BackgroundNo clear synthesis of evidence examining household and area-level social determinants of multimorbidity exists. This study aimed to systematically review the existing literature on associations between household and area-level social determinants of health (SDoH) and multimorbidity prevalence or incidence in the general population.MethodsSix databases (MedLine, EMBASE, PsychINFO, Web of Science, CINAHL Plus and Scopus) were searched. The search was limited to peer-reviewed studies conducted in high-income countries and published in English between 2010 and 2019. A second reviewer screened all titles with abstracts and a subset of full texts. Study quality was assessed and protocol pre-registered (CRD42019135281).Results41 studies spanning North America, Europe and Australasia were included. Household income and area-level deprivation were the most explored with fairly consistent findings. The odds of multimorbidity were up to 4.4 times higher for participants with the lowest level of income compared with the highest level. Those living in the most deprived areas had the highest prevalence or incidence of multimorbidity (pooled OR 1.42, 95% CI 1.41 to 1.42). Associations between deprivation and multimorbidity differed by age and multimorbidity type. Findings from the few studies investigating household tenure, household composition and area-level rurality were mixed and contradictory; homeownership and rurality were associated with increased and decreased multimorbidity, while living alone was found to be associated with a higher risk of multimorbidity and not associated.ConclusionImproving our understanding of broader social determinants of multimorbidity—particularly at the household level—could help inform strategies to tackle multimorbidity.

BackgroundProviding high quality acute hospital care for patients with dementia is an increasing challenge as the prevalence of the disease rises. Informal carers of people with dementia are a critical resource for improving inpatient care, due to their insights into patients’ needs and preferences. We summarise informal carers’ perspectives of acute hospital care to inform best practice service delivery.MethodsWe conducted a systematic search of bibliographic databases and sought relevant grey literature. We used thematic synthesis analysis to assimilate results of the studies and describe components of care that influence perceived quality.ResultsTwenty papers met the inclusion criteria. Findings identified four overarching components of care that influenced carer experience and their perceptions of care quality: ‘Patient care’, ‘Staff interactions’, ‘Carer’s situation’ and ‘Hospital environment’. Need for improvement was identified in staff training, provision of help with personal care needs, and dignified treatment of patients. Carers need to be informed, involved and supported during hospital admission in order to promote the most positive experience.ConclusionThis review identifies common perspectives of informal carers of people with dementia in the acute hospital setting and highlights important areas to address to improve the experience of an admission for both carer and patient.

ObjectiveThis study investigated the barriers and facilitators that senior leaders’ experience when using knowledge generated from the analysis of administrative health or care records (‘analytics’) to inform strategic health and care decision-making.SettingOne London-based sustainability and transformation partnership (STP) in England, as it was on the cusp of forming an integrated care system (ICS).Participants20 senior leaders, including health and social care commissioners, public health leads and health providers. Participants were eligible for inclusion if they were a senior leader of a constituent organisation of the STP and involved in using analytics to make decisions for their own organisations or health and care systems.DesignSemi-structured interviews conducted between January 2020 and March 2020 and analysed using the framework method to generate common themes.ResultsOrganisational fragmentation hindered use of analytics by creating siloed data systems, barriers to data sharing and different organisational priorities. Where trusted and collaborative relationships existed between leaders and analysts, organisational barriers were circumvented and access to and support for analytics facilitated. Trusted and collaborative relationships between individual leaders of different organisations also aided cross-organisational priority setting, which was a key facilitator of strategic health and care decision-making and use of analytics. Data linked across health and care settings were viewed as an enabler of use of analytics for decision-making, while concerns around data quality often stopped analytics use as a part of decision-making, with participants relying more so on expert opinion or intuition.ConclusionsThe UK Governments’ 2021 White Paper set out aspirations for data to transform care. While necessary, policy changes to facilitate data sharing across organisations will be insufficient to realise this aim. Better integration of organisations with aligned priorities could support and sustain cross-organisational relationships between leaders and analysts, and leaders of different organisations, to facilitate use of analytics in decision-making.

Background: Health-justice partnerships (HJPs) are collaborations between healthcare and legal services which support patients with social welfare issues such as welfare benefits, debt, housing, education and employment. HJPs exist across the world in a variety of forms and with diverse objectives. This review synthesizes the international evidence on the impacts of HJPs.Methods: A systematic scoping review of international literature was undertaken. A wide-ranging search was conducted across academic databases and grey literature sources, covering OECD countries from January 1995 to December 2018. Data from included publications were extracted and research quality was assessed. A narrative synthesis approach was used to analyze and present the results.Results: Reported objectives of HJPs related to: prevention of health and legal problems; access to legal assistance; health improvement; resolution of legal problems; improvement of patient care; support for healthcare services; addressing inequalities; and catalyzing systemic change. There is strong evidence that HJPs: improve access to legal assistance for people at risk of social and health disadvantage; positively influence material and social circumstances through resolution of legal problems; and improve mental wellbeing. A wide range of other positive impacts were identified for individuals, services and communities; the strength of evidence for each is summarized and discussed.Conclusion: HJPs are effective in tackling social welfare issues that affect the health of disadvantaged groups in society and can therefore form a key part of public health strategies to address inequalities.

respondents took an Implicit Association Test, a validated tool measuring attitudes and beliefs that people are not conscious of. They also completed the Hudelson scale assessing the relative responsibility to adapt to migrants. These quantitative results were then discussed as a group with the respondents. Results The results suggested that more than 80% (95% CI: 0.71-0.85) of GPs in training have implicit preferences for their ingroup to the detriment of the exogroup of migrants. Also, 60% (95% IC: 0.52-0.67) of respondents placed the responsibility to adapt on migrant patients when their values and habits differ from those of the host country.Qualitative data indicate trainees were not aware of these biases. Conclusion This study shows that GPs trainees have implicit and explicit bias detrimental to ethnic minority groups, of which they are not aware of.