NIHR CLAHRC Community e-newsletter: Healthcare transitions - a complex journey -
CLAHRC East Midlands
Researchers from NIHR CLAHRC East Midlands are evaluating a diabetes integrated care pathway covering Leicester, Leicestershire and Rutland. An evaluation of this new integrated care pathway is being carried out for the CLAHRC by a team based at the Leicester Diabetes Centre. The results are due to be published soon.
Health anxiety can lead to increased visits to accident and emergency departments, walk in centres or urgent same day appointments at the GP surgery with little patient benefit. Despite some availability of effective treatment for health anxiety, few people take it up. In response, the Urgent Care Study is helping people who often use unscheduled care to manage the distress caused by worries about their health. In particular, to find out whether Cognitive Behavioural Therapy (CBT), a type of talking therapy, delivered remotely (via video calling or over the telephone), will improve physical and emotional health and reduce health care service use.For more information about the study, click here. To view short view interviews, click here.
Adding a computerised test of attention and activity (QbTest) to standard care can reduce the time needed to make a diagnostic decision on ADHD, a study funded by NIHR CLAHRC East Midlands has demonstrated. It also can increase the likelihood of excluding ADHD when it is not present and improve clinicians’ confidence in their decision-making, without compromising diagnostic accuracy, the clinical trial published in the Journal of Child Psychology and Psychiatry showed.
CLAHRC East of England
Transitions Preparation Project - Impact in a local NHS Trust
While UK legislation and policy recommends a flexible cut-off age for leaving Child and Adolescent Mental Health Services (CAMHS), young people are transferred to adult services at age 18 at the latest. The CAMHS Transition Preparation Project brought together young people service users, as well as NHS practitioners and researchers, to explore what CAMHS transition preparation might involve and to co-devise a practical Transition Preparation Programme (TPP).
The young people’s primary recommendations to improve preparation for transition were: dedicated transition peer support workers, a personalised transition workbook, and a virtual ‘podwalk’ tour of mental health clinics. The 12-month project officially concluded in March 2016, but work has continued to embed in Cambridgeshire and Peterborough NHS Foundation Trust (CPFT).
- Three peer support workers and three Band 6 transition workers have been employed to support the transition of young people into adult services,
- Young people have filmed and published a virtual tour of Adult Mental Health Serviceshttps://www.youtube.com/embed/FFOTSN29hfU
- A transitions booklet has been developed and published,
- Interface meetings between CAMHS and adult teams have been introduced to discuss individuals’ transitions.
- The transitions booklet has been part of the transitions CQUIN in both CPFT and NHS England
Contact: Valerie Dunn; Valerie.email@example.com
CLAHRC Greater Manchester
Supporting carers to enhance patient discharge during end-of-life care
Evidence shows that family carers are the main factor in enabling death at home and the odds of discharging patients from hospital to die at home are reduced five-fold if carers are reluctant to support discharge. However, such reluctance may often stem from a lack of preparation and information. In collaboration with Marie Curie, this study looked at the barriers to supporting carers.
The findings revealed an absence of formal procedures for identifying carers’ support needs within current hospital practice. Carers were involved in discussions around discharge but in relation to patients’ needs which overwhelmingly emphasised practical issues, such as equipment requirements, with little consideration of emotional needs. For the full findings please see our recent paper in Palliative Medicine and for further information please contact Michael Spence.
Some patient groups are at a greater risk of developing Acute Kidney Injury (AKI) and at CLAHRC Greater Manchester we have been working with a number of partners to target the most vulnerable groups. This includes improving education for clinicians through the development of a new RCGP Toolkit due to be launched in June 2018 and enhancing management of post-AKI patients once discharged back into primary care, through the Bury Post-AKI project.
In addition to supporting implementation of these interventions, our Kidney Health programme team has also been analysing in-depth qualitative, quantitative data to better understand the processes of implementation, and attempt to capture any potential improvements in patient care and cost-benefits. For further information please contact Rebecca Spencer.
CLAHRC North Thames
Costs to the National Health Service (NHS) in England associated with delayed discharge are approximately £100m per year.
CLAHRC North Thames researchers looked beyond the undoubted financial burden this places on a hard-pressed NHS and other services, taking a 360° view of the current evidence around impact of delayed transition between providers of care.
The results, published in Health Expectations, and also a CLAHRC BITE– saw researchers investigate the repercussions for subsequent services of extra bed days for patients who cannot transition to other care. These patients are predominantly elderly and delays often occur because community and social care services are not available to support patients at home or in a care home.
Researchers also highlighted the real implications for inpatients' health and safety - increased risk of mortality, hospital-acquired infections and mental ill health. Other adverse outcomes were increased the stress levels of staff involved in the process. Delayed transition also creates diversion from staff’s primary focus on patient care and can lead to deleterious interprofessional relationships.
Contact Dr Antonio Rojas-Garcia
CLAHRC North West Coast
Transitional Care for Young Adults with Long Term Conditions
The aim of the project is to develop and implement an evidence-based intervention which improves the quality of transitional care, associated health outcomes, and reduces health inequalities for young people with complex needs across the North West coast footprint.
The initial focus has been on developing a core outcome set for evaluating transition to adult care using juvenile idiopathic arthritis (JIA) and epilepsy as exemplar conditions, whilst undertaking preliminary work on the identification of intervention(s) to be evaluated.
The research has been hosted at Alder Hey Children’s Hospital in Liverpool and involved cross hospital working with Preston Hospital and the Walton Centre.
A theoretical framework to unite the six Cs of transition model with core outcomes and Alder Hey’s 10 Steps programme has been developed.
CLAHRC North West London
‘This Sickle Cell Life’ examines young people’s experiences of living with sickle cell, and explores how young people with sickle cell move from using child to adult services. We take a sociological approach to look beyond clinical settings to think about how education, social relationships and families are all affected by transitions to adulthood.
Our analysis of interviews with young people highlights their struggles to exercise their patient expertise in healthcare settings. This ranges from negotiating their care in hospital to how they interact with others in their social context, for example with peers and teachers at school.
We are working in partnership with NIHR CLAHRC NWL to get this work into practice, and will disseminate our findings via our website and Twitter account. Read more about this project on the CLAHRC NWL blog.
The research team acknowledges the support of the National Institute for Health Research Clinical Research Network (NIHR CRN)
Attention deficit hyperactivity disorder (ADHD) is a common condition which is widely associated with children and adolescents, but can also continue into adulthood. Little is known about how many services offer specialist care for adults with ADHD, or how many young people need to access them when they are too old for children’s services. CATCh-uS aims to establish how many young adults are in need of services, and to investigate patient, carer, and practitioner views about the transition process. It will also map currently available adult ADHD services around the country. Read more on the project page.
Our Care for Offenders: Continuity Of Access (COCOA) project found that between 50% to 90% of the prison population experience mental health problems. For those leaving prison, this can directly impact quality of life after release, and can lead to self-harm and re-offending. A distrust of medical professionals, and other authority figures, was found to prevent prisoners from seeking help when experiencing problems.
These findings led to the development of the Engager project. Working with prisoners, Engager aims to develop a care package to support offenders transitioning from pre-release healthcare to post-release healthcare. Those receiving the care package have been overwhelmingly positive, and 28 of the 40 participants who have been released have remained involved with the programme. Visit the project page for more info.
The majority of older people in hospital have frailty and are at risk of early readmission or death after being discharged. Contact with a transitional care service is recommended to enhance recovery after hospitalisation for an acute illness or injury, however the benefits of rehabilitation in such care can reduce over time. The HERO project aims to investigate whether an extended, home-based rehabilitation programme developed for older people with frailty can improve health-related quality of life post hospital discharge, thereby reducing the probability of readmission. Read more on the project page.
Treatment in a pain management or self-management programme can help people learn how to improve mobility, reduce reliance on drugs, and gain a sense of control over their pain. It can help them to re-establish their roles in family and social life. But the positive impact of these programmes isn’t always sustainable after the programme has ended.
North Bristol NHS Trust have a patient-led peer support network to help patients self-manage chronic pain. Patients develop a new group together, with support from a patient tutor, after completing a clinician-led pain management or self-management programme.
Peer support groups have huge potential to help patients at low cost, by enhancing the clinical treatment they already receive and preventing relapse.
This initial evaluation of experiences and perceived effectiveness of peer support groups will give an understanding of how these networks work. It will shed light on the potential impact of these groups on developing patients’ resilience and on sustaining or improving their outcomes from pain management and self-management programmes.
CLAHRC West Midlands
Over the past 30 months, research assistants from eight European countries have been recruiting and following up over 1000 young people who have reached the transition boundary (TB) of their child and adolescent mental health service (CAMHS).
Prof Swaran Singh from Mental Health and Wellbeing at Warwick Medical School is leading on this EU-funded study called MILESTONE, which focuses specifically on transition and covers the UK, Ireland, Belgium, the Netherlands, France, Germany, Italy and Croatia.
The idea is that the young person, parent/carer and clinician all complete versions of the TRAM (Transition Readiness and Appropriateness Measure), with findings presented to the clinician in a summary format, with graphs and tables. These highlight differences in the responses, and can act as a basis for discussion on transition options. Barriers to care are highlighted, and addressing these will help ensure that the end of care at CAMHS and potential transition to AMHS are smooth processes.
From the outset, MILESTONE study has benefitted from substantial involvement of young project advisors, all with mental health service and transition experience. They have been helping the research team with various tasks and activities, also with the exciting public dissemination plans. If all goes well, they will be performing a TEDx talk later this year on the topic of mental health transitions.
CLAHRC Yorkshire & Humber
Improving patient flow is a laudable way to manage the chronic shortage of beds in hospitals. It does however constrain hospital staff into a system that focuses on getting people medically fit for discharge and out. For older people in particular, the focus on discharge, rather than transition to home, has problematic consequences. As part of PACT we have extensive interview and observational data on the experiences of both older people transitioning from hospital to home and professionals delivering care and support. We aim to use this data we have gathered to develop an intervention that will support older patients and their caregivers to be more involved in their care and to be more resilient when they leave hospital.
This project is linked to the NIHR CLAHRC YH Evidence-based Transformation within the NHS Theme. For more information about PACT contact firstname.lastname@example.org or email@example.com or follow us on twitter @PACT_YQSR
The NIHR CLAHRC Avoiding Attendances and Admissions in Long Term Conditions Theme has linked routine patient data across different urgent and emergency care (UEC) settings. This includes data from ambulance providers and acute hospital trusts. This linked data has identified patient groups, such as those with mental health problems, who may benefit from alternative care outside hospital. Emergency and urgent care services provide important care for people experiencing an acute mental health crisis and continue to be focus of national UK policy. (Click on the headline to read the full story)