One of the few studies of service user involvement in a clinical trials was published this month in the journal Trials: ‘Involving older people in a multi-centre randomised trial of a complex intervention in pre-hospital emergency care: implementation of a collaborative model‘. The study was part of the SAFER2 (Support and Assessment for Fall Emergency Referrals) trial led by the University of Swansea with Ambulance Services in the East Midlands, London and Wales and involving CaHRU at the University of Lincoln. The study was led by Bridie Evans and the trial lead was Prof Helen Snooks, both from Swansea University.
The study describes how it was planned for service users to be involved in the trial and how involvement actually occurred. The study team planned for service users to be involved at strategic level, at each study site and locally and this did take place. For example at strategic level, service users were involved in the trial management, trial steering, and data monitoring and ethics committees In addition, service users were also involved in study writing days and task and finish groups. Service users were also involved at study sites. Finally, service user reference groups were consulted at various points during the study.
Overall, the study showed how service users could be integrated into the activities of a clinical trial, the processes involved and facilitators and barriers to involvement at various levels.
Dr Coral Sirdifield of CaHRU contributed to a recent report produced under the EU Health Programme (2008-2013) following completion of the HEALIT4EU project, ‘Study on sound evidence for a better understanding of health literacy in the European Union‘. Prof Niro Siriwardena, director of CaHRU, is UK coordinator of the EPHORT consortium led by the Netherlands Institute for Health Services Research which provides commissioned reports to the EU under this programme.
The authors describe health literacy as enabling “people to make judgements and take decisions in everyday life concerning healthcare, disease prevention and health promotion to maintain or improve their quality of life”, and state that it can be seen as encompassing not only an individual skill, but also an individual’s social support system and the context within which they are using basic, communicative and critical literacy skills. Health literacy is a multidimensional concept which incorporates the ability to understand, use, interact with and critically evaluate health information and services and to actively manage personal health in the context of one’s social network and the healthcare system. Poor health literacy is associated with worse health outcomes despite higher health care service use and is an important factor in health inequalities.
The report maps health literacy interventions in an EU context, and existing policies and actions aimed at improving health literacy in EU member states. The authors also developed prediction models around determining health literacy using publicly available information sources. Information around health literacy policy and practice in the UK was supplied by Prof Siriwardena and Dr Sirdifield from the University of Lincoln.
The main recommendations of the research are as follows:
- More attention should be given to the development and evaluation of health literacy interventions in a European context, using research designs which have sufficiently scientific rigour and which include cost-effectiveness in their design.
- There is a need for agreement among researchers on valid measurement tools for health literacy in a European context, and more systematic use of validated, preferably comprehensive, measurement tools in interventions.
- Health literacy research funding should give more attention to (a) the quality of the studies and (b) the need for specific kind of evidence, such as: intervention studies, effectiveness and cost-effectiveness, and international comparative research.
- Though health literacy is on the agenda in most of the EU Member States, in many countries the efforts are not coordinated through a policy at the most appropriate level. A more programmatic and evidence-based policy to health literacy in individual EU Member States and further exchanges of knowledge and best-practices at EU level could be beneficial with regard to the outcomes of these efforts.
- The concept of ‘health literacy’ can be considered a useful complement to more general health promotion and education policies, as it enables to better tailor health promotion and education approaches to individuals or populations with low literacy and increase the effectiveness of such policies.
- Policies on health literacy should also address the context in which people have to be “health literate” – this is the health care system itself, how providers deliver care, how services are organised, how health information is provided, etc. In addition, from a public health perspective health literacy policies should be implemented in other relevant contexts such as the education system and at the workplace. However, most of the current interventions and programmes do not seem to focus on the context. Instead, they seem to focus on individuals, or groups ‘at risk’, or people with low health literacy skills.”
The report recommends that more attention should be given to the development and evaluation of well-designed health literacy interventions in Europe context which include cost-effectiveness analyses and valid tools for measuring health literacy. In terms of policy the report recommends that EU Member States support evidence-based policy towards health literacy and exchange knowledge and best-practice; include health literacy to complement health promotion and education policies; and address the healthcare context for health literacy in terms of the health system, care provision, service organisation, and health information together with other relevant contexts such as the education system and the workplace.
A new study ‘What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review‘ was published this month, and included CaHRU’s Viet-Hai Phung as one of the report co-authors. Over the last 15 years, The NHS has undertaken many reviews of urgent care. It has also recommended service delivery changes to improve access to, and the quality of, urgent care. Despite this, rising demand continues to strain the emergency and urgent care system.
In response, the National Institute for Health Research’s (NIHR) Health Services and Delivery Research (HSDR) programme commissioned this report from the University of Sheffield’s ScHARR as part of a wider series of evidence syntheses. The report contains five separate reviews linked to themes in the NHS England review – demand for urgent and emergency care; telephone triage and advice; ambulance clinicians managing patients with urgent conditions; delivering Emergency Department (ED) services; and emergency and urgent care networks. Alongside this, the team conducted systematic reviews and quality assessed additional primary research papers.
The key findings for each review were:
There is little empirical evidence to explain increases in demand for urgent care;
Telephone triage services provide appropriate and safe decision making with high patient satisfaction but the required clinical skill mix and effectiveness in a system is unclear;
Extended paramedic roles have been implemented in various health settings and appear to be successful at reducing transport to hospital;
There is potential for GP services co-located within the ED to improve care;
No empirical evidence exists to support the design and development of urgent care networks.
The rapid review assessed the existing evidence base on delivering emergency and urgent care services. The research also identified two major gaps that further research needs to investigate. Firstly, we need to assess the current state of the urgent care. Secondly, we need to have a better understanding of the nature of demand, which can then be used to inform service delivery improvements.
[su_document url=”https://communityandhealth.dev.lincoln.ac.uk/files/2015/06/CaHRU-Newsletter-Spring-2015.pdf” responsive=”no”]Multi-morbidity, goal-oriented care, the community and equity[/su_document]
The latest edition of the CaHRU Newsletter (Spring 2015) was published this week. The newsletter presents the work of the research centre over the previous three months and includes articles from the CaHRU blog covering publications, conferences and funding. The newsletter is produced by Sue Bowler, CaHRU administrator.
A new briefing paper, ‘Ethnicity and prehospital emergency care provided by ambulance services‘, was published today by The Race Equality Foundation. The paper was co-authored by Viet-Hai Phung, Professor Niro Siriwardena, and Dr Zahid Asghar from CaHRU and Dr Karen Windle from the School of Health and Social Care.
It builds on work that CaHRU is undertaking on people from minority groups and their prehospital care. The briefing paper describes the inequalities in access to, as well as treatment and outcomes from, prehospital care for minority ethnic groups in the UK. It discusses how inequalities are driven by factors that include limited cultural awareness among service providers, as well as limited language proficiency and understanding of the healthcare system among these patients groups and how these inequalities manifest themselves in differences in treatment and outcomes.
The paper goes on to examine the implications arising from these inequalities for service delivery, especially since increasing ethnic diversity is raising issues of equality and equity higher up the legislative and policy agendas. It concludes by exploring potential solutions, which include: a more integrated approach to collecting patient ethnicity data; interventions that target at-risk groups in particular locations; and better cultural competency training for service providers.