The National Health Service Plan (July 2000) aimed to empower patients with more influence upon their own treatment. Provision of additional educational health information (AEHI) serves to inform ...families about health conditions and to allow them to manage their own health after discharge. However, to date, it is unknown how parents or carers perceive this information.
To identify parents' and carers' views towards the current provision of AEHI following discharge of their child from an emergency care service, to assess their needs concerning AEHI and to provide recommendations for subsequent research.
Between 11 April and 19 June 2007, a piloted questionnaire was handed out at random times to each family attending the children's emergency department while they were waiting to be clinically assessed. 1046 families chose to participate and answered questions about their ethnicity, language preference and ability, media access and their sources of health information. The data were analysed using descriptive methods.
A majority of families wish to receive hospital AEHI as leaflets. Additionally, families frequently use a variety of other resources such as extended family and friends and the Internet to address their information needs. Poor literacy is a barrier to understanding in 15.6% of the study population. 73% of carers with children aged between 10 and 16 years wish their children to receive AEHI.
The authors identified a gap in the provision of health information with respect to appropriate educational material for children and young persons, for families with poor literacy skills and those with language barriers.
IntroductionThis protocol describes a study of a quality improvement collaborative (QIC) to support implementation and delivery of comprehensive geriatric assessment (CGA) in UK care homes. The QIC ...will be formed of health and social care professionals working in and with care homes and will be supported by clinical, quality improvement and research specialists. QIC participants will receive quality improvement training using the Model for Improvement. An appreciative approach to working with care homes will be encouraged through facilitated shared learning events, quality improvement coaching and assistance with project evaluation.Methods and analysisThe QIC will be delivered across a range of partnering organisations which plan, deliver and evaluate health services for care home residents in four local areas of one geographical region. A realist evaluation framework will be used to develop a programme theory informing how QICs are thought to work, for whom and in what ways when used to implement and deliver CGA in care homes. Data collection will involve participant observations of the QIC over 18 months, and interviews/focus groups with QIC participants to iteratively define, refine, test or refute the programme theory. Two researchers will analyse field notes, and interview/focus group transcripts, coding data using inductive and deductive analysis. The key findings and linked programme theory will be summarised as context-mechanism-outcome configurations describing what needs to be in place to use QICs to implement service improvements in care homes.Ethics and disseminationThe study protocol was reviewed by the National Health Service Health Research Authority (London Bromley research ethics committee reference: 205840) and the University of Nottingham (reference: LT07092016) ethics committees. Both determined that the Proactive HEAlthcare of Older People in Care Homes study was a service and quality improvement initiative. Findings will be shared nationally and internationally through conference presentations, publication in peer-reviewed journals, a graphical illustration and a dissemination video.
Clinical practice guidelines (CPGs) aim to improve patient care, but their use remains variable. We explored attitudes that influence CPG use amongst newly qualified doctors.
A self-completed, ...anonymous questionnaire was sent to all Foundation Doctors in England and Wales between December 2012 and May 2013. We included questions designed to measure the 11 domains of the validated Theoretical Domains Framework (TDF). We correlated these responses to questions assessing current and future intention to use CPGs.
A total of 13,138 doctors were invited of which 1693 corrected (13 %) responded. 1,035 (62.5 %) reported regular CPG use with 575 (34.4 %) applying CPGs 2-3 times per week. A significant minority of 606 (36.6 %) declared an inability to critically appraise evidence. Despite efforts to design a questionnaire that captured the domains of the TDF, the domain scales created had low internal reliability. Using previously published studies and input from an expert statistical group, an alternative model was sought using exploratory factor analysis. Five alternative domains were identified. These were judged to represent: "confidence", "familiarity", "commitment and duty", "time" and "perceived benefits". Using regression analyses, the first three were noted as consistent predictors of both current and future intentions to use CPGs in decreasing strength order.
In this large survey of newly qualified doctors, "confidence", "familiarity" and "commitment and duty" were identified as domains that influence use of CPGs in frontline practice. Additionally, a significant minority were not confident in critically appraising evidence. Our findings suggest a number of approaches that may be taken to improve junior doctors' commitment to CPGs through processes that increase their confidence and familiarity in using CPGs. Despite limitations of a self-reported survey and potential non-response bias, these findings are from a large representative sample and a review of existing implementation strategies may be warranted based on these findings.
The UK has an ageing population, which means that more and more older people with complex social and healthcare problems will present to emergency departments (EDs). This article explains why ED ...staff must have appropriate training and education in all aspects of caring for frail older people, including the use of appropriate and specific assessment tools. The authors also refer to a soon-to-be-published guideline for the care of frail older people with emergency care needs.
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