The number of large-scale general practice provider collaborations is growing in England. Expectations of what they will achieve are significant. Trade-offs exist between mandated/voluntary collaborations; networks/single organisations; and different governance structures. Better Improved clinica outcomes and cost savings do not automatically result from 'scaling-up'. Policy-makers should move in this direction with caution, informed by ongoing evaluation.
A number of evaluations of models of integrated care have not produced the expected result of reduced hospital admissions, and in some cases have even found people receiving integrated care services using hospitals more than matched controls. We tested three hypotheses for these surprising results with a group of 50 integrated care experts in a seminar: (1) problems with the model; (2) problems of implementation; and (3) problems of evaluation. Our group of experts did not rule out any of these hypotheses and came up with some advice as to manage these issues. For example, model designers should rigorously test the underlying logic; commissioners should seek out advice from experts and patients/professionals; and evaluators should choose outcomes wisely, use mixed methods approaches, and provide regular feedback loops to implementation sites. Evaluating integrated care is a skilled task that requires multiple approaches in terms of the design and implementation of the models. National research funders or other appropriate bodies might consider developing an advisory service to provide support to local systems planning evaluations.
remarks and reflections are based on data collected as part of the 'Talking with Children Study'. The primary aim of this study was to gain an in-depth understanding of what children newly diagnosed with cancer knew about their disease and treatment, how they came to know, and what they wanted to know, as a first step in developing guidance for professionals for talking with children in the early phases of cancer treatment. Methods Design An ethnographic approach, comprising participant observation and informal interviews alongside participatory methods, was used by a researcher embedded in a clinical team. This researcher (Gemma Bryan) had extensive previous experience of working with children, had no prior affiliation with either the inpatient or outpatient units, and was not known to patients or their families prior to the study commencing. When meeting children eligible for recruitment into the study, the researcher was careful to tell children that she was not a nurse or a doctor and that she was a researcher who wanted to know 'what they think about and talk about'. During data collection the researcher was mindful to distinguish herself from other hospital staff in her attire by dressing in casual clothes. Setting This study took place within the hematology and oncology service of a large tertiary children's hospital in England. Participants, consent and assent A purposive sample was selected to include children, boys and girls, across the range of childhood cancer diagnoses, and aged four to 12 years old. Children were excluded if they
Good-quality evidence of the impacts of scaling up general practice provider organisations in England is scarce. As more general practice collaborations emerge, evaluation of their impacts will be important to understand which work, in which settings, how, and why.
The Covid-19 pandemic has dramatically impacted primary health care (PHC) across Europe. Since March 2020, the Covid-19 Health System Response Monitor (HSRM) has documented country-level responses using a structured template distributed to country experts. We extracted all PHC-relevant data from the HSRM and iteratively developed an analysis framework examining the models of PHC delivery employed by PHC providers in response to the pandemic, as well as the government enablers supporting these models. Despite the heterogenous PHC structures and capacities across European countries, we identified three prevalent models of PHC delivery employed: (1) multi-disciplinary primary care teams coordinating with public health to deliver the emergency response and essential services; (2) PHC providers defining and identifying vulnerable populations for medical and social outreach; and (3) PHC providers employing digital solutions for remote triage, consultation, monitoring and prescriptions to avoid unnecessary contact. These were supported by government enablers such as increasing workforce numbers, managing demand through public-facing risk communications, and prioritising pandemic response efforts linked to vulnerable populations and digital solutions. We discuss the importance of PHC systems maintaining and building on these models of PHC delivery to strengthen preparedness for future outbreaks and better respond to the contemporary health challenges.
Considered in the context of middle range transition theory, we might suggest that parental foreground (seeking information directly) and background (passive actors) roles are the result of differing levels of uncertainty, and depend on the situation and preferences and child and family needs that may present differently over time in different contexts. Our work contributes to the emerging consensus that communication is more than a core set of skills that healthcare professionals just need to learn: clear specifications of mutual roles, responsibilities and a shared understanding of goals is also essential.
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