ORCID Profile
0000-0002-8109-1930
Current Organisation
University of Aberdeen
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Publisher: JMIR Publications Inc.
Date: 11-04-2023
Abstract: synchronous outpatient patient-to-provider communication is becoming widespread in UK healthcare. It has mostly been tested in primary care but is increasingly used in secondary care outpatient services. During the pandemic, Aberdeen Royal Infirmary in Scotland expanded its outpatient asynchronous consultation system from dermatology to gastroenterology and pain management. e conducted a multi-method study between April 2021 to July 2022 including staff, patient, and public perspectives and quantitative data from the NHS to obtain a rounded picture of innovation as it happened. hree online and one face-to-face focus groups (n=22) on public readiness for the new service and 14 semi-structured interviews with staff on service design and delivery were conducted. The new service's effects were examined using NHS data on service usage, a patient satisfaction survey (n=66), and six follow-up semi-structured interviews. Satisfaction survey responses were analyzed descriptively. Service users’ demographics, acceptability across specialties, non-attendance rates, and appointment outcomes were compared. The Scottish Index of Multiple Deprivation was used to measure health inequality. In idual interviews and focus group transcripts were thematically analyzed. taff anticipated a simple technical system transfer from dermatology to other receptive specialties, but despite a favourable setting and organizational assistance, it has been complicated. It was thought to function better for pain self-management since it fitted pre-existing practices. Staff rapidly learned how to explain and utilize the system, and the gastrointestinal and pain management departments started offering digital appointments in December 2021. From February through July 2022, dermatology, gastrointestinal, and pain management offered 1709 appointments to a range of people (totalling n=1417). Asynchronous appointments reduced travel by an estimated 44,712 miles compared to face-to-face mode. People living in more and less deprived areas were equally likely to accept asynchronous consultations, treatment, or open returns, according to NHS data analysis. In the survey, only 18% of respondents were unhappy or very unhappy to be offered a digital appointment invitation. The benefits mentioned included better access, convenience, decreased travel and waiting time, information gathering/sharing, and clinical flexibility. Overall, patients, the public, and staff saw its potential as an NHS service but highlighted informed choice and flexibility, noting that it may not work for others, especially in iduals with limited digital or writing abilities. Better communication—including ‘appointment’ definitions—may increase patient acceptance. synchronous pain management and gastroenterology consultations are viable and acceptable. Transfer of this technology into new services is easiest when there is a limited disruption to existing administrative processes but regardless always needs significant and continuous support. This study can inform practical strategies for supporting staff in implementing asynchronous consultations (e.g., preparing for the process's non-linearity, working around task issues). For potential patients, careful technical support and explanation are needed, as well as a choice of consultation routes, to ensure digital inclusion.
Publisher: Springer Science and Business Media LLC
Date: 17-12-2019
DOI: 10.1007/S11136-019-02381-9
Abstract: For patients with end-stage knee osteoarthritis, joint replacement is a widely used and successful operation to help improve quality-of-life when non-operative measures have failed. For a significant proportion of patients there is a choice between a partial or total knee replacement. Decision aids can help people weigh up the need for and benefits of treatment against possible risks and side-effects. This study explored patients’ experiences of deciding to undergo knee replacement surgery to identify information priorities, to inform a knee replacement decision aid. Four focus groups were held with 31 patients who were candidates for both partial and total knee replacement surgery. Two focus groups included patients with no prior knee replacement surgery (pre-surgery) two with patients with one knee already replaced and who were candidates for a second surgery on their other knee (post-surgery). Data were analysed using Framework Analysis. Participants described a process of arriving at ‘readiness for surgery’ a turning point where the need for treatment outweighed their concerns. Referral and personal factors influenced their decision-making and expectations of surgery in the hope to return to a former self. Those with previous knee surgery offered insights into whether their expectations were met. ‘Information for decisions’ details the practicality and the optimal timing for the delivery of a knee replacement decision aid. In particular, participants would have valued hearing about the experiences of other patients and seeing detailed pictures of both surgical options. Information priorities were identified to include in a decision aid for knee replacement surgery. Patients’ experiences of surgical decision-making have much in common with the Necessity-Concerns Framework. Whilst originally developed to understand drug treatment decisions and adherence, it provides a useful lens to understand decision-making about surgery. The use of a decision aid could enhance decision-making on knee replacement surgery. Ultimately, patients’ understanding of the risks and benefits of both surgical options could be improved and in turn, help informed decision-making. The knee replacement decision aid is perceived as a useful tool to be associated with other detailed information resources as recommended.
Publisher: Elsevier BV
Date: 06-2023
Publisher: National Institute for Health and Care Research
Date: 08-2021
DOI: 10.3310/PGFAR09100
Abstract: Long-term monitoring is important in chronic condition management. Despite considerable costs of monitoring, there is no or poor evidence on how, what and when to monitor. The aim of this study was to improve understanding, methods, evidence base and practice of clinical monitoring in primary care, focusing on two areas: chronic kidney disease and chronic heart failure. The research questions were as follows: does the choice of test affect better care while being affordable to the NHS? Can the number of tests used to manage in iduals with early-stage kidney disease, and hence the costs, be reduced? Is it possible to monitor heart failure using a simple blood test? Can this be done using a rapid test in a general practitioner consultation? Would changes in the management of these conditions be acceptable to patients and carers? Various study designs were employed, including cohort, feasibility study, Clinical Practice Research Datalink analysis, seven systematic reviews, two qualitative studies, one cost-effectiveness analysis and one cost recommendation. This study was set in UK primary care. Data were collected from study participants and sourced from UK general practice and hospital electronic health records, and worldwide literature. The participants were NHS patients (Clinical Practice Research Datalink: 4.5 million patients), chronic kidney disease and chronic heart failure patients managed in primary care (including 750 participants in the cohort study) and primary care health professionals. The interventions were monitoring with blood and urine tests (for chronic kidney disease) and monitoring with blood tests and weight measurement (for chronic heart failure). The main outcomes were the frequency, accuracy, utility, acceptability, costs and cost-effectiveness of monitoring. Chronic kidney disease: serum creatinine testing has increased steadily since 1997, with most results being normal (83% in 2013). Increases in tests of creatinine and proteinuria correspond to their introduction as indicators in the Quality and Outcomes Framework. The Chronic Kidney Disease Epidemiology Collaboration equation had 2.7% greater accuracy (95% confidence interval 1.6% to 3.8%) than the Modification of Diet in Renal Disease equation for estimating glomerular filtration rate. Estimated annual transition rates to the next chronic kidney disease stage are ≈ 2% for people with normal urine albumin, 3–5% for people with microalbuminuria (3–30 mg/mmol) and 3–12% for people with macroalbuminuria ( 30 mg/mmol). Variability in estimated glomerular filtration rate-creatinine leads to misclassification of chronic kidney disease stage in 12–15% of tests in primary care. Glycaemic-control and lipid-modifying drugs are associated with a 6% (95% confidence interval 2% to 10%) and 4% (95% confidence interval 0% to 8%) improvement in renal function, respectively. Neither estimated glomerular filtration rate-creatinine nor estimated glomerular filtration rate-Cystatin C have utility in predicting rate of kidney function change. Patients viewed phrases such as ‘kidney damage’ or ‘kidney failure’ as frightening, and the term ‘chronic’ was misinterpreted as serious. Diagnosis of asymptomatic conditions (chronic kidney disease) was difficult to understand, and primary care professionals often did not use ‘chronic kidney disease’ when managing patients at early stages. General practitioners relied on Clinical Commissioning Group or Quality and Outcomes Framework alerts rather than National Institute for Health and Care Excellence guidance for information. Cost-effectiveness modelling did not demonstrate a tangible benefit of monitoring kidney function to guide preventative treatments, except for in iduals with an estimated glomerular filtration rate of 60–90 ml/minute/1.73 m 2 , aged 70 years and without cardiovascular disease, where monitoring every 3–4 years to guide cardiovascular prevention may be cost-effective. Chronic heart failure: natriuretic peptide-guided treatment could reduce all-cause mortality by 13% and heart failure admission by 20%. Implementing natriuretic peptide-guided treatment is likely to require predefined protocols, stringent natriuretic peptide targets, relative targets and being located in a specialist heart failure setting. Remote monitoring can reduce all-cause mortality and heart failure hospitalisation, and could improve quality of life. Diagnostic accuracy of point-of-care N-terminal prohormone of B-type natriuretic peptide (sensitivity, 0.99 specificity, 0.60) was better than point-of-care B-type natriuretic peptide (sensitivity, 0.95 specificity, 0.57). Within-person variation estimates for B-type natriuretic peptide and weight were as follows: coefficient of variation, 46% and coefficient of variation, 1.2%, respectively. Point-of-care N-terminal prohormone of B-type natriuretic peptide within-person variability over 12 months was 881 pg/ml (95% confidence interval 380 to 1382 pg/ml), whereas between-person variability was 1972 pg/ml (95% confidence interval 1525 to 2791 pg/ml). For in iduals, monitoring provided reassurance future changes, such as increased testing, would be acceptable. Point-of-care testing in general practice surgeries was perceived positively, reducing waiting time and anxiety. Community heart failure nurses had greater knowledge of National Institute for Health and Care Excellence guidance than general practitioners and practice nurses. Health-care professionals believed that the cost of natriuretic peptide tests in routine monitoring would outweigh potential benefits. The review of cost-effectiveness studies suggests that natriuretic peptide-guided treatment is cost-effective in specialist settings, but with no evidence for its value in primary care settings. No randomised controlled trial evidence was generated. The pathways to the benefit of monitoring chronic kidney disease were unclear. It is difficult to ascribe quantifiable benefits to monitoring chronic kidney disease, because monitoring is unlikely to change treatment, especially in chronic kidney disease stages G3 and G4. New approaches to monitoring chronic heart failure, such as point-of-care natriuretic peptide tests in general practice, show promise if high within-test variability can be overcome. The following future work is recommended: improve general practitioner–patient communication of early-stage renal function decline, and identify strategies to reduce the variability of natriuretic peptide. This study is registered as PROSPERO CRD42015017501, CRD42019134922 and CRD42016046902. This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research Vol. 9, No. 10. See the NIHR Journals Library website for further project information.
Publisher: Informa UK Limited
Date: 04-04-2018
DOI: 10.1080/02770903.2018.1452034
Abstract: Our aim was to conduct a systematic review and synthesis of qualitative evidence exploring the lived experience of adults with severe asthma. We searched MEDLINE via OvidSP, PsycINFO via OvidSP, PubMed, CINAHL, EMBASE, Sociological Abstracts, Google Scholar, the journals Qualitative Health Research and Qualitative Research, and a study of experiences of living with asthma by the Health Experiences Research group. Studies were included if they used qualitative methods and explored the subjective experiences of adults (≥18 years) with a clear diagnosis of severe asthma. From 575 identified studies, five met the inclusion criteria. Synthesis revealed an overarching theme of efforts that people living with severe asthma engage in to achieve personal control over their condition. In iduals 'strive for autonomy' through dealing with symptoms and treatment, acquiring knowledge, making decisions and reclaiming identity. This systematic review found a paucity of qualitative studies reporting on people's perspectives of living with severe asthma, and a focus on clinical rather than personal issues. Our synthesis reveals that severe asthma was disempowering, and a threat to identity and life roles. What was important to people living with severe asthma was striving to achieve a greater level of personal control over their condition, but these efforts received little support from their healthcare providers. Thus, more attention should be paid to understanding the self-management strategies and personal goals of people living with severe asthma. This may assist in designing interventions to better support patient self-management and improve health outcomes.
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Louise Locock.