Abstract
Background
IMPlementing IMProved Asthma self-management as RouTine (IMP
2
ART) is a programme of work developing and evaluating a strategy for implementing supported asthma self-management ...in UK primary care. The strategy encompasses patient-facing resources, professional education, and organisational approaches to embed supported self-management. This paper reports the development of a theoretically informed interprofessional education programme which aims to raise awareness of and enable healthcare professionals to deliver effective supported self-management.
Methods
Aligned with the Medical Research Council (MRC) Complex Intervention Framework, the multidisciplinary team developed educational content in three phases: (1) developmental phase, identifying educational and behaviour change theory to guide development, in consultation with a professional advisory group; (2) feasibility pilot phase, testing the education using a ‘think-aloud’ method; and (3) pre-pilot phase, delivering the education within the IMP
2
ART strategy.
Results
The developmental phase identified educational and behaviour change theory and the need to provide two education modules: (1) a team module to raise awareness of supported asthma self-management for the whole team and (2) an individual study module for those who conduct asthma reviews with patients. The feasibility pilot highlighted content and design features in need of refinement and the pre-pilot identified substantial changes to the delivery strategy for the education modules.
Conclusions
A multi-stage development process, aligned with the MRC Framework, contributed to the module design and delivery. Prior explorative work, multi-disciplinary team discussions, and professional advisory group consultation, informed the initial development, and in-practice testing and pre-pilot stages enabled refinement. In our experience, there were important benefits of working together as an educationalist/researcher team. The education programme, a core component of the implementation strategy, is now being tested in the IMP
2
ART UK-wide cluster randomised controlled trial.
Asthma is a common long-term condition and major public health problem. Supported self-management for asthma that includes a written personalised asthma action plan, supported by regular professional ...review, reduces unscheduled consultations and improves asthma outcomes and quality of life. However, despite unequivocal inter/national guideline recommendations, supported self-management is poorly implemented in practice. The IMPlementing IMProved Asthma self-management as RouTine (IMP
ART) implementation strategy has been developed to address this challenge. The aim of this implementation trial is to determine whether facilitated delivery of the IMP
ART strategy increases the provision of asthma action plans and reduces unscheduled care in the context of routine UK primary care.
IMP
ART is a parallel group, cluster randomised controlled hybrid II implementation trial. One hundred forty-four general practices will be randomly assigned to either the IMP
ART implementation strategy or control group. Following a facilitation workshop, implementation group practices will receive organisational resources to help them prioritise supported self-management (including audit and feedback; an IMP
ART asthma review template), training for professionals and resources to support patients to self-manage their asthma. The control group will continue with usual asthma care. The primary clinical outcome is the between-group difference in unscheduled care in the second year after randomisation (i.e. between 12 and 24 months post-randomisation) assessed from routine data. Additionally, a primary implementation outcome of asthma action plan ownership at 12 months will be assessed by questionnaire to a random sub-group of people with asthma. Secondary outcomes include the number of asthma reviews conducted, prescribing outcomes (reliever medication and oral steroids), asthma symptom control, patients' confidence in self-management and professional support and resource use. A health economic analysis will assess cost-effectiveness, and a mixed methods process evaluation will explore implementation, fidelity and adaptation.
The evidence for supported asthma self-management is overwhelming. This study will add to the literature regarding strategies that can effectively implement supported self-management in primary care to reduce unscheduled consultations and improve asthma outcomes and quality of life.
ISRCTN15448074. Registered on 2 December 2019.
IMPlementing IMProved Asthma self-management as RouTine (IMP
ART) is a programme of work developing and evaluating a strategy for implementing supported asthma self-management in UK primary care. The ...strategy encompasses patient-facing resources, professional education, and organisational approaches to embed supported self-management. This paper reports the development of a theoretically informed interprofessional education programme which aims to raise awareness of and enable healthcare professionals to deliver effective supported self-management.
Aligned with the Medical Research Council (MRC) Complex Intervention Framework, the multidisciplinary team developed educational content in three phases: (1) developmental phase, identifying educational and behaviour change theory to guide development, in consultation with a professional advisory group; (2) feasibility pilot phase, testing the education using a 'think-aloud' method; and (3) pre-pilot phase, delivering the education within the IMP
ART strategy.
The developmental phase identified educational and behaviour change theory and the need to provide two education modules: (1) a team module to raise awareness of supported asthma self-management for the whole team and (2) an individual study module for those who conduct asthma reviews with patients. The feasibility pilot highlighted content and design features in need of refinement and the pre-pilot identified substantial changes to the delivery strategy for the education modules.
A multi-stage development process, aligned with the MRC Framework, contributed to the module design and delivery. Prior explorative work, multi-disciplinary team discussions, and professional advisory group consultation, informed the initial development, and in-practice testing and pre-pilot stages enabled refinement. In our experience, there were important benefits of working together as an educationalist/researcher team. The education programme, a core component of the implementation strategy, is now being tested in the IMP
ART UK-wide cluster randomised controlled trial.
This book will help you to develop some of the essential assessment skills that are needed to support patients with long-term conditions in secondary and primary care settings. You may be at the ...beginning of your career, or you may be an experienced practitioner who is moving into long-term conditions care. At whatever level you may be, this book will give you some guidance on how to use appropriate assessment tools and to reflect on your experience from practice.Supporting patients with long-term conditions is not solely the domain of nursing. This book is intended to be suitable for a range of practitioners who are interested in developing their assessment skills further. However some examples have been given from a nursing perspective.The exercises throughout the book have been designed to encourage you to reflect on your practice and draw from the wide range of evidence that is available to support your development. You can work through them at your own pace and return to chapters that you need to learn more about.
Aims To inform managers and gatekeepers of the pre‐requisites for staff engaging in post‐graduate level study. To acknowledge the support students in new roles require in clinical practice and ...continuing professional development (CPD).
Background A post‐graduate course for case managers/community matrons was developed as a rapid response to government policy. As a result, candidates entered this programme with non‐traditional requirements. However, this did not appear to hinder their success.
Evaluation Student entry data and their achievements on completion were collected and compared with another post‐graduate course that did require standard entry academic requirements. Final results were analysed and a narrative obtained from students and mentors.
Key issues Gatekeepers should recognize the importance of past experience and motivation of candidates in relation to CPD and also the student’s insight and self‐awareness when accessing courses.
Conclusion Candidates accessing post‐graduate courses can achieve learning outcomes at an advanced level when given the right support and are capable of undertaking the role of case manager/community matron .
Implications for nursing management The article is relevant in light of the current financial constraints for Trusts to ration the funding of CPD. Choosing the right person to attend the right course often depends on the manager’s discretion and not necessarily the candidates’ ability or motivation. It highlights the importance of not only recognizing the candidates’ academic level but also their motivation to study, and with careful selection candidates should be allowed the opportunity to access higher levels of CPD. Fitness to practice is also an important aspect to consider on completion of a course and this can be achieved with the mapping of competencies in relation to the post holder’s specific job.
In 2005 John Reid, the then Secretary of Health, announced the need for 3?000 community matrons to be appointed to coordinate the care of the growing numbers of people living with long term ...conditions. Although by the date agreed there were only 1?348 in post, according to Snow (2007), some PCTs have decided not to recruit further community matrons. Following the first evaluations of the role there also appears to be some confusion as to the title used by professionals who case manage this client group. The title of community matron has been used interchangeably with case manager, and therefore requires some clarification. This paper attempts to review the role of community matron and case manager, identify the professionals who take up these posts, and the professional qualifications and preparation required for the roles.
