IT intervention to support medicine optimisation in primary care

Jeffries, M. et al. (2017) Understanding the implementation and adoption of an information technology intervention to support medicine optimisation in primary care: qualitative study using strong structuration theory. BMJ Open. 7:e014810

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Objectives: Using strong structuration theory, we aimed to understand the adoption and implementation of an electronic clinical audit and feedback tool to support medicine optimisation for patients in primary care.

Conclusions: Successful implementation of information technology interventions for medicine optimisation will depend on a combination of the infrastructure within primary care, social structures embedded in the technology and the conventions, norms and dispositions of those utilising it. Future interventions, using electronic audit and feedback tools to improve medication safety, should consider the complexity of the social and organisational contexts and how internal and external structures can affect the use of the technology in order to support effective implementation.

Read the full article here

Transforming community care with digital technologies

Chris Gregory, head of clinical systems for LGSS Local Health and Care Shared Service explains how mobile solutions are transforming the work of community-based health teams | NHE

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As the IT provider to Northamptonshire Healthcare NHS FT, LGSS has been involved in delivering mobile working solutions to a number of community-based health teams, including health visitors and district nurses, and for providing similar solutions in local government.

The trend towards delivering care closer to home to meet both patient aspirations, and the need to deliver savings through the reduction of estate, means that increasing levels of flexible working are being demanded across the NHS. If done successfully, mobile working can help to deliver the type of service that patients tell us they would like from their health service.

As with many IT services we’ve had a few attempts at delivering practical mobile working solutions, each based on and constrained by the technology available at the time. Prior to our latest deployment, we asked staff what they needed from a mobile device. Overwhelmingly, those who responded wanted:

  • A small form factor: There is plenty of other equipment a district nurse needs to carry so devices need to be small, as light as possible and certainly no more awkward to carry than the files of paper notes previously used
  • Sufficient battery life to get through an entire working day
  • A fast start-up: Ensuring that as little of the precious contact time with the patient was spent waiting for the technology
  • Versatility: Multiple means of inputting data, suggesting the need for both touchscreen and keyboard input

Read the full article here

NHS Digital has published guidance to help organisations deliver the NHS e-referrals service CQUIN requirements for 2017/18

The document will guide providers through the available data, and support them to make the necessary changes on their e-RS systems | NHS Digital

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Image source: NHS Digital

The NHS e-Referral Service (e-RS) combines electronic booking with a choice of place, date and time for first outpatient appointments. Patients can arrange their hospital appointment with their GP during consultation, or independently either online or by telephone.

The purpose of this guidance is to:

  • Provide summary information to support provider organisations in submitting their plans in Quarter 1 and making the necessary changes on the NHS e-Referral Service to deliver the Quarter 2 to Quarter 4 CQUIN requirements, appending or signposting to appropriate detailed guidance.
  • Support providers and commissioners in understanding the data available within e-RS to help with the monitoring of delivery.

Read the full overview here

Read the full guidance here

New go-to website for resources and learning in palliative and end of life care

Nicola Spencer introduces the enhanced Ambitions for Palliative and End of Life Care website which will be the new go-to place for resources and learning | NHS England

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Struggling to keep up to date and informed on changes impacting on palliative and end of life care? Not sure where to find the latest resources and improvement examples?

Then you will be pleased to hear we have launched a tailor made national End of Life Care (EoLC) Knowledge Hub providing you with a ‘one stop shop’ of palliative and EoLC information.

This hub provides anyone involved in the commissioning or provision of palliative and end of life care with a quick and easy way to source information, including helpful tools and resources to drive delivery of the Ambitions for Palliative and End of Life Care – a national framework for local action.

Read the full overview here

Find the website here

What transforming care looks like

Tom Lindley explains how the technology used in Airedale and Partners vanguard is changing care for people in care homes | NHS England

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Here, in one of the most rural parts of the National Health Service, our clinicians are not just blessed with an excellent bedside manner. Increasingly, they are also becoming skilled in having a “webside manner” – as we harness the full potential of telemedicine to test out and develop a new model of care for the NHS.

We have adopted the same technology that NASA uses to ensure the health and well-being of their astronauts, like Major Tim Peake, as they orbit the Earth. But our approach is generating significant benefits not in space but much closer to home, as part of a project that is unprecedented in its size and scope.

Read the full news story here

 

Technology enabled care services

TSA, the industry body for technology enabled care, has published Putting people first: commissioning for connected care, homes and communities.

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This report looks at how the care technology sector supports health and social care commissioners to commission technology enabled care services that meet the growing and changing needs of the entire system.  One of the themes included in the report is that commissioners need to ensure the commissioning approach focuses on outcomes and not inputs.

Cost-effectiveness of telehealth for patients with raised cardiovascular disease risk: evidence from the Healthlines randomised controlled trial

Dixon, P. et al. BMJ Open. 6:e012352

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Image source: Neil Webb – Wellcome Images // CC BY-NC-ND 4.0

Objectives: To investigate the cost-effectiveness of a telehealth intervention for primary care patients with raised cardiovascular disease (CVD) risk.

Design: A prospective within-trial patient-level economic evaluation conducted alongside a randomised controlled trial.

Setting: Patients recruited through primary care, and intervention delivered via telehealth service.

Participants: Adults with a 10-year CVD risk ≥20%, as measured by the QRISK2 algorithm, with at least 1 modifiable risk factor.

Intervention: A series of up to 13 scripted, theory-led telehealth encounters with healthcare advisors, who supported participants to make behaviour change, use online resources, optimise medication and improve adherence. Participants in the control arm received usual care.

Primary and secondary outcome measures: Cost-effectiveness measured by net monetary benefit at the end of 12 months of follow-up, calculated from incremental cost and incremental quality-adjusted life years (QALYs). Productivity impacts, participant out-of-pocket expenditure and the clinical outcome were presented in a cost-consequences framework.

Results: 641 participants were randomised—325 to receive the telehealth intervention in addition to usual care and 316 to receive only usual care. 18% of participants had missing data on either costs, utilities or both. Multiple imputation was used for the base case results. The intervention was associated with incremental mean per-patient National Health Service (NHS) costs of £138 (95% CI 66 to 211) and an incremental QALY gain of 0.012 (95% CI −0.001 to 0.026). The incremental cost-effectiveness ratio was £10 859. Net monetary benefit at a cost-effectiveness threshold of £20 000 per QALY was £116 (95% CI −58 to 291), and the probability that the intervention was cost-effective at this threshold value was 0.77. Similar results were obtained from a complete case analysis.

Conclusions: There is evidence to suggest that the Healthlines telehealth intervention was likely to be cost-effective at a threshold of £20 000 per QALY.

Read the full article here