Introduction
Over half of post-COVID-hospitalisation adults have persistent symptoms 2 years after discharge, providing a challenge for individuals and healthcare systems. We therefore aimed to ...describe a typology of UK healthcare pathways post-hospital discharge as a first step towards understanding clinical effectiveness and cost-effectiveness of different healthcare pathways.
Methods
In 2021, we surveyed hospital sites taking part in the UK Post-hospital COVID-19 (PHOSP-COVID) study. The online survey explored the availability of proactive follow-up, patient selection, involvement of multidisciplinary teams, investigations, assessment and access to mental health and rehabilitation interventions. The typology was defined by a three-stage process: 1) using the survey results to develop a bespoke algorithm to inform a draft classification, 2) a stakeholder event for refinement and 3) finalisation between the Project Advisory Group and research team. The bespoke algorithm was used to map each site onto the classification with further mapping by level of mental health and rehabilitation provision.
Results
70% of hospital sites (45 out of 64) responded to the survey. 82% (37 out of 45) reported delivering a follow-up service after hospital discharge during the first few months of the pandemic. Only 13 out of 37 services (35%) were delivered by permanent staff. The final typology of five categories included no proactive follow-up, and a matrix of four groups based on patient selection (prespecified subgroup/all patients) and complexity of assessment (low/high). The complexity of assessment, rehabilitation and mental health interventions was variable within sites.
Discussion
We describe the first typology of post-hospitalisation COVID-19 healthcare pathways to enable modelling of clinical effectiveness and cost-effectiveness to inform future policy. Our results highlight the heterogeneity and vulnerability of healthcare services after COVID-19 hospitalisation.
Insomnia has a bidirectional relationship with broader mental health functioning, including anxiety and depression. Yet, poor sleep has historically been neglected as a specific treatment target in ...mental health programmes (Freeman, Sheaves, Waite, Harvey, & Harrison, 2020).
All patients over a 12-month period entering the Improving Access to Psychological Therapies (IAPT) service endorsing a ‘poor sleep’ questionnaire item at assessment, were offered a self-guided digital sleep intervention, Sleepio, in addition to routine care. Sleepio is based on the principles of Cognitive Behavioural Therapy for Insomnia (CBT-I). Propensity score matching established a non-Sleepio control group matched on demographic and baseline clinical measures.
Patients who signed up to Sleepio (n = 510) achieved significantly better outcomes on core clinical metrics (PHQ-9, GAD-7, WSAS) than controls. IAPT recovery rates11IAPT recovery rate is percentage of those above clinical cutoff on either PHQ-9 or GAD-7 at baseline who no longer meet this criterion at discharge. (on PHQ-9 and GAD-7) were 64.7%, versus 58% in the control group. Duration of clinical contact time was marginally elevated overall in the Sleepio group but by less than 1 h
Significant clinical benefit was associated with the introduction of an evidence-based digital sleep intervention alongside other mental health interventions for depression and anxiety. Widespread deployment was achieved with immediate availability, minimal additional clinical time or staff training. This approach provides a feasible and highly scalable model for improving mental health outcomes in clinical services.
•Sleep problems are frequently neglected in mental health care settings, despite best practice guidelines.•Adjunctive digital CBT for insomnia was offered at scale in a real-world clinic treating depression and anxiety.•We found significant uplift in recovery metrics for depression and anxiety, with only marginally extra clinical time.•This demonstrates a feasible and effective protocol for improving outcomes in mental health care settings.
Online peer support platforms have been shown to provide a supportive space that can enhance social connectedness and personal empowerment. Some studies have analysed forum messages, showing that ...users describe a range of advantages, and some disadvantages to their use. However, the direct examination of users’ experiences of such platforms is rare and may be particularly informative for enhancing their helpfulness. This study aimed to understand users’ experiences of the Support, Hope and Recovery Online Network (SHaRON), an online cognitive behavioural therapy-based peer support platform for adults with mild to moderate anxiety or depression. Platform users (n = 88) completed a survey on their use of different platform features, feelings about using the platform, and overall experience. Responses were analysed descriptively and using thematic analysis. Results indicated that most features were generally well used, with the exception of private messaging. Many participants described feeling well supported and finding the information and resources helpful; the majority of recent users (81%) rated it as helpful overall. However, some participants described feeling uncomfortable about posting messages, and others did not find the platform helpful and gave suggestions for improvements. Around half had not used the platform in the past 3 months, for different reasons including feeling better or forgetting about it. Some described that simply knowing it was there was helpful, even without regular use. The findings highlight what is arguably a broader range of user experiences than observed in previous studies, which may have important implications for the enhancement of SHaRON and other platforms.
Purpose - Depression and anxiety are common features of all forms of multiple sclerosis (MS) and have a significant impact on an individual's quality of life, everyday functioning and rehabilitation ...outcome. They are potentially treatable causes of disability in this population. This study aimed to investigate the use of the Hospital Anxiety and Depression Scales (HADS) as a useful tool for measuring anxiety and depression in people with MS who live in the community and to provide normative data for clinicians and researchers.Design methodology approach - In total, 144 individuals with MS completed the HADS as part of a larger community postal survey.Findings - Individuals with MS report significantly greater levels of anxiety and depression than a healthy population. The HADS had good levels of internal reliability in this sample. Raw scores and percentile equivalents for use with MS patients are reported.Originality value - This study provides useful normative data on the HADS in a community sample of people with MS, which has been unavailable to date. The findings support previous studies, indicating high prevalence rates of anxiety and depression in this patient population, highlighting a need for interventions aimed at addressing the psychological distress associated with MS.
Introduction:
Chronic pain is one of the most prevalent causes of disability worldwide, and digital interventions may be one of the ways to meet this need. Randomised controlled trials have ...demonstrated that digital interventions can be effective in treating chronic pain. This study aimed to establish the clinical effectiveness of a web-based pain management programme (PMP), specifically whether it would lead to improved clinical outcomes and reduced health care costs in a real-world clinical setting.
Methods:
Of 738 participants, 438 engaged with the programme and 300 did not. Two analyses were conducted: a within-subjects pre–post comparison of clinical outcomes for participants who completed the programme and a between-groups comparison of health care usage for those who engaged and those who did not.
Results:
Participants who completed the programme made significant improvements with regard to their perceived health status, level of disability, mood, confidence managing pain, problems in life due to pain and level of pain. Around one-third of participants made reliable changes in their levels of disability, depression and anxiety. There was no relationship between gender or age and engagement with the programme. Those who engaged with the programme demonstrated reduced health care costs in the year following referral, whereas health care costs of non-engagers increased. Limitations of the study include a high drop-out rate and a non-randomised comparison group. Results must therefore be interpreted with some caution.
Conclusion:
A web-based pain management programme can be clinically effective and may be a useful addition to the treatments offered by pain management services.
The development of a self-report measuredesigned to assess illness-specific catastrophicthoughts in chronic obstructive pulmonary disease (COPD)is described. The measure is then used to ...testhypotheses about the relationship between catastrophicthoughts and anxiety in COPD. Preliminary findingssuggest that the measure, the Interpretation ofBreathing Problems Questionnaire (IBPQ), has goodpsychometric properties. Tests of specific hypothesesindicated that more severe catastrophic thoughts wereassociated with higher levels of anxiety. Catastrophicthoughts and anxiety were also more severe in unsafe than in safe situations. Severity ofcatastrophic thoughts was a significant predictor ofanxiety, particularly of situation specific (IBPQ)anxiety. Satisfaction with social support, but not age,duration, or severity of illness, was also important,particularly in safe situations. Implications for acognitive model of anxiety in COPD, and for treatment ofanxiety in this disorder, are briefly discussed. Limitations of the study are noted. Suggestionsare made for further research.
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