manchester, Manchester, UK
| | - Sally Giles
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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21
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Hodkinson A, Peters D, Panagioti M, Pifarre J, Yuguero O. Editorial: The public health problem of burnout in health professionals. Front Public Health 2023; 11:1173312. [PMID: 37026133 PMCID: PMC10070948 DOI: 10.3389/fpubh.2023.1173312] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 03/10/2023] [Indexed: 04/08/2023] Open
Affiliation(s)
- Alexander Hodkinson
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, United Kingdom
| | - David Peters
- Centre for Resilience, University of Westminster, London, United Kingdom
| | - Maria Panagioti
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, United Kingdom
| | - Josep Pifarre
- Medicine and Surgery Department, Universitat de Lleida, Lleida, Spain
| | - Oriol Yuguero
- ErLab, Lleida Institute for Biomedical Research IRBLLEIDA, Lleida, Spain
- *Correspondence: Oriol Yuguero
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22
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Angelakis I, Panagioti M. PTSD increases suicide risk in the community especially for young women from deprived communities. Evid Based Nurs 2023; 26:24. [PMID: 35906010 DOI: 10.1136/ebnurs-2022-103531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 01/17/2023]
Affiliation(s)
- Ioannis Angelakis
- NIHR Greater Manchester Patient Safety Translational Research Centre, Division of Psychology and Mental Health, The University of Manchester Faculty of Biology Medicine and Mental Health, Manchester, Manchester, UK
| | - Maria Panagioti
- NIHR Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, The University of Manchester Faculty of Biology Medicine and Health, Manchester, Manchester, UK
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23
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Tsimpida D, Panagioti M, Kontopantelis E. Forty years on: a new national study of hearing in England and implications for global hearing health policy. Int J Audiol 2023; 62:62-70. [PMID: 35080184 DOI: 10.1080/14992027.2021.2022791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE We aimed to update the prevalence estimates of hearing loss in older adults in England using a nationally representative sample of adults aged 50 years old and older. DESIGN A comparative cross-sectional study design was implemented. Hearing loss was defined as ≥35 dB HL at 3.0 kHz, as measured via Hearcheck in the better-hearing ear. STUDY SAMPLE We compared the estimates based on the English census in 2015 to estimates from psychoacoustic hearing data available for 8,263 participants in the English Longitudinal Study of Ageing (ELSA) Wave 7 (2014-2015). RESULTS Marked regional variability in hearing loss prevalence was revealed among participants with similar age profiles. The regional differences in hearing outcomes reached up to 13.53% in those belonging to the 71-80 years old group; the prevalence of hearing loss was 49.22% in the North East of England (95%CI 48.0-50.4), versus 35.69% in the South East (95%CI 34.8-36.50). CONCLUSION A socio-spatial approach in planning sustainable models of hearing care based on the actual populations' needs and not on age demographics might offer a viable opportunity for healthier lives. Regular assessment of the extent and causality of the population's different audiological needs within the country is strongly supported.
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Affiliation(s)
- Dialechti Tsimpida
- Institute for Health Policy and Organisation (IHPO), Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Maria Panagioti
- NIHR Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Evangelos Kontopantelis
- Institute for Health Policy and Organisation (IHPO), Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Zhou AY, Hann M, Panagioti M, Patel M, Agius R, Van Tongeren M, Esmail A, Bower P. Exploring Associations between Stressors and Burnout in Trainee Doctors During the COVID-19 Pandemic in the UK. Acad Psychiatry 2022; 46:723-728. [PMID: 35661339 PMCID: PMC9165924 DOI: 10.1007/s40596-022-01660-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/12/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The authors examined associations between stressors and burnout in trainee doctors during the COVID-19 pandemic. METHODS An anonymous online questionnaire including 42 questions on general and pandemic-specific stressors, and the Maslach Burnout Inventory-Health Services Survey (MBI-HSS), was sent to 1000 randomly selected trainee doctors in North-West England. Main outcomes were burnout scores that were stratified into Emotional Exhaustion (EE), Depersonalisation (DP), and reduced Personal Accomplishment (PA) and associations between stressors and burnout using stepwise regression analysis. RESULTS A total of 362 complete responses were received giving a response rate of 37%. Mean scores for EE, DP, and PA derived from the MBI-HSS were 27.7, 9.8, and 34.3 respectively. Twenty-three stressors were found to be associated with burnout dimensions. "Increase in workload and hours due to COVID-19," "Poor leadership and management in the National Health Service," and "Not feeling valued" were found to have strong associations with burnout dimensions. Only "Not confident in own abilities" was found to be associated with all burnout dimensions. CONCLUSIONS Associations with burnout were found to be identified in a range of work, pandemic, and non-work-related stressors, supporting the need for multi-level interventions to mitigate burnout.
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Affiliation(s)
| | - Mark Hann
- University of Manchester, Manchester, UK
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25
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Panagioti M, Tyler N, Hodkinson A. Interventions to improve teamwork and wellbeing in primary care settings: a mixed method review. Eur J Public Health 2022. [PMCID: PMC9593382 DOI: 10.1093/eurpub/ckac129.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background General practices are experiencing increasing pressures due to rising demand, declining staff numbers, and knock-on impacts on patient care. The COVID-19 pandemic has added further challenges and reinforced the importance of teamwork and organisational settings. We undertook a mixed-method systematic review to explore which interventions can improve teamwork within primary care and improve inter-sector partnerships with other health and social care services. Methods Five major bibliographic databases were systematically searched for relevant studies from inception to February 2022. We included controlled intervention study designs and linked qualitative studies. For amenable data, meta-analysis is being undertaken using random effects models taking into account the between study heterogeneity (quantified using the I2 statistic) and potential publication bias (funnel plots and Egger's test). The qualitative studies are analysed using thematic analyses. Results The original search yield of 3012 studies, of which 14 studies with 1,534 participants were include in our analyses. Most of the evaluated interventions focused on improving non-technical skills and provided evidence of improvements in the quality of teamwork in primary care. Meta-analysis and narrative synthesis is undertaken to examine the impact of the teamwork interventions on staff outcomes (team attitudes, knowledge, and functioning; wellbeing), and patient outcomes (e.g. quality of patient care, patient satisfaction/experience). Conclusions The findings provide information of immediate importance for the mental health and wellbeing and teamwork support of professionals entering primary care and for the organisation of primary care services.
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Affiliation(s)
| | - N Tyler
- Manchester University , Manchester, UK
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26
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Hodkinson A, Zhou A, Johnson J, Geraghty K, Riley R, Zhou A, Panagopoulou E, Chew-Graham CA, Peters D, Esmail A, Panagioti M. Associations of physician burnout with career engagement and quality of patient care: systematic review and meta-analysis. BMJ 2022; 378:e070442. [PMID: 36104064 PMCID: PMC9472104 DOI: 10.1136/bmj-2022-070442] [Citation(s) in RCA: 85] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To examine the association of physician burnout with the career engagement and the quality of patient care globally. DESIGN Systematic review and meta-analysis. DATA SOURCES Medline, PsycINFO, Embase, and CINAHL were searched from database inception until May 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Observational studies assessing the association of physician burnout (including a feeling of overwhelming emotional exhaustion, feelings of cynicism and detachment from job defined as depersonalisation, and a sense of ineffectiveness and little personal accomplishment) with career engagement (job satisfaction, career choice regret, turnover intention, career development, and productivity loss) and the quality of patient care (patient safety incidents, low professionalism, and patient satisfaction). Data were double extracted by independent reviewers and checked through contacting all authors, 84 (49%) of 170 of whom confirmed their data. Random-effect models were used to calculate the pooled odds ratio, prediction intervals expressed the amount of heterogeneity, and meta-regressions assessed for potential moderators with significance set using a conservative level of P<0.10. RESULTS 4732 articles were identified, of which 170 observational studies of 239 246 physicians were included in the meta-analysis. Overall burnout in physicians was associated with an almost four times decrease in job satisfaction compared with increased job satisfaction (odds ratio 3.79, 95% confidence interval 3.24 to 4.43, I2=97%, k=73 studies, n=146 980 physicians). Career choice regret increased by more than threefold compared with being satisfied with their career choice (3.49, 2.43 to 5.00, I2=97%, k=16, n=33 871). Turnover intention also increased by more than threefold compared with retention (3.10, 2.30 to 4.17, I2=97%, k=25, n=32 271). Productivity had a small but significant effect (1.82, 1.08 to 3.07, I2=83%, k=7, n=9581) and burnout also affected career development from a pooled association of two studies (3.77, 2.77 to 5.14, I2=0%, n=3411). Overall physician burnout doubled patient safety incidents compared with no patient safety incidents (2.04, 1.69 to 2.45, I2=87%, k=35, n=41 059). Low professionalism was twice as likely compared with maintained professionalism (2.33, 1.96 to 2.70, I2=96%, k=40, n=32 321), as was patient dissatisfaction compared with patient satisfaction (2.22, 1.38 to 3.57, I2=75%, k=8, n=1002). Burnout and poorer job satisfaction was greatest in hospital settings (1.88, 0.91 to 3.86, P=0.09), physicians aged 31-50 years (2.41, 1.02 to 5.64, P=0.04), and working in emergency medicine and intensive care (2.16, 0.98 to 4.76, P=0.06); burnout was lowest in general practitioners (0.16, 0.03 to 0.88, P=0.04). However, these associations did not remain significant in the multivariable regressions. Burnout and patient safety incidents were greatest in physicians aged 20-30 years (1.88, 1.07 to 3.29, P=0.03), and people working in emergency medicine (2.10, 1.09 to 3.56, P=0.02). The association of burnout with low professionalism was smallest in physicians older than 50 years (0.36, 0.19 to 0.69, P=0.003) and greatest in physicians still in training or residency (2.27, 1.45 to 3.60, P=0.001), in those who worked in a hospital (2.16, 1.46 to 3.19, P<0.001), specifically in emergency medicine specialty (1.48, 1.01 to 2.34, P=0.042), or situated in a low to middle income country (1.68, 0.94 to 2.97, P=0.08). CONCLUSIONS This meta-analysis provides compelling evidence that physician burnout is associated with poor function and sustainability of healthcare organisations primarily by contributing to the career disengagement and turnover of physicians and secondarily by reducing the quality of patient care. Healthcare organisations should invest more time and effort in implementing evidence-based strategies to mitigate physician burnout across specialties, and particularly in emergency medicine and for physicians in training or residency. SYSTEMATIC REVIEW REGISTRATION PROSPERO number CRD42021249492.
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Affiliation(s)
- Alexander Hodkinson
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Anli Zhou
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Judith Johnson
- School of Psychology, University of Leeds, Leeds, UK
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - Keith Geraghty
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Ruth Riley
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Andrew Zhou
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Efharis Panagopoulou
- Laboratory of Hygiene, Aristotle Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - David Peters
- Westminster Centre for Resilience, Faculty of Science and Technology, University of Westminster, London, UK
| | - Aneez Esmail
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Maria Panagioti
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
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Hodkinson A, Kontopantelis E, Zghebi SS, Grigoroglou C, McMillan B, Marwijk HV, Bower P, Tsimpida D, Emery CF, Burge MR, Esmiol H, Cupples ME, Tully MA, Dasgupta K, Daskalopoulou SS, Cooke AB, Fayehun AF, Houle J, Poirier P, Yates T, Henson J, Anderson DR, Grey EB, Panagioti M. Association Between Patient Factors and the Effectiveness of Wearable Trackers at Increasing the Number of Steps per Day Among Adults With Cardiometabolic Conditions: Meta-analysis of Individual Patient Data From Randomized Controlled Trials. J Med Internet Res 2022; 24:e36337. [PMID: 36040779 PMCID: PMC9472038 DOI: 10.2196/36337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/14/2022] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Current evidence supports the use of wearable trackers by people with cardiometabolic conditions. However, as the health benefits are small and confounded by heterogeneity, there remains uncertainty as to which patient groups are most helped by wearable trackers. OBJECTIVE This study examined the effects of wearable trackers in patients with cardiometabolic conditions to identify subgroups of patients who most benefited and to understand interventional differences. METHODS We obtained individual participant data from randomized controlled trials of wearable trackers that were conducted before December 2020 and measured steps per day as the primary outcome in participants with cardiometabolic conditions including diabetes, overweight or obesity, and cardiovascular disease. We used statistical models to account for clustering of participants within trials and heterogeneity across trials to estimate mean differences with the 95% CI. RESULTS Individual participant data were obtained from 9 of 25 eligible randomized controlled trials, which included 1481 of 3178 (47%) total participants. The wearable trackers revealed that over the median duration of 12 weeks, steps per day increased by 1656 (95% CI 918-2395), a significant change. Greater increases in steps per day from interventions using wearable trackers were observed in men (interaction coefficient -668, 95% CI -1157 to -180), patients in age categories over 50 years (50-59 years: interaction coefficient 1175, 95% CI 377-1973; 60-69 years: interaction coefficient 981, 95% CI 222-1740; 70-90 years: interaction coefficient 1060, 95% CI 200-1920), White patients (interaction coefficient 995, 95% CI 360-1631), and patients with fewer comorbidities (interaction coefficient -517, 95% CI -1188 to -11) compared to women, those aged below 50, non-White patients, and patients with multimorbidity. In terms of interventional differences, only face-to-face delivery of the tracker impacted the effectiveness of the interventions by increasing steps per day. CONCLUSIONS In patients with cardiometabolic conditions, interventions using wearable trackers to improve steps per day mostly benefited older White men without multimorbidity. TRIAL REGISTRATION PROSPERO CRD42019143012; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=143012.
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Affiliation(s)
- Alexander Hodkinson
- Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Health Services Research and Primary Care, National Institute for Health Research School for Primary Care Research, Manchester, United Kingdom
| | - Evangelos Kontopantelis
- Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Health Services Research and Primary Care, National Institute for Health Research School for Primary Care Research, Manchester, United Kingdom.,Division of Informatics, Imaging & Data Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, United Kingdom
| | - Salwa S Zghebi
- Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Health Services Research and Primary Care, National Institute for Health Research School for Primary Care Research, Manchester, United Kingdom
| | - Christos Grigoroglou
- Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Health Services Research and Primary Care, National Institute for Health Research School for Primary Care Research, Manchester, United Kingdom
| | - Brian McMillan
- Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Health Services Research and Primary Care, National Institute for Health Research School for Primary Care Research, Manchester, United Kingdom
| | - Harm van Marwijk
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Brighton, Brighton, United Kingdom
| | - Peter Bower
- Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Health Services Research and Primary Care, National Institute for Health Research School for Primary Care Research, Manchester, United Kingdom
| | - Dialechti Tsimpida
- Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Health Services Research and Primary Care, National Institute for Health Research School for Primary Care Research, Manchester, United Kingdom
| | - Charles F Emery
- Department of Psychology, The Ohio State University College of Arts and Sciences, Columbus, OH, United States
| | - Mark R Burge
- Department of Medicine, Endocrinology and Metabolism, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Hunter Esmiol
- Department of Medicine, Endocrinology and Metabolism, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Margaret E Cupples
- Department of General Practice and Primary Care, Centre for Public Heath, Queen's University Belfast, Belfast, United Kingdom
| | - Mark A Tully
- School of Medicine, Ulster University, Londonderry, United Kingdom
| | - Kaberi Dasgupta
- Department of Medicine, McGill University, Montreal, QC, Canada.,Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Stella S Daskalopoulou
- Department of Medicine, McGill University, Montreal, QC, Canada.,Centre for Translational Biology, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | | | - Ayorinde F Fayehun
- Department of Family Medicine, University College Hospital, Ibadan, Nigeria
| | - Julie Houle
- Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Paul Poirier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Laval, QC, Canada
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom
| | - Joseph Henson
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom
| | - Derek R Anderson
- Department of Psychology, The Ohio State University College of Arts and Sciences, Columbus, OH, United States
| | - Elisabeth B Grey
- Centre for Motivation and Health Behaviour Change, Department for Health, University of Bath, Bath, United Kingdom
| | - Maria Panagioti
- Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Health Services Research and Primary Care, National Institute for Health Research School for Primary Care Research, Manchester, United Kingdom
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Angelakis I, Huggett C, Gooding P, Panagioti M, Hodkinson A. Effectiveness of cognitive-behavioural therapies of varying complexity in reducing depression in adults: systematic review and network meta-analysis. Br J Psychiatry 2022; 221:459-467. [PMID: 35346407 DOI: 10.1192/bjp.2022.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cognitive-behavioural therapy (CBT) is frequently used as an umbrella term to include a variety of psychological interventions. It remains unclear whether more complex CBT contributes to greater depression reduction. AIMS To (a) compare the effectiveness of core, complex and ultra-complex CBT against other psychological intervention, medication, treatment-as-usual and no treatment in reducing depression at post-treatment and in the long term and (b) explore important factors that could moderate the effectiveness of these interventions. METHOD MEDLINE, PsycInfo, Embase, Web of Science and the Cochrane Register of Controlled Trials were searched to November 2021. Only randomised controlled trials were eligible for the subsequent network meta-analysis. RESULTS We included 107 studies based on 15 248 participants. Core (s.m.d. = -1.14, 95% credible interval (CrI) -1.72 to -0.55 [m.d. = -8.44]), complex (s.m.d. = -1.24, 95% CrI -1.85 to -0.64 [m.d. = -9.18]) and ultra-complex CBT (s.m.d. = -1.45, 95% CrI -1.88 to -1.02 [m.d. = -10.73]) were all significant in reducing depression up to 6 months from treatment onset. The significant benefits of the ultra-complex (s.m.d. = -1.09, 95% CrI -1.61 to -0.56 [m.d. = -8.07]) and complex CBT (s.m.d. = -0.73, 95% CrI -1.36 to -0.11 [m.d. = -5.40]) extended beyond 6 months. Ultra-complex CBT was most effective in individuals presenting comorbid mental health problems and when delivered by non-mental health specialists. Ultra-complex and complex CBT were more effective for people younger than 59 years. CONCLUSIONS For people without comorbid conditions healthcare and policy organisations should invest in core CBT. For people <59 years of age with comorbid conditions investments should focus on ultra-complex and complex CBT delivered without the help of mental health professionals.
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Affiliation(s)
- Ioannis Angelakis
- PhD, National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, University of Manchester, UK; and School of Psychology, University of South Wales, Pontypridd, UK
| | - Charlotte Huggett
- MSc, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, UK; and Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, UK
| | - Patricia Gooding
- PhD, Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, UK
| | - Maria Panagioti
- PhD, National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, University of Manchester, UK; and National Institute for Health Research School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, University of Manchester, UK
| | - Alexander Hodkinson
- PhD, National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, University of Manchester, UK; and National Institute for Health Research School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, University of Manchester, UK
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Husain N, Tofique S, Chaudhry IB, Kiran T, Taylor P, Williams C, Memon R, Aggarwal S, Alvi MH, Ananiadou S, Ansari MA, Aseem S, Beck A, Alam S, Colucci E, Davidson K, Edwards S, Emsley R, Green J, Gumber A, Hawton K, Jafri F, Khaliq A, Mason T, Mcreath A, Minhas A, Naeem F, Naqvi HA, Noureen A, Panagioti M, Patel A, Poppleton A, Shiri T, Simic M, Sultan S, Nizami AT, Zadeh Z, Zafar SN, Chaudhry N. Youth Culturally adapted Manual Assisted Problem Solving Training (YCMAP) in Pakistani adolescent with a history of self-harm: protocol for multicentre clinical and cost-effectiveness randomised controlled trial. BMJ Open 2022; 12:e056301. [PMID: 35568489 PMCID: PMC9109112 DOI: 10.1136/bmjopen-2021-056301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 04/20/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Suicide is a global health concern. Sociocultural factors have an impact on self-harm and suicide rates. In Pakistan, both self-harm and suicide are considered as criminal offence's and are condemned on both religious and social grounds. The proposed intervention 'Youth Culturally Adapted Manual Assisted Problem Solving Training (YCMAP)' is based on principles of problem-solving and cognitive-behavioural therapy. YCMAP is a brief, culturally relevant, scalable intervention that can be implemented in routine clinical practice if found to be effective. METHOD AND ANALYSIS A multicentre rater blind randomised controlled trial to evaluate the clinical and cost-effectiveness of YCMAP including a sample of 652 participants, aged 12-18 years, presenting to general physicians/clinicians, emergency room after self harm or self referrals. We will test the effectiveness of 8-10 individual sessions of YCMAP delivered over 3 months compared with treatment as usual. Primary outcome measure is repetition of self-harm at 12 months. The seconday outcomes include reduction in suicidal ideation, hopelessness and distress and improvement in health related quality of life. Assessments will be completed at baseline, 3, 6, 9 and 12 months postrandomisation. The nested qualitative component will explore perceptions about management of self-harm and suicide prevention among adolescents and investigate participants' experiences with YCMAP. The study will be guided by the theory of change approach to ensure that the whole trial is centred around needs of the end beneficiaries as key stakeholders in the process. ETHICS AND DISSEMINATION Ethics approval has been obtained from the Ethics Committee of University of Manchester, the National Bioethics Committee in Pakistan. The findings of this study will be disseminated through community workshops, social media, conference presentations and peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04131179.
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Affiliation(s)
- Nusrat Husain
- Division of Psychology and Mental Health, The University of Manchester School of Medical Sciences, Manchester, UK
- Manchester Global Foundation, Manchester, UK
| | - Sehrish Tofique
- Division of Neuro-Cognitive Disorder, Older Adults Mental Health, Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Imran B Chaudhry
- Psychiatry, Greater Manchester West Mental Hlth NHS Fdn Trust, Manchester, UK
- Psychiatry, Dr Ziauddin Hospital, Karachi, Sindh, Pakistan
| | - Tayyeba Kiran
- Division of Mood Disorder, Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Peter Taylor
- Psychology & Mental Health, The University of Manchester, Manchester, UK
| | | | - Rakhshi Memon
- Science and Technology Studies, University College London, London, UK
| | - Shilpa Aggarwal
- Psychiatry, SRCC Children's Hospital (Narayana Health), Mumbai, India
| | - Mohsin Hassan Alvi
- Health Economics, Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - S Ananiadou
- School of Computer Science, The University of Manchester, Manchester, UK
| | | | - Saadia Aseem
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
| | - Andrew Beck
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Sumira Alam
- Psychiatry, Services Institute of Medical Sciences, Lahore, Punjab, Pakistan
| | | | - Kate Davidson
- Psycho-social Interventions, University of Glasgow, Glasgow, UK
| | - Sarah Edwards
- Research Ethics and Governance, University College London, London, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jonathan Green
- Division of Neuroscience & Experimental Psychology, The University of Manchester, Manchester, UK
| | - Anil Gumber
- Health Economics, Hallam University, Sheffield, UK
| | - Keith Hawton
- Psychiatry, Centre for Suicide Research, Oxford University, Oxford, UK
| | - Farhat Jafri
- Community Medicine, Karachi Medical and Dental College, Karachi, Pakistan
| | - Ayesha Khaliq
- Division of Eating Feeding, Nutrition and Elimination Disorders, Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Thomas Mason
- Division of Population Health, Health Services Research & Primary Care, Manchester Institute for Collaborative Research on Ageing, University of Manchester, Manchester, UK
| | | | | | - Farooq Naeem
- Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Haider Ali Naqvi
- Psychiatry, Dow University of Health Sciences, Karachi, Pakistan
| | - Amna Noureen
- Division of Child and Adolescent Mental Health, Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Maria Panagioti
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Anita Patel
- Health Economics, Queen Mary University, London, UK
| | - Aaron Poppleton
- Center for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Tinevimbo Shiri
- Health Economics, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Mima Simic
- Child and Adolescent Psychiatrist, South London and Maudsley NHS Foundation Trust, London, UK
| | - Sarwat Sultan
- Department of Applied Psychology, Bahauddin Zakariya University, Multan, Punjab, Pakistan
| | | | - Zainab Zadeh
- Child and Adolescent Mental Health, Pakistan Institute of Living and Learning, Karachi, Pakistan
| | | | - Nasim Chaudhry
- Research and Development, Pakistan Institute of Living and Learning, Karachi, Pakistan
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30
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Birtwell K, Planner C, Hodkinson A, Hall A, Giles S, Campbell S, Tyler N, Panagioti M, Daker-White G. Transitional Care Interventions for Older Residents of Long-term Care Facilities: A Systematic Review and Meta-analysis. JAMA Netw Open 2022; 5:e2210192. [PMID: 35507344 PMCID: PMC9069255 DOI: 10.1001/jamanetworkopen.2022.10192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Residents of long-term care facilities (LTCFs) experience high hospitalization rates, yet little is known about the effects of transitional care interventions for these residents. OBJECTIVE To assess the association of transitional care interventions with readmission rates and other outcomes for residents of LTCFs who are 65 years and older and LTCF staff and to explore factors that potentially mitigate the association. DATA SOURCES MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health Literature were searched for English-language studies published until July 21, 2021. Associated qualitative studies were identified using aspects of the CLUSTER (citations, lead authors, unpublished materials, searched Google Scholar, tracked theories, ancestry search for early examples, and follow-up of related projects) methodology. STUDY SELECTION Controlled design studies evaluating transitional care interventions for residents of LTCFs 65 years and older were included. Records were independently screened by 2 reviewers; disagreements were resolved through discussion and involvement of a third reviewer. From 14 538 records identified, 15 quantitative and 4 qualitative studies met the eligibility criteria. DATA EXTRACTION AND SYNTHESIS The study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Data were extracted by one reviewer and checked by a second reviewer. Fixed-effect and random-effects models were used according to the number of studies reporting the outcomes of interest. MAIN OUTCOMES AND MEASURES The primary outcome consisted of 30-, 60-, and 90-day readmission rates (hospital and emergency department [ED]). Other outcomes included length of stay, functional independence (Barthel score), and quality of life. The I2 statistic was used to quantify heterogeneity. RESULTS Of 14 538 records identified from searches, 15 quantitative studies (totaling 32 722 participants or records) and 4 qualitative studies were included. People allocated to transitional care interventions were 1.7 times less likely to be readmitted to the hospital or ED compared with those in control groups (14 studies; odds ratio, 1.66 [95% CI, 1.18-2.35]; I2 = 81% [95% CI, 70%-88%]). Length of stay in the ED was significantly decreased for intervention groups (3 studies; standardized mean difference, -3.00 [95% CI, -3.61 to -2.39]; I2 = 99% [95% CI, 98%-99%]). There were no significant differences for other outcomes. Factors associated with outcomes included communication and referral processes between health care professionals. CONCLUSIONS AND RELEVANCE Emerging evidence suggests that transitional care interventions are associated with lower readmissions for residents of LTCFs 65 years and older. Despite this and with aging populations, investment in such interventions has been remarkably low across most countries.
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Affiliation(s)
- Kelly Birtwell
- National Institute for Health Research, School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Claire Planner
- National Institute for Health Research, School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Alexander Hodkinson
- National Institute for Health Research, School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
| | - Alex Hall
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Sally Giles
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
| | - Stephen Campbell
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
| | - Natasha Tyler
- National Institute for Health Research, School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
| | - Maria Panagioti
- National Institute for Health Research, School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
| | - Gavin Daker-White
- National Institute for Health Research, School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
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Hodkinson A, Tsimpida D, Kontopantelis E, Rutter MK, Mamas MA, Panagioti M. Comparative effectiveness of statins on non-high density lipoprotein cholesterol in people with diabetes and at risk of cardiovascular disease: systematic review and network meta-analysis. BMJ 2022; 376:e067731. [PMID: 35331984 PMCID: PMC8943592 DOI: 10.1136/bmj-2021-067731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare the efficacy of different statin treatments by intensity on levels of non-high density lipoprotein cholesterol (non-HDL-C) for the prevention of cardiovascular disease in people with diabetes. DESIGN Systematic review and network meta-analysis. DATA SOURCES Medline, Cochrane Central Register of Controlled Trials, and Embase from inception to 1 December 2021. REVIEW METHODS Randomised controlled trials comparing different types and intensities of statins, including placebo, in adults with type 1 or type 2 diabetes mellitus were included. The primary outcome was changes in levels of non-HDL-C, calculated from measures of total cholesterol and HDL-C. Secondary outcomes were changes in levels of low density lipoprotein cholesterol (LDL-C) and total cholesterol, three point major cardiovascular events (non-fatal stroke, non-fatal myocardial infarction, and death related to cardiovascular disease), and discontinuations because of adverse events. A bayesian network meta-analysis of statin intensity (low, moderate, or high) with random effects evaluated the treatment effect on non-HDL-C by mean differences and 95% credible intervals. Subgroup analysis of patients at greater risk of major cardiovascular events was compared with patients at low or moderate risk. The confidence in network meta-analysis (CINeMA) framework was applied to determine the certainty of evidence. RESULTS In 42 randomised controlled trials involving 20 193 adults, 11 698 were included in the meta-analysis. Compared with placebo, the greatest reductions in levels of non-HDL-C were seen with rosuvastatin at high (-2.31 mmol/L, 95% credible interval -3.39 to -1.21) and moderate (-2.27, -3.00 to -1.49) intensities, and simvastatin (-2.26, -2.99 to -1.51) and atorvastatin (-2.20, -2.69 to -1.70) at high intensity. Atorvastatin and simvastatin at any intensity and pravastatin at low intensity were also effective in reducing levels of non-HDL-C. In 4670 patients at greater risk of a major cardiovascular events, atorvastatin at high intensity showed the largest reduction in levels of non-HDL-C (-1.98, -4.16 to 0.26, surface under the cumulative ranking curve 64%). Simvastatin (-1.93, -2.63 to -1.21) and rosuvastatin (-1.76, -2.37 to -1.15) at high intensity were the most effective treatment options for reducing LDL-C. Significant reductions in non-fatal myocardial infarction were found for atorvastatin at moderate intensity compared with placebo (relative risk=0.57, confidence interval 0.43 to 0.76, n=4 studies). No significant differences were found for discontinuations, non-fatal stroke, and cardiovascular deaths. CONCLUSIONS This network meta-analysis indicated that rosuvastatin, at moderate and high intensity doses, and simvastatin and atorvastatin, at high intensity doses, were most effective at moderately reducing levels of non-HDL-C in patients with diabetes. Given the potential improvement in accuracy in predicting cardiovascular disease when reduction in levels of non-HDL-C is used as the primary target, these findings provide guidance on which statin types and intensities are most effective by reducing non-HDL-C in patients with diabetes. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021258819.
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Affiliation(s)
- Alexander Hodkinson
- National Institute for Health Research School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Dialechti Tsimpida
- National Institute for Health Research School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Institute for Health Policy and Organisation, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Division of Medical Education, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Evangelos Kontopantelis
- National Institute for Health Research School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Institute for Health Policy and Organisation, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Division of Informatics, Imaging, and Data Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Martin K Rutter
- Division of Diabetes, Endocrinology, and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Diabetes, Endocrinology, and Metabolism Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Mamas A Mamas
- National Institute for Health Research School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, UK
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Maria Panagioti
- National Institute for Health Research School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
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Bourne RS, Jennings JK, Panagioti M, Hodkinson A, Sutton A, Ashcroft DM. Medication-related interventions to improve medication safety and patient outcomes on transition from adult intensive care settings: a systematic review and meta-analysis. BMJ Qual Saf 2022; 31:609-622. [PMID: 35042765 PMCID: PMC9304084 DOI: 10.1136/bmjqs-2021-013760] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 12/14/2021] [Indexed: 12/26/2022]
Abstract
BackgroundPatients recovering from an episode in an intensive care unit (ICU) frequently experience medication errors on transition to the hospital ward. Structured handover recommendations often underestimate the challenges and complexity of ICU patient transitions. For adult ICU patients transitioning to a hospital ward, it is currently unclear what interventions reduce the risks of medication errors.The aims were to examine the impact of medication-related interventions on medication and patient outcomes on transition from adult ICU settings and identify barriers and facilitators to implementation.MethodsThe systematic review protocol was preregistered on PROSPERO. Six electronic databases were searched until October 2020 for controlled and uncontrolled study designs that reported medication-related (ie, de-prescribing; medication errors) or patient-related outcomes (ie, mortality; length of stay). Risk of bias (RoB) assessment used V.2.0 and ROBINS-I Cochrane tools. Where feasible, random-effects meta-analysis was used for pooling the OR across studies. The quality of evidence was assessed by Grading of Recommendations, Assessment, Development and Evaluations.ResultsSeventeen studies were eligible, 15 (88%) were uncontrolled before-after studies. The intervention components included education of staff (n=8 studies), medication review (n=7), guidelines (n=6), electronic transfer/handover tool or letter (n=4) and medicines reconciliation (n=4). Overall, pooled analysis of all interventions reduced risk of inappropriate medication continuation at ICU discharge (OR=0.45 (95% CI 0.31 to 0.63), I2=55%, n=9) and hospital discharge (OR=0.39 (95% CI 0.2 to 0.76), I2=75%, n=9). Multicomponent interventions, based on education of staff and guidelines, demonstrated no significant difference in inappropriate medication continuation at the ICU discharge point (OR 0.5 (95% CI 0.22 to 1.11), I2=62%, n=4), but were very effective in increasing de-prescribing outcomes on hospital discharge (OR 0.26 (95% CI 0.13 to 0.55), I2=67%, n=6)). Facilitators to intervention delivery included ICU clinical pharmacist availability and participation in multiprofessional ward rounds, while barriers included increased workload associated with the discharge intervention process.ConclusionsMulticomponent interventions based on education of staff and guidelines were effective at achieving almost four times more de-prescribing of inappropriate medication by the time of patient hospital discharge. Based on the findings, practice and policy recommendations are made and guidance is provided on the need for, and design of theory informed interventions in this area, including the requirement for process and economic evaluations.
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Affiliation(s)
- Richard S Bourne
- Pharmacy and Critical Care, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Jennifer K Jennings
- Pharmacy and Critical Care, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Maria Panagioti
- National Institute for Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre (PSTRC), School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Alexander Hodkinson
- National Institute for Health Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Anthea Sutton
- School of Health and Related Sciences (ScHARR), The University of Sheffield, Sheffield, Sheffield, UK
| | - Darren M Ashcroft
- National Institute for Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre (PSTRC), School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Zhou AY, Hann M, Panagioti M, Patel M, Agius R, Van Tongeren M, Esmail A, Bower P. Cross-sectional study exploring the association between stressors and burnout in junior doctors during the COVID-19 pandemic in the United Kingdom. J Occup Health 2022; 64:e12311. [PMID: 35025106 PMCID: PMC8757574 DOI: 10.1002/1348-9585.12311] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/26/2021] [Accepted: 12/19/2021] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES This study aims to develop a comprehensive list of stressors relevant to junior doctors and will also report findings exploring the associations between burnout and stressors, which include work and non-work-related stressors as well as pandemic-related stressors. METHODS An anonymous online questionnaire was sent to 1000 randomly selected junior doctors in the North-West of England. The questionnaire included 37 questions on general and pandemic-specific stressors, and the Maslach Burnout Inventory Health Services Survey. The main outcomes of interest were junior doctor ratings of stressors and scores for burnout (emotional exhaustion [EE], depersonalisation [DP], and personal accomplishment [PA]). Stepwise regression analysis was undertaken to assess associations between stressors and burnout. RESULTS In total, 326 responses were collected (response rate = 33%). Of the top 10 stressors rated by junior doctors, 60% were related to the pandemic. Multiple stressors were found to be associated with the burnout dimensions. Fatigue (β = .43), pandemic-related workload increase (β = .33), and feeling isolated (β = .24) had the strongest associations with EE, whereas fatigue (β = .21), uncertainty around COVID-19 information (β = .22) and doing unproductive tasks (β = .17) had the strongest associations with DP. Working beyond normal scope due to COVID-19 (β = -.26), not confident in own ability (β = -.24) and not feeling valued (β = -.20) were found to have the strongest associations with PA. CONCLUSIONS Junior doctors experience a combination of general stressors and additional stressors emerging from the pandemic which significantly impact burnout. Monitoring these stressors and targeting them as part of interventions could help mitigating burnout in junior doctors.
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Affiliation(s)
- Anli Yue Zhou
- Division of Population Health, Health Services Research & Primary Care, National Institute for Health Research School for Primary Care Research, University of Manchester, Manchester, UK.,Division of Population Health, Health Services Research & Primary Care, Centre for Occupational and Environmental Health, University of Manchester, Manchester, UK
| | - Mark Hann
- Division of Population Health, Health Services Research & Primary Care, Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Maria Panagioti
- Division of Population Health, Health Services Research & Primary Care, National Institute for Health Research School for Primary Care Research, University of Manchester, Manchester, UK
| | | | - Raymond Agius
- Division of Population Health, Health Services Research & Primary Care, Centre for Occupational and Environmental Health, University of Manchester, Manchester, UK
| | - Martie Van Tongeren
- Division of Population Health, Health Services Research & Primary Care, Centre for Occupational and Environmental Health, University of Manchester, Manchester, UK
| | - Aneez Esmail
- Division of Population Health, Health Services Research & Primary Care, National Institute for Health Research School for Primary Care Research, University of Manchester, Manchester, UK
| | - Peter Bower
- Division of Population Health, Health Services Research & Primary Care, National Institute for Health Research School for Primary Care Research, University of Manchester, Manchester, UK
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Zhou AY, Zghebi SS, Hodkinson A, Hann M, Grigoroglou C, Ashcroft DM, Esmail A, Chew-Graham CA, Payne R, Little P, de Lusignan S, Cherachi-Sohi S, Spooner S, Zhou AK, Kontopantelis E, Panagioti M. Investigating the links between diagnostic uncertainty, emotional exhaustion, and turnover intention in General Practitioners working in the United Kingdom. Front Psychiatry 2022; 13:936067. [PMID: 35958644 PMCID: PMC9360551 DOI: 10.3389/fpsyt.2022.936067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/30/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND General Practitioners (GPs) report high levels of burnout, job dissatisfaction, and turnover intention. The complexity of presenting problems to general practice makes diagnostic uncertainty a common occurrence that has been linked to burnout. The interrelationship between diagnostic uncertainty with other factors such as burnout, job satisfaction and turnover intention have not been previously examined. OBJECTIVES To examine associations between diagnostic uncertainty, emotional exhaustion (EE), depersonalization (DP), job satisfaction, and turnover intention in GPs. METHODS Seventy general practices in England were randomly selected through the Oxford-Royal College of General Practitioners Research and Surveillance Centre (RCGP-RSC). A total of 348 GPs within 67 these practices completed a 10-item online questionnaire which included questions on GP characteristics, work-life balance, job satisfaction, sickness presenteeism, diagnostic uncertainty, turnover intention as well as EE and DP. Associations between diagnostic uncertainty and each of EE, DP, job satisfaction, and turnover intention were evaluated in multivariate mixed-effect ordinal logistic regressions whilst adjusting for covariates, to account for the correlation in the three outcomes of interest. RESULTS Almost one-third of GPs (n = 101; 29%) reported experiencing >10% of diagnostic uncertainty in their day-to-day practice over the past year. GPs reporting greater diagnostic uncertainty had higher levels of EE [OR = 3.90; 95% CI = (2.54, 5.99)], job dissatisfaction [OR = 2.01; 95% CI = (1.30, 3.13)] and turnover intention [OR = 4.51; 95% CI = (2.86, 7.11)]. GPs with no sickness presenteeism had lower levels of EE [OR = 0.53; 95% CI = (0.35, 0.82)], job dissatisfaction [OR = 0.56; 95% CI = (0.35, 0.88)], and turnover intention [OR = 0.61; 95% CI = (0.41, 0.91)]. CONCLUSION Diagnostic uncertainty may not only negatively impact on the wellbeing of GPs, but could also have adverse implications on workforce retention in primary care.
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Affiliation(s)
- Anli Yue Zhou
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Salwa S Zghebi
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Alexander Hodkinson
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,NIHR Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Mark Hann
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Christos Grigoroglou
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Institute for Health Policy and Organisation (IHPO), Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Darren M Ashcroft
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,NIHR Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, University of Manchester, Manchester, United Kingdom
| | - Aneez Esmail
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | | | - Rupert Payne
- Centre for Academic Primary Care Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Paul Little
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Simon de Lusignan
- Medical Sciences Division, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.,Royal College of General Practitioners Research and Surveillance Centre, London, United Kingdom
| | - Sudeh Cherachi-Sohi
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,NIHR Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Sharon Spooner
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Andrew K Zhou
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Evangelos Kontopantelis
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Maria Panagioti
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,NIHR Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
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Zhou AY, Panagioti M, Hann M, Agius R, Van Tongeren M, Esmail A, Bower P. Contributors to stress and burnout in junior doctors during the COVID-19 pandemic. Saf Health Work 2022. [PMCID: PMC8817298 DOI: 10.1016/j.shaw.2021.12.1672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Kontopantelis E, Panagioti M, Farragher T, Munford LA, Parisi R, Planner C, Spooner S, Tse A, Ashcroft DM, Esmail A. Consultation patterns and frequent attenders in UK primary care from 2000 to 2019: a retrospective cohort analysis of consultation events across 845 general practices. BMJ Open 2021; 11:e054666. [PMID: 34930742 PMCID: PMC8718478 DOI: 10.1136/bmjopen-2021-054666] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To describe the distribution of consultations at the practice level and examine whether increases are uniform or driven by people who consult more frequently. DESIGN Retrospective cohort study. SETTING UK general practice data from the Clinical Practice Research Datalink (CPRD) GOLD database. PARTICIPANTS 1 699 709 314 consultation events from 12 330 545 patients, in 845 general practices (1 April 2000 to 31 March 2019). METHODS Consultation information was aggregated by financial year into: all consultations/all staff; all consultations/general practitioners (GPs); face-to-face consultations/all staff; face-to-face consultations/GPs. Patients with a number of consultations above the 90th centile, within each year, were classified as frequent attenders. Negative binomial regressions examined the association between available practice characteristics and consultation distribution. RESULTS Among frequent attenders, all consultations by GPs increased from a median (25th and 75th centile) of 13 (10 and 16) to 21 (18 and 25) and all consultations by all staff increased from 27 (23-30) to 60 (51-69) over the study period. Approximately four out of ten consultations of any type concerned frequent attenders and the proportion of consultations attributed to them increased over time, particularly for face-to-face consultations with GPs, from a median of 38.0% (35.9%-40.3%) in 2000-2001 to 43.0% (40.6%-46.4%) in 2018-2019. Regression analyses indicated decreasing trends over time for face-to-face consultations and increasing trends for all consultation types, for both GPs and all staff. Frequent attenders consulted approximately five times more than the rest of the practice population, on average, with adjusted incidence rate ratios ranging between 4.992 (95% CI 4.917 to 5.068) for face-to-face consultations with all staff and 5.603 (95% CI 5.560 to 5.647) for all consultations with GPs. CONCLUSIONS Frequent attenders progressively contributed to increased workload in general practices across the UK from 2000 to 2019. Important knowledge gaps remain in terms of the demographic, social and health characteristics of frequent attenders and how UK general practices can be prepared to meet the needs of these patients.
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Affiliation(s)
- Evangelos Kontopantelis
- Division of Informatics, Imaging and Data Science, The University of Manchester, Manchester, UK
- National Institute for Health Research (NIHR) School for Primary Care Research, Oxford, UK
| | - Maria Panagioti
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
| | - Tracey Farragher
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Luke A Munford
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Rosa Parisi
- Division of Informatics, Imaging and Data Science, The University of Manchester, Manchester, UK
- National Institute for Health Research (NIHR) School for Primary Care Research, Oxford, UK
| | - Claire Planner
- National Institute for Health Research (NIHR) School for Primary Care Research, Oxford, UK
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
| | - Sharon Spooner
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
- Health Organisation, Policy and Economics (HOPE) Group, Centre for Primary Care & Health Services Research, The University of Manchester, Manchester, UK
| | - Alice Tse
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Darren M Ashcroft
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
- Division of Pharmacy & Optometry, The University of Manchester, Manchester, UK
| | - Aneez Esmail
- National Institute for Health Research (NIHR) School for Primary Care Research, Oxford, UK
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
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Husain MO, Chaudhry IB, Blakemore A, Shakoor S, Husain MA, Lane S, Kiran T, Jafri F, Memon R, Panagioti M, Husain N. Prevalence of depression and anxiety in patients with chronic obstructive pulmonary disease and their association with psychosocial outcomes: A cross-sectional study from Pakistan. SAGE Open Med 2021; 9:20503121211032813. [PMID: 34659761 PMCID: PMC8511919 DOI: 10.1177/20503121211032813] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 06/25/2021] [Indexed: 12/03/2022] Open
Abstract
Objectives: Chronic obstructive pulmonary disease contributes to substantial health and
economic burden worldwide. Co-morbid depression and anxiety are highly
prevalent in patients with chronic obstructive pulmonary disease. Depressive
symptoms in chronic obstructive pulmonary disease are associated with poorer
survival, longer hospitalisation and impaired quality of life. Literature on
chronic obstructive pulmonary disease is largely derived from high-income
countries; yet 90% of deaths related to chronic obstructive pulmonary
disease occur in low- and middle-income countries. We aimed to establish the
prevalence of anxiety and depression in patients with chronic obstructive
pulmonary disease, as well as the association with psychosocial
outcomes. Methods: This was a cross-sectional study of chronic obstructive pulmonary disease
patients attending outpatient primary care clinics in Karachi, Pakistan. The
Patient Health Questionnaire-9 was used to assess depression and the
Generalised Anxiety Disorder-7 scale was used for the assessment of anxiety.
Health-related quality of life was assessed with EuroQol–Five Dimensions,
social support with Oslo-3 and social stress with Life Events Checklist. We
recruited 293 subjects. Results: The prevalence of depression and anxiety in the sample was 51%
(n = 149) and 20% (n = 59),
respectively. Depressed chronic obstructive pulmonary disease patients
reported significantly lower health-related quality of life scores as
compared to non-depressed patients. Participants with depression had
significantly higher levels of anxiety, less social support, higher social
stress and more subjective impairment in quality of life. Conclusion: Given the association with reduced social support and increased perceived
stress, the role of psychosocial interventions must be explored in improving
outcomes of chronic obstructive pulmonary disease patients in Pakistan.
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Affiliation(s)
- Muhammad Omair Husain
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada.,Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Imran B Chaudhry
- Department of Psychiatry, Dr. Ziauddin Hospital, Karachi, Pakistan
| | - Amy Blakemore
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Suleman Shakoor
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | | | - Steven Lane
- Medical Statistics Biostatistics, University of Liverpool, Liverpool, UK
| | - Tayyeba Kiran
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Farhat Jafri
- Department of Community Medicine, Karachi Medical & Dental College, Karachi, Pakistan
| | | | - Maria Panagioti
- Division of Population Health, The University of Manchester, Manchester, UK
| | - Nusrat Husain
- Division of Psychology & Mental Health, The University of Manchester, Manchester, UK
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Giles SJ, Panagioti M, Riste L, Cheraghi-Sohi S, Lewis P, Adeyemi I, Davies K, Morris R, Phipps D, Dickenson C, Ashcroft D, Sanders C. Visual impairment and medication safety: a protocol for a scoping review. Syst Rev 2021; 10:248. [PMID: 34526103 PMCID: PMC8442271 DOI: 10.1186/s13643-021-01800-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 08/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The number of individuals with a visual impairment in the UK was estimated a few years ago to be around 1.8 million. People can be visually impaired from birth, childhood, early adulthood or later in life. Those with visual impairment are subject to health inequities and increased risk for patient safety incidents in comparison to the general population. They are also known to be at an increased risk of experiencing medication errors compared to those without visual impairment. In view of this, this review aims to understand the issues of medication safety for VI people. METHODS/DESIGN Four electronic bibliographic databases will be searched: MEDLINE, Embase, PsycInfo and CINAHL. Our search strategy will include search combinations of two key blocks of terms. Studies will not be excluded based on design. Included studies will be empirical studies. They will include studies that relate to both medication safety and visual impairment. Two reviewers (SG and LR) will screen all the titles and abstracts. SG, LR, RM, SCS and PL will perform study selection and data extraction using standard forms. Disagreements will be resolved through discussion or third party adjudication. Data to be collected will include study characteristics (year, objective, research method, setting, country), participant characteristics (number, age, gender, diagnoses), medication safety incident type and characteristics. DISCUSSION The review will summarise the literature relating to medication safety and visual impairment.
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Affiliation(s)
- Sally J Giles
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Suite 11, 7th floor, Williamson Building, Oxford Road M13 9PL, Manchester, UK.
- Centre for Primary Care, University of Manchester, Oxford Road M13 9PL, Manchester, UK.
| | - Maria Panagioti
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Suite 11, 7th floor, Williamson Building, Oxford Road M13 9PL, Manchester, UK
- Centre for Primary Care, University of Manchester, Oxford Road M13 9PL, Manchester, UK
| | - Lisa Riste
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Suite 11, 7th floor, Williamson Building, Oxford Road M13 9PL, Manchester, UK
| | - Sudeh Cheraghi-Sohi
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Suite 11, 7th floor, Williamson Building, Oxford Road M13 9PL, Manchester, UK
- Centre for Primary Care, University of Manchester, Oxford Road M13 9PL, Manchester, UK
| | - Penny Lewis
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Isabel Adeyemi
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Suite 11, 7th floor, Williamson Building, Oxford Road M13 9PL, Manchester, UK
| | - Karen Davies
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Suite 11, 7th floor, Williamson Building, Oxford Road M13 9PL, Manchester, UK
| | - Rebecca Morris
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Suite 11, 7th floor, Williamson Building, Oxford Road M13 9PL, Manchester, UK
- Centre for Primary Care, University of Manchester, Oxford Road M13 9PL, Manchester, UK
| | - Denham Phipps
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Christine Dickenson
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Darren Ashcroft
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Suite 11, 7th floor, Williamson Building, Oxford Road M13 9PL, Manchester, UK
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Caroline Sanders
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Suite 11, 7th floor, Williamson Building, Oxford Road M13 9PL, Manchester, UK
- Centre for Primary Care, University of Manchester, Oxford Road M13 9PL, Manchester, UK
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Tyler N, Daker-White G, Grundy A, Quinlivan L, Armitage C, Campbell S, Panagioti M. Effects of the first COVID-19 lockdown on quality and safety in mental healthcare transitions in England. BJPsych Open 2021; 7:e156. [PMID: 34493959 PMCID: PMC8410739 DOI: 10.1192/bjo.2021.996] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 08/05/2021] [Accepted: 08/10/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic forced the rapid implementation of changes to practice in mental health services, in particular transitions of care. Care transitions pose a particular threat to patient safety. AIMS This study aimed to understand the perspectives of different stakeholders about the impact of temporary changes in practice and policy of mental health transitions as a result of coronavirus disease 2019 (COVID-19) on perceived healthcare quality and safety. METHOD Thirty-four participants were interviewed about quality and safety in mental health transitions during May and June 2020 (the end of the first UK national lockdown). Semi-structured remote interviews were conducted to generate in-depth information pertaining to various stakeholders (patients, carers, healthcare professionals and key informants). Results were analysed thematically. RESULTS The qualitative data highlighted six overarching themes in relation to practice changes: (a) technology-enabled communication; (b) discharge planning and readiness; (c) community support and follow-up; (d) admissions; (e) adapting to new policy and guidelines; (f) health worker safety and well-being. The COVID-19 pandemic exacerbated some quality and safety concerns such as tensions between teams, reduced support in the community and increased threshold for admissions. Also, several improvement interventions previously recommended in the literature, were implemented locally. DISCUSSION The practice of mental health transitions has transformed during the COVID-19 pandemic, affecting quality and safety. National policies concerning mental health transitions should concentrate on converting the mostly local and temporary positive changes into sustainable service quality improvements and applying systematic corrective policies to prevent exacerbations of previous quality and safety concerns.
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Affiliation(s)
- Natasha Tyler
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK
| | - Gavin Daker-White
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK
| | - Andrew Grundy
- School of Health Science, University of Nottingham, UK
| | - Leah Quinlivan
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK; and Centre for Mental Health and Safety, University of Manchester, UK
| | - Chris Armitage
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK; Manchester Centre for Health Psychology, University of Manchester, UK; and Manchester Academic Health Science Centre, Manchester University Foundation Trust, UK
| | - Stephen Campbell
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK
| | - Maria Panagioti
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK
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Hodkinson A, Heneghan C, Mahtani KR, Kontopantelis E, Panagioti M. Benefits and harms of Risperidone and Paliperidone for treatment of patients with schizophrenia or bipolar disorder: a meta-analysis involving individual participant data and clinical study reports. BMC Med 2021; 19:195. [PMID: 34429113 PMCID: PMC8386072 DOI: 10.1186/s12916-021-02062-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/13/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Schizophrenia and bipolar disorder are severe mental illnesses which are highly prevalent worldwide. Risperidone and Paliperidone are treatments for either illnesses, but their efficacy compared to other antipsychotics and growing reports of hormonal imbalances continue to raise concerns. As existing evidence on both antipsychotics are solely based on aggregate data, we aimed to assess the benefits and harms of Risperidone and Paliperidone in the treatment of patients with schizophrenia or bipolar disorder, using individual participant data (IPD), clinical study reports (CSRs) and publicly available sources (journal publications and trial registries). METHODS We searched MEDLINE, Central, EMBASE and PsycINFO until December 2020 for randomised placebo-controlled trials of Risperidone, Paliperidone or Paliperidone palmitate in patients with schizophrenia or bipolar disorder. We obtained IPD and CSRs from the Yale University Open Data Access project. The primary outcome Positive and Negative Syndrome Scale (PANSS) score was analysed using one-stage IPD meta-analysis. Random-effect meta-analysis of harm outcomes involved methods for coping with rare events. Effect-sizes were compared across all available data sources using the ratio of means or relative risk. We registered our review on PROSPERO, CRD42019140556. RESULTS Of the 35 studies, IPD meta-analysis involving 22 (63%) studies showed a significant clinical reduction in the PANSS in patients receiving Risperidone (mean difference - 5.83, 95% CI - 10.79 to - 0.87, I2 = 8.5%, n = 4 studies, 1131 participants), Paliperidone (- 6.01, 95% CI - 8.7 to - 3.32, I2 = 4.3%, n = 13, 3821) and Paliperidone palmitate (- 7.89, 95% CI - 12.1 to - 3.69, I2 = 2.9%, n = 5, 2209). CSRs reported nearly two times more adverse events (4434 vs. 2296 publication, relative difference (RD) = 1.93, 95% CI 1.86 to 2.00) and almost 8 times more serious adverse events (650 vs. 82; RD = 7.93, 95% CI 6.32 to 9.95) than the journal publications. Meta-analyses of individual harms from CSRs revealed a significant increased risk among several outcomes including extrapyramidal disorder, tardive dyskinesia and increased weight. But the ratio of relative risk between the different data sources was not significant. Three treatment-related gynecomastia events occurred, and these were considered mild to moderate in severity. CONCLUSION IPD meta-analysis conclude that Risperidone and Paliperidone antipsychotics had a small beneficial effect on reducing PANSS score over 9 weeks, which is more conservative than estimates from reviews based on journal publications. CSRs also contained significantly more data on harms that were unavailable in journal publications or trial registries. Sharing of IPD and CSRs are necessary when performing meta-analysis on the efficacy and safety of antipsychotics.
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Affiliation(s)
- Alexander Hodkinson
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care and Health Services Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK.
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, M13 9PL, UK.
| | - Carl Heneghan
- Nuffield Department of Primary Care health Sciences, University of Oxford, Oxford, UK
| | - Kamal R Mahtani
- Nuffield Department of Primary Care health Sciences, University of Oxford, Oxford, UK
| | - Evangelos Kontopantelis
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care and Health Services Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK
- Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, M13 9PL, UK
| | - Maria Panagioti
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care and Health Services Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, M13 9PL, UK
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Daker-White G, Panagioti M, Giles S, Blakeman T, Moore V, Hall A, Jones PP, Wright O, Shears B, Tyler N, Campbell S. Beyond the control of the care home: A meta-ethnography of qualitative studies of Infection Prevention and Control in residential and nursing homes for older people. Health Expect 2021; 25:2095-2106. [PMID: 34420254 PMCID: PMC9615085 DOI: 10.1111/hex.13349] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/22/2021] [Accepted: 08/04/2021] [Indexed: 11/26/2022] Open
Abstract
Objective This study aimed to develop interpretive insights concerning Infection Prevention and Control (IPC) in care homes for older people. Design This study had a meta‐ethnography design. Data Sources Six bibliographic databases were searched from inception to May 2020 to identify the relevant literature. Review Methods A meta‐ethnography was performed. Results Searches yielded 652 records; 15 were included. Findings were categorized into groups: The difficulties of enacting IPC measures in the care home environment; workload as an impediment to IPC practice; the tension between IPC and quality of life for care home residents; and problems dealing with medical services located outside the facility including diagnostics, general practice and pharmacy. Infection was revealed as something seen to lie ‘outside’ the control of the care home, whether according to origins or control measures. This could help explain the reported variability in IPC practice. Facilitators to IPC uptake involved repetitive training and professional development, although such opportunities can be constrained by the ways in which services are organized and delivered. Conclusions Significant challenges were revealed in implementing IPC in care homes including staffing skills, education, workloads and work routines. These challenges cannot be properly addressed without resolving the tension between the objectives of maintaining resident quality of life while enacting IPC practice. Repetitive staff training and professional development with parallel organisational improvements have prospects to enhance IPC uptake in residential and nursing homes. Patient or Public Contribution A carer of an older person joined study team meetings and was involved in writing a lay summary of the study findings.
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Affiliation(s)
- Gavin Daker-White
- Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK.,Division of Population Health, Health Services Research and Primary Care, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Maria Panagioti
- Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK.,Division of Population Health, Health Services Research and Primary Care, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Sally Giles
- Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK.,Division of Population Health, Health Services Research and Primary Care, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Thomas Blakeman
- Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Victoria Moore
- Division of Population Health, Health Services Research and Primary Care, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,The University of Manchester Law School, Manchester, UK
| | - Alex Hall
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - Paul P Jones
- Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Oliver Wright
- Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Bethany Shears
- Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Natasha Tyler
- Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK.,Division of Population Health, Health Services Research and Primary Care, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Stephen Campbell
- Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK.,Division of Population Health, Health Services Research and Primary Care, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
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Grigoroglou C, van der Feltz-Cornelis C, Hodkinson A, Coventry PA, Zghebi SS, Kontopantelis E, Bower P, Lovell K, Gilbody S, Waheed W, Dickens C, Archer J, Blakemore A, Adler DA, Aragones E, Björkelund C, Bruce ML, Buszewicz M, Carney RM, Cole MG, Davidson KW, Gensichen J, Grote NK, Russo J, Huijbregts K, Huffman JC, Menchetti M, Patel V, Richards DA, Rollman B, Smit A, Zijlstra-Vlasveld MC, Wells KB, Zimmermann T, Unutzer J, Panagioti M. Effectiveness of collaborative care in reducing suicidal ideation: An individual participant data meta-analysis. Gen Hosp Psychiatry 2021; 71:27-35. [PMID: 33915444 DOI: 10.1016/j.genhosppsych.2021.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/15/2021] [Accepted: 04/18/2021] [Indexed: 10/21/2022]
Abstract
UNLABELLED To assess whether CC is more effective at reducing suicidal ideation in people with depression compared with usual care, and whether study and patient factors moderate treatment effects. METHOD We searched Medline, Embase, PubMed, PsycINFO, CINAHL, CENTRAL from inception to March 2020 for Randomised Controlled Trials (RCTs) that compared the effectiveness of CC with usual care in depressed adults, and reported changes in suicidal ideation at 4 to 6 months post-randomisation. Mixed-effects models accounted for clustering of participants within trials and heterogeneity across trials. This study is registered with PROSPERO, CRD42020201747. RESULTS We extracted data from 28 RCTs (11,165 patients) of 83 eligible studies. We observed a small significant clinical improvement of CC on suicidal ideation, compared with usual care (SMD, -0.11 [95%CI, -0.15 to -0.08]; I2, 0·47% [95%CI 0.04% to 4.90%]). CC interventions with a recognised psychological treatment were associated with small reductions in suicidal ideation (SMD, -0.15 [95%CI -0.19 to -0.11]). CC was more effective for reducing suicidal ideation among patients aged over 65 years (SMD, - 0.18 [95%CI -0.25 to -0.11]). CONCLUSION Primary care based CC with an embedded psychological intervention is the most effective CC framework for reducing suicidal ideation and older patients may benefit the most.
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Affiliation(s)
- Christos Grigoroglou
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England.
| | | | - Alexander Hodkinson
- National Institute of Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
| | - Peter A Coventry
- Department of Health Sciences, University of York, York, England
| | - Salwa S Zghebi
- National Institute of Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
| | - Evangelos Kontopantelis
- Faculty of Biology, Medicine and Health, Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, England
| | - Peter Bower
- National Institute of Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, England; Greater Manchester Mental Health NHS Foundation Trust, Manchester, England
| | - Simon Gilbody
- Department of Health Sciences, Hull York Medical School, HYMS, University of York, York, England
| | - Waquas Waheed
- National Institute of Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
| | | | - Janine Archer
- School of Health and Society, School of Health and Society, University of Salford, England
| | - Amy Blakemore
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, England
| | - David A Adler
- Departments of Psychiatry and Medicine, Tufts Medical Center and Tufts University School of Medicine, England
| | - Enric Aragones
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
| | - Cecilia Björkelund
- Primary Health Care School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Martha L Bruce
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Marta Buszewicz
- Institute of Epidemiology and Health, Faculty of Population and Health Sciences, University College London, London, England
| | - Robert M Carney
- Department of Psychiatry, Washington University in St. Louis (WUSTL), St. Louis, Missouri, USA
| | - Martin G Cole
- Department of Psychiatry, St. Mary's Hospital Center, McGill University, Montreal, Quebec, Canada
| | - Karina W Davidson
- Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, LMU Klinikum, Ludwig-Maximilians, University Munich Pettenkoferstr. 10, 80336 Munich, Germany
| | - Nancy K Grote
- School of Social Work, University of Washington, Seattle, USA
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Klaas Huijbregts
- Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Jeff C Huffman
- Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Vikram Patel
- The Pershing Square Professor of Global Health, Harvard Medical School, Boston, MA, USA
| | - David A Richards
- Institute of Health Research, University of Exeter College of Medicine and Health, Exeter, England; Western University of Norway, Bergen, Norway
| | - Bruce Rollman
- Center for Behavioral Health, Media and Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Annet Smit
- HAN University of Applied Sciences, Nijmegen, Netherlands
| | | | - Kenneth B Wells
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA; Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA
| | - Thomas Zimmermann
- Department of General Practice / Primary Care, Centre for Psychosocial Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jurgen Unutzer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Maria Panagioti
- National Institute of Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
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Hodkinson A, Kontopantelis E, Adeniji C, van Marwijk H, McMillian B, Bower P, Panagioti M. Interventions Using Wearable Physical Activity Trackers Among Adults With Cardiometabolic Conditions: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e2116382. [PMID: 34283229 PMCID: PMC9387744 DOI: 10.1001/jamanetworkopen.2021.16382] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE Wearable physical activity (PA) trackers, such as accelerometers, fitness trackers, and pedometers, are accessible technologies that may encourage increased PA levels in line with current recommendations. However, whether their use is associated with improvements in PA levels in participants who experience 1 or more cardiometabolic conditions, such as diabetes, prediabetes, obesity, and cardiovascular disease, is unknown. OBJECTIVE To assess the association of interventions using wearable PA trackers (accelerometers, fitness trackers, and pedometers) with PA levels and other health outcomes in adults with cardiometabolic conditions. DATA SOURCES For this systematic review and meta-analysis, searches of MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and PsycINFO were performed from January 1, 2000, until December 31, 2020, with no language restriction. A combination of Medical Subject Heading terms and text words of diabetes, obesity, cardiovascular disease, pedometers, accelerometers, and Fitbits were used. STUDY SELECTION Randomized clinical trials or cluster randomized clinical trials that evaluated the use of wearable PA trackers, such as pedometers, accelerometers, or fitness trackers, were included. Trials were excluded if they assessed the trackers only as measuring tools of PA before and after another intervention, they required participants to be hospitalized, assessors were not blinded to the trackers, or they used a tracker to measure the effect of a pharmacological treatment on PA among individuals. DATA EXTRACTION AND SYNTHESIS The study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. A random-effects model was used for the meta-analysis. MAIN OUTCOMES AND MEASURES The primary outcome was mean difference in PA levels. When the scale was different across studies, standardized mean differences were calculated. Heterogeneity was quantified using the I2 statistic and explored using mixed-effects metaregression. RESULTS A total of 38 randomized clinical trials with 4203 participants were eligible in the systematic review; 29 trials evaluated pedometers, and 9 evaluated accelerometers or fitness trackers. Four studies did not provide amenable outcome data, leaving 34 trials (3793 participants) for the meta-analysis. Intervention vs comparator analysis showed a significant association of wearable tracker use with increased PA levels overall (standardized mean difference, 0.72; 95% CI, 0.46-0.97; I2 = 88%; 95% CI, 84.3%-90.8%; P < .001) in studies with short to medium follow-up for median of 15 (range, 12-52) weeks. Multivariable metaregression showed an association between increased PA levels and interventions that involved face-to-face consultations with facilitators (23 studies; β = -0.04; 95% CI, -0.11 to -0.01), included men (23 studies; β = 0.48; 95% CI, 0.01-0.96), and assessed pedometer-based interventions (26 studies; β = 0.20; 95% CI, 0.02-0.32). CONCLUSIONS AND RELEVANCE In this systematic review and meta-analysis, interventions that combined wearable activity trackers with health professional consultations were associated with significant improvements in PA levels among people with cardiometabolic conditions.
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Affiliation(s)
- Alexander Hodkinson
- National Institute for Health Research, School
for Primary Care Research, Manchester Academic Health Science Centre, University of
Manchester, Manchester, United Kingdom
| | - Evangelos Kontopantelis
- National Institute for Health Research, School
for Primary Care Research, Manchester Academic Health Science Centre, University of
Manchester, Manchester, United Kingdom
| | - Charles Adeniji
- National Institute for Health Research, School
for Primary Care Research, Manchester Academic Health Science Centre, University of
Manchester, Manchester, United Kingdom
| | - Harm van Marwijk
- Department of Primary Care and Public Health,
Brighton and Sussex Medical School, University of Brighton, Brighton, United
Kingdom
| | - Brian McMillian
- National Institute for Health Research, School
for Primary Care Research, Manchester Academic Health Science Centre, University of
Manchester, Manchester, United Kingdom
| | - Peter Bower
- National Institute for Health Research, School
for Primary Care Research, Manchester Academic Health Science Centre, University of
Manchester, Manchester, United Kingdom
| | - Maria Panagioti
- National Institute for Health Research, School
for Primary Care Research, Manchester Academic Health Science Centre, University of
Manchester, Manchester, United Kingdom
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Tyler N, Wright N, Panagioti M, Grundy A, Waring J. What does safety in mental healthcare transitions mean for service users and other stakeholder groups: An open-ended questionnaire study. Health Expect 2021; 24 Suppl 1:185-194. [PMID: 33471958 PMCID: PMC8137494 DOI: 10.1111/hex.13190] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 11/30/2020] [Accepted: 12/14/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Historically, safety mental health research has tended to focus on risks of homicide, suicide and deaths. Although wider safety issues are now recognized in regards to mental health services, the safety of mental health transitions, a key research and policy priority according to World Health Organisation, has not been explored. OBJECTIVE The purpose of this study was to investigate perceptions of safety in mental health transitions (hospital to community) amongst five stakeholder groups. DESIGN AND SETTING An online, international cross-sectional, open-ended questionnaire. PARTICIPANTS There were five stakeholder participant groups: service users; families/carers; mental health-care professionals; researchers; and end users of research. RESULTS Ninety-three participants from 12 different countries responded. Three overarching themes emerged: 'individual/clinical', 'systems/services' and 'human, behavioural and social' elements of safe mental health transitions. Whilst there was a great focus on clinical elements from researchers and healthcare professionals, service users and carers considered safety in terms of human, behavioural and social elements of transitional safety (ie loneliness, emotional readiness for discharge) and systems/services (ie inter-professional communication). DISCUSSION Safety in mental health-care transitions is perceived differently by service users and families compared to healthcare professionals and researchers. Traditional safety indicators for care transitions such as suicide, self-harm and risk of adverse drug events are raised as important. However, service users and families in particular have a much wider perception of transitions safety. CONCLUSION Future quality and safety research and policy should consider including a service user voice and consider integration of psychosocial elements in discharge interventions.
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Affiliation(s)
- Natasha Tyler
- Faculty of Biology, Medicine and HealthNIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC)University of ManchesterManchesterUK
| | - Nicola Wright
- School of Health SciencesUniversity of NottinghamNottinghamUK
| | - Maria Panagioti
- NIHR Greater Manchester Patients Safety Translational Research CentreUniversity of ManchesterManchesterUK
| | | | - Justin Waring
- Health Services Management CentreUniversity of BirminghamBirminghamUK
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Skevington SM, Rowland C, Panagioti M, Bower P, Krägeloh C. Enhancing the multi-dimensional assessment of quality of life: introducing the WHOQOL-Combi. Qual Life Res 2021; 30:891-903. [PMID: 33331967 PMCID: PMC7952286 DOI: 10.1007/s11136-020-02661-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION We revisited the global concept of subjective quality of life (QoL) as assessed by the WHOQOL-BREF to investigate whether it could be elaborated into a conceptually more comprehensive instrument with good psychometric properties. Responding to a growing need for shorter QoL measures with broader social, spiritual and environmental contents, facets from WHOQOL international modules were examined for potential integration into the new WHOQOL-Combi. METHOD Adults over 65 years, diagnosed with one or more chronic diseases (n = 2833), completed 41 WHOQOL items during the CLASSIC survey; each item represented a WHOQOL facet. This pool of specific QoL facets contained 24 from the WHOQOL-BREF (excluding general items), and 17 from recent international WHOQOL short-form modules, selected for their generic properties. Rasch modelling reduced the final item pool when assessing the WHOQOL-Combi's conceptual structure. Comparisons are made with the WHOQOL-BREF. RESULTS Modelling confirmed the tenability of a 36-item solution scored as a five-domain profile, comprised of 24 WHOQOL-BREF facets and 12 new facets from modules. Social and psychological domains were strengthened by three facets, spiritual QoL by five, and physical QoL by one. The WHOQOL-Combi showed sound model fit, excellent internal consistency (α = .95), and scores discriminated between socio-demographic categories. Concurrent validity with the EQ-5D-5L was confirmed for physical and psychological domains. Performance was similar to the WHOQOL-BREF. CONCLUSION The WHOQOL-Combi offers a contemporary, comprehensive, integrated, multi-dimensional subjective QoL instrument with enhanced evaluations of social, spiritual, psychological and physical QoL. Acceptable to older people, future research should evaluate younger age groups and other cultures.
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Affiliation(s)
- Suzanne M Skevington
- International Hub for Quality of Life Research, Manchester Centre for Health Psychology, Division of Psychological Science and Mental Health, University of Manchester, Manchester, M13 9PL, UK.
| | - Christine Rowland
- International Hub for Quality of Life Research, Manchester Centre for Health Psychology, Division of Psychological Science and Mental Health, University of Manchester, Manchester, M13 9PL, UK
| | - Maria Panagioti
- NIHR School for Primary Care Research, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL, UK
| | - Peter Bower
- NIHR School for Primary Care Research, Centre for Primary Care, Division of Population of Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Christian Krägeloh
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
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Tyler N, Giles S, Daker‐White G, McManus BC, Panagioti M. Cover image. Health Expect 2021. [DOI: 10.1111/hex.13204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Galleta-Williams H, Esmail A, Grigoroglou C, Zghebi SS, Zhou AY, Hodkinson A, Panagioti M. The importance of teamwork climate for preventing burnout in UK general practices. Eur J Public Health 2021; 30:iv36-iv38. [PMID: 32894291 PMCID: PMC7526765 DOI: 10.1093/eurpub/ckaa128] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
This short report aims to investigate the association between teamwork and burnout among general practitioners (GPs). A two-stage survey was conducted. In stage one, validated self-report measures of burnout and teamwork were completed by 50 GPs across 12 general practices in Greater Manchester, UK. In stage two, staff members across 3 of the 12 general practices (GPs, nursing staff, managers and admin staff) responded to free text questions about teamwork (n = 20). The results of the stage one survey showed that teamwork in GPs was significantly negatively associated with the emotional exhaustion (r = −0.326, P < 0.05) and depersonalization (r = −0.421, P < 0.01) domains of the burnout measure and significantly positively associated with the personal accomplishment (r = 0.296, P < 0.05) domain. Free text responses in stage two were assigned into three themes: (i) addressing organizational barriers which might threaten teamwork, (ii) promoting the view of teamwork as a shared responsibility among all staff members of the general practice and (iii) implementing improvement strategies which can be embedded in the busy environment of general practices. GPs and other staff members of general practices valued the importance of teamwork for boosting their morale and mitigating burnout. Future research should focus on designing and embedding brief teamwork improvement strategies in general practices.
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Affiliation(s)
- Henry Galleta-Williams
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Aneez Esmail
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Christos Grigoroglou
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Salwa S Zghebi
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Anli Yue Zhou
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Alexander Hodkinson
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Maria Panagioti
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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48
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Sattar R, Lawton R, Panagioti M, Johnson J. Meta-ethnography in healthcare research: a guide to using a meta-ethnographic approach for literature synthesis. BMC Health Serv Res 2021; 21:50. [PMID: 33419430 PMCID: PMC7796630 DOI: 10.1186/s12913-020-06049-w] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 12/26/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Qualitative synthesis approaches are increasingly used in healthcare research. One of the most commonly utilised approaches is meta-ethnography. This is a systematic approach which synthesises data from multiple studies to enable new insights into patients' and healthcare professionals' experiences and perspectives. Meta-ethnographies can provide important theoretical and conceptual contributions and generate evidence for healthcare practice and policy. However, there is currently a lack of clarity and guidance surrounding the data synthesis stages and process. METHOD This paper aimed to outline a step-by-step method for conducting a meta-ethnography with illustrative examples. RESULTS A practical step-by-step guide for conducting meta-ethnography based on the original seven steps as developed by Noblit & Hare (Meta-ethnography: Synthesizing qualitative studies.,1998) is presented. The stages include getting started, deciding what is relevant to the initial interest, reading the studies, determining how the studies are related, translating the studies into one another, synthesising the translations and expressing the synthesis. We have incorporated adaptations and developments from recent publications. Annotations based on a previous meta-ethnography are provided. These are particularly detailed for stages 4-6, as these are often described as being the most challenging to conduct, but with the most limited amount of guidance available. CONCLUSION Meta-ethnographic synthesis is an important and increasingly used tool in healthcare research, which can be used to inform policy and practice. The guide presented clarifies how the stages and processes involved in conducting a meta-synthesis can be operationalised.
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Affiliation(s)
- Raabia Sattar
- University of Leeds, Leeds, LS2 9JT UK
- Bradford Institute for Health Research, Bradford, BD9 6RJ UK
| | - Rebecca Lawton
- University of Leeds, Leeds, LS2 9JT UK
- Bradford Institute for Health Research, Bradford, BD9 6RJ UK
| | - Maria Panagioti
- National Institute of Health Research for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL UK
| | - Judith Johnson
- University of Leeds, Leeds, LS2 9JT UK
- Bradford Institute for Health Research, Bradford, BD9 6RJ UK
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Panagioti M, Angelakis I, Tarrier N, Gooding P. Correction to: A Prospective Investigation of the Impact of Distinct Posttraumatic (PTSD) Symptom Clusters on Suicidal Ideation. Cogn Ther Res 2021. [DOI: 10.1007/s10608-020-10199-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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50
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Tyler N, Planner C, Byrne M, Blakeman T, Keers RN, Wright O, Pascall Jones P, Giles S, Keyworth C, Hodkinson A, Taylor CDJ, Armitage CJ, Campbell S, Panagioti M. Developing Best Practice Guidance for Discharge Planning Using the RAND/UCLA Appropriateness Method. Front Psychiatry 2021; 12:789418. [PMID: 34925112 PMCID: PMC8680088 DOI: 10.3389/fpsyt.2021.789418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/09/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Discharge from acute mental health inpatient units is often a vulnerable period for patients. Multiple professionals and agencies are involved and processes and procedures are not standardized, often resulting in communication delays and co-ordination failures. Early and appropriate discharge planning and standardization of procedures could make inpatient care safer. Aim: To inform the development of a multi-component best practice guidance for discharge planning (including the 6 component SAFER patient flow bundle) to support safer patient transition from mental health hospitals to the community. Methods: Using the RAND/UCLA Appropriateness method, a panel of 10 professional stakeholders (psychiatrists, psychiatric nurses, clinical psychologists, pharmacists, academics, and policy makers) rated evidence-based statements. Six hundred and sixty-eight statements corresponding to 10 potential components of discharge planning best practice were rated on a 9-point integer scale for clarity, appropriateness and feasibility (median ≥ 7-9) using an online questionnaire then remote online face-to-face meetings. Results: Five of the six "SAFER" patient flow bundle components were appropriate and feasible for inpatient mental health. One component, "Early Flow," was rated inappropriate as mental health settings require more flexibility. Overall, 285 statements were rated as appropriate and feasible. Forty-four statements were considered appropriate but not feasible to implement. Discussion: This consensus study has identified components of a best practice guidance/intervention for discharge planning for UK mental health settings. Although some components describe processes that already happen in everyday clinical interactions (i.e., review by a senior clinician), standardizing such processes could have important safety benefits alongside a tailored and timely approach to post-discharge care.
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Affiliation(s)
- Natasha Tyler
- National Institute of Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,National Institute for Health Research, School for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Claire Planner
- National Institute of Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Matthew Byrne
- Division of Dentistry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Thomas Blakeman
- National Institute of Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Richard N Keers
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, United Kingdom.,Suicide, Risk and Safety Research Unit, Greater Manchester Mental Health National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Oliver Wright
- Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, United Kingdom
| | - Paul Pascall Jones
- Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, United Kingdom
| | - Sally Giles
- National Institute of Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Chris Keyworth
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Alexander Hodkinson
- National Institute for Health Research, School for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Christopher D J Taylor
- Secondary Care Psychological Therapies Service, Pennine Care National Health Service (NHS) Foundation Trust, Bury, United Kingdom.,Division of Psychology and Mental Health, Manchester Academic Health Science Centre, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Christopher J Armitage
- National Institute of Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom.,University National Health Service (NHS) Foundation Trust Manchester Academic Health Sciences Centre, Manchester, United Kingdom.,National Institute of Health Research (NIHR) Manchester Biomedical Research Council, Manchester, United Kingdom
| | - Stephen Campbell
- National Institute of Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,National Institute for Health Research, School for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Maria Panagioti
- National Institute of Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,National Institute for Health Research, School for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
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