bluuebunny/crossref_metadata_2025_split huggingface dataset:
Educational training in disease management for persons providing peer support to patients with type 2 diabetes and arterial hypertension at the primary healthcare level.
Authors: Virtic Tina , Mori Lukančič Majda , Mihevc Matic , Zavrnik Črt , Ketiš Zalika Klemenc , Susič Antonija  Poplas 
Published: January 2024

Introduction: Good metabolic control of a patient with type 2 diabetes (T2D) and arterial hypertension (AH) requires continuous monitoring of patient's health and associated diseases, where lifelong education and support represent key factors in patient empowerment and successful self-management. This is a task beyond the capabilities of healthcare professionals in Slovenia, which could be solved with engagement and cooperation of partners outside the healthcare system. Therefore, appropriate organisation, training and functioning of lay persons, who will provide peer support, can significantly contribute to improved integrated care in patients with T2D and AH. In this way trained peer supporters will voluntarily share their knowledge, experiences and support to other patients with the same chronic disease without linguistic nor cultural barriers.
Aim: The aim of our pilot study was to determine the acceptability, effectiveness and feasibility of educational training in disease management for persons providing peer support to patients with T2D and AH at the primary healthcare level in Slovenia.
Methods: This study is a part of an ongoing international research project SCUBY (SCale Up diaBetes and hYpertension care). Our pilot study started with recruitment of 36 patients with T2D and/or AH. Participants were educated in a total of 15 hours of group and individual training by nurses with special skills. Before and after completing the training, participants filled out questionnaires including sociodemographic and clinical data, knowledge about T2D and AH, Appraisal of Diabetes Scale and Theoretical Framework of Acceptability.
Results: 31 patients (21 women and 10 men) successfully completed structured educational training in management of their T2D and AH and became trained peer supporters. Their average age was 63,9 ± 8,9 years, they were treated for T2D on average of 14,3 ± 11,7 years and for AH on average of 7,9 ± 8,1 years. Compared to the knowledge at the time of entering the research, their knowledge about T2D (p<0,001) as well as about AH (p=0,022) increased significantly. The impact on the quality of life with T2D was insignificantly better (p=0,146). The participants rated training as highly acceptable in all 7 domains of acceptability; the total mean score on a 5-point scale was 4,44 ± 0,52.
Conclusions: Educational training in disease management for peer supporters proved to be highly acceptable, effective and feasible, which indicates a great potential for successful implementation of peer support for patients with T2D and AH at the primary healthcare level in Slovenia. Active role of trained peer supporters will lead to the development of a new form of cooperation and collaboration between patients, their family members, informal caregivers in local community and healthcare professionals.
What is successful integrated community care? A systematic literature review.
Authors: Steurs Manon , Verté Dominique , Verté Emily 
Published: January 2024

Introduction: The ageing process vastly impacts the need for care and support, as it is often associated with a decrease in health and function. Governments of ageing populations are using “ageing in place” as the main policy perspective, in which people receive care and support in their personal environment. Although great value is within this perspective, recent studies accentuate that the location where people live vastly impacts their need for care and support. This highlights the need for the development of new, long-term care systems to address these challenges. Scholars argue that the issue can be resolved by implementing locally, integrated and community-based health and social care. Integrated community care (ICC) has been defined as a range of strategies to support multiple stakeholders to co-develop and health, care and social support services and infrastructures, aiming to achieve several goals. However, it is unclear of which key elements ICC consists of.
Method: The main goal of this systematic literature review was to identify the key elements which successful ICC consists of. We searched five electronic databases with several search strings which we defined as closely related to, a part of or the same as ICC based on the preliminary results of the literature review. A total of 65 articles were included in the review based on eligibility criteria, divided into two groups. The first group included twenty articles mentioning ICC or one of the search strings in the title or abstract, the second group contains forty-five articles linked to ICC but clearly focus on a different issue or topic. Thematic analysis was used to code the articles.
Results: Eight key elements of integrated community care were identified, namely: (1) asset-based, (2) person-centred, (3) co-development, (4) governance, (5) locality, (6) improvement of mental and physical health, (7) improvement of the existing health care system, (8) tackling determinants of health. Different perspectives and possible difficulties related to these elements were discussed.
Discussion: We identified eight key elements of ICC, dealing with the starting point (asset-based and person-centred), strategies and stakeholders (co-development, governance, locality) and aims or ambitions (improvement of mental and physical health, improvement of the existing health care system, and tackling health determinants). However, it is still unclear how these elements correlate with each other. Some of these key elements remain rather vague or abstract. Further research should focus on formulating specific definitions for these elements in the context of ICC as well as codifying ways to implement these key elements in practice.
Implementation and Evaluation of Innovation in Integrated Care: Strategies to Overcome the Challenge of Work as Imagined
Authors: Shearkhani Sara , Smith Kelly , Pradhan Rishma 
Published: January 2024

Health system learning is an iterative process. The six phases of a learning health system (LHS) are problem identification, design, implementation, evaluation, modification, and dissemination. In theory, evaluation is supposed to inform design and implementation and in turn implementation process and modification as the direct result of the evaluation endeavour set the direction for future evaluation. In other words, evaluation and implementation go hand-in-hand. In practice, however, when designing an integrated model of care, more often than not in the fast-paced environment of the healthcare where lives are literally at stake, both evaluation and implementation planning are sacrificed. This happens for many reasons, from lack of resources to lack of expertise. One main reason that work as imagined is perceived as work as done is that those who run the program are smart and dedicated people who are well aware of the needs of their communities and clients, and have their best interest at heart.
East Toronto Health Partners (ETHP) has invested in evaluations since 2018 to create a learning health system by embedding rapid cycles of evaluation to support learning, knowledge transfer, and decision making for scale and spread of their new models of care. One of the main findings of our evaluation work was that implementation planning and monitoring the implementation process raised the likelihood of a successful evaluation which in turn resulted in tangible improvement in the program.
In our poster presentation, we will focus on both implementation and evaluation. We showcase the link between the logic model/evaluation plan and the implementation plan. We will cover the following questions:

Why having an implementation plan is necessary to bring an idea for an intervention to a reality?
How an implementation plan helps you to carry out your evaluation plan more successfully?
What questions you should be thinking about when you are developing your implementation plan?

We will share examples of best practices. The poster will also provide practical implementation templates that can be used in different setting.
Developing and Setting Up a Lung Cancer Triage Phoneline For Rural West Wales
Authors: Rees Pat , Davies Richard , Gemine Rachel , Shanbhag Savita 
Published: January 2024

The incidence of people diagnosed with and living with cancer in the UK is increasing and by 2030, 1 in 2 people will develop cancer (The Cancer Delivery Plan 2016-2020 WAG). Health care providers must explore innovative ways to provide quality care both in terms of outcomes and patient experience set against the challenge of finite resources. Within Wales there are over 2,300 patients diagnosed with lung cancer each year, however less than 20% of these are diagnosed at early stage when they are eligible for curative treatment. It has been shown that early diagnoses leads to improved survival.
More than 90% of patients with lung cancer are symptomatic at diagnosis.
Rates of lung cancer diagnosis have been drastically impacted by COVID, with referral rates and presentation to GPs at an all-time low in 2020-21. Screening of patients by triage nurse will help reduce GP workload by allowing patients to be referred, for Chest X-ray, and then to Secondary Care for onward management.
To improve early diagnosis of lung cancer, LUMEN (Lung Cancer Symptom Assessment Line) Nurse Led Service was developed with the following aims:

To deliver a triage service that is safe, effective, equitable and accessible.
Develop and launch this service and integrate into current lung cancer pathways.
Promote and deliver the service and determine acceptability, feasibility, safety, and cost-effectiveness of the pathway.

By increasing patient access to diagnostic testing, we hope to increase early diagnosis and subsequent patient outcomes.
Patient benefits
The Nurse will make onward referrals to lung cancer team, support the person throughout this journey and offer smoking cessation advice, if needed.
Staff Benefits
Role is varied and includes raising awareness of lung cancer symptoms, promoting the service, and liaising with various teams to improve patient journey.
Goals of older hospitalized patients with multimorbidity
Authors: Tent Sanne , Verhoeff Marlies , Festen Suzanne , Van Munster Barbara 
Published: January 2024

Background: The increased prevalence of older patients, often presenting with multimorbidity, challenges the traditional disease-focused approach in hospital care. To improve healthcare for older hospitalized patients with multimorbidity, patient-centered healthcare is recognized by experts as essential. An important aspect of patient-centered care is aligning healthcare to personal goals. From literature, we know that older adults rate life enjoyment, social relations, quality of life, mobility and maintenance of autonomy as most important in daily life. In the hospital setting, however, little is known about goals of older patients. Besides, patients with multimorbidity experience more burden of their disease, functional disabilities, and a reduced quality of life which can lead to prioritizing different goals. These potential differences in goals between patients with and without multimorbidity have not been established so far. Therefore, we aimed to explore goals of older hospitalized patients with multimorbidity and compare their goals to those of older hospitalized patients without multimorbidity.
Method: Older hospitalized patients (aged ≥ 70 years) were included between February 2017 and March 2020 in a prospective mixed-methods cohort study at the University Medical Centre Groningen, the Netherlands. Multimorbidity was defined as presenting with polypharmacy and two or more diseases scored with the Charlson Comorbidity index. Goals were assessed by a standardized interview, whereafter they were categorized into one of the ten predefined categories and analyzed descriptively. Goal categories were ‘wanting to know what the matter is’, ‘controlling disease’, ‘staying alive’, ‘alleviating complaints’, ‘improving condition’ (fitness), ‘improving daily functioning’, ‘improving/maintaining social functioning’, ‘resuming work/hobbies’, ‘regain/maintain autonomy’ and ‘undefinable’
Results: Four-hundred-ninety-three older hospitalized patients (mean age 76.7 ± 5.5, 64% male) were included, of which 223 patients with multimorbidity (45%). Patients were hospitalized for 7.9 ± 8.5 days on average. Patients with multimorbidity experienced more mobility problems (67% vs 52%), physical impairments (66% vs 50%) and rated their health lower (a score of 60.2 vs 67.5 on the EuroQol - Visual Analogue Scale) compared to patients without multimorbidity. The most often mentioned goals were ‘controlling disease’ (27%) and ‘alleviating complaints’ (22%). No differences were found in goals mentioned by patients with and without multimorbidity. Forty-one percent of both patients with and without multimorbidity mentioned goals that were disease-unrelated.
Conclusion: Our study shows no major differences in goals of older hospitalized patients with and without multimorbidity. However, the large proportion of patients mentioning disease-unrelated goals emphasizes the importance of goal elicitation by healthcare professionals within hospital care to provide optimally integrated care.
Team Around the Patient: multi-professional opportunities to support care delivery in hospitals.
Authors: Walsby Alex , Williams Sharon , Best Stephanie 
Published: January 2024

Background: Demands on healthcare are outstripping the resources available. Many organisations are struggling to recruit sufficient registered nursing staff to maintain service delivery and are re-evaluating how safe, high quality, sustainable care could be provided. The concept “Team Around the Patient” being piloted in Hywel Dda University Health Board seeks to understand who can provide what care outside of traditional workforce models. The objective of this study is to examine perceptions of key health board stakeholders of the Team Around the Patient model of care and establish research priorities, and to design and test a workforce analysis model to test the implementation of Team Around the Patient. The model will be designed for use in adult, acute inpatient hospital wards.
Methods: Before implementing the Team Around the Patient on select adult surgical and medical wards semi structured interviews were undertaken with key health board stakeholders to gather their understandings and perspectives on the concept, and create a working definition. A purposive approach was taken to engage a range of professional opinions including corporate and operational nursing, patient experience, allied health professionals, workforce and operational development. Interview topics included opportunities, quality indicators, barriers and enablers and organisational impacts. Ethical approval was provided by Swansea University and through The Integrated Research Application System (IRAS). Interviews were recorded, transcribed and thematically analysed.
Results: In total 15 participants were interviewed. High level findings show support for the concept, with many participants identifying the potential new roles to be included. Key quality indicators such as inpatient falls, medication errors, pressure damage, length of stay, complaints and staff experience were identified as being important measures for this concept. Challenges associated with introducing new roles were mainly associated with workforce culture, delegation and finance.
Conclusion: The results indicate overall support for “Team around the Patient” as a model of care which will help to alleviate issues surrounding skill shortages, while introducing more collaborative, inter-professional working. Further research is underway to gain wider perspectives of the concept from national and international experts in the fields of health care, academia and policy makers. The next stage of the research will include observational studies of health care delivery in practice to test the model of workforce analysis. The aim will be to identify opportunities for non-nursing staff groups to support care delivery where a gap in practice, or inefficiencies in the timely delivery of care, has been identified.
Realist Evaluation of Home-Based Palliative Care Programme for Non-Cancer Patients
Authors: Nurjono Milawaty , Lee Jing Yi , Ho Ezra , Tan Chao Min , Liaw Karen , Lee2 Angel , Vrijhoef Hubertus Johannes Maria , Koh Lip Hoe , Ng Foong Ling , Oh Hong Choon 
Published: January 2024

Introduction: Disproportionately higher deaths attributed to non-cancer causes in Singapore highlight the need for palliative beyond those with cancers. The Violet Program (ViP) was developed to provide home-based palliative to non-cancer patients residing in the Eastern region of Singapore. VIP aims to (i) reduce unnecessary acute hospital utilization (ii) improve symptoms management (iii) reduce caregiver burden through caregiver support (iv) honour patient preferences better through integrated care while (v) keeping healthcare cost affordable. It is acknowledge that successful implementation and the long-term sustainability of ViP is contingent on its ability to effectively attract, grow and develop its manpower resources. However, identifying, attracting, developing, and retaining competent and engaged community-based palliative care workforce staff remains a major challenge. The aim of this study is to understand attributes of staff and contextual factors well suited for ViP and factors leading to sustainability of such a workforce
Methods: This study was conducted in 2 phases according to realist evaluation principles. First, initial programme theories (IPT) related to sustainability of palliative care manpower were developed through a scoping review and semi-structured interviews with those who were involved in the conceptualization of ViP. IPTs were expressed in Context (C) Mechanism (M) and Outcome (O) configurations. Then, IPTs were tested using interviews with healthcare care workers (HCW) who were involved in ViP. Only CMO configurations supported by substantial evidence were elicited and refined.
Results: 36 HCW of varied roles were interviewed. At the HCW level, (i) familiarity with palliative care framework (ii) comfort in dealing with death (iii) passion for palliative care field (iv) exposure to palliative care during medical/nursing training and (iv) ability to self-care were found to be important attributes for ViP care team. At the institutional level, (continuous) training and provision of socio-emotional support to staff were found to contribute to retention of staff. Self-efficacy for the required tasks, empathy for affected patients/family, passion-driven motivation and dedication to go the extra mile and strong emotional resilience were found to be the key driving forces behind the sustainability of workforce for ViP for the longer term.
Implications: This study illustrated the applicability of using realist evaluation for assessment of context specific insights for the identification of suitable workforce and how to sustain them in the longer term. These insights can potentially be used as selection criteria for recruitment of staff for ViP and points to area for training of staff.
Towards Active Integrated Waiting Lists: The Patient Lived Experience
Authors: Hayes Daniel , Lipscombe Paul , Betts Pete , Cledwyn Victoria , De Jesus Merlisa , Robbins Tim , Chapman Rachel , Randeva Harpal , Patel Kiran 
Published: January 2024

Background: Specialist healthcare providers internationally face challenges managing elective care waiting lists. There is an increase focus on how we can provide integrated care solutions to achieve active rather than passive waiting. This requires potentially complex interactions across care boundaries and care providers alongside novel digital solutions. Crucially however we must also understand the lived patient experience of people on those waiting lists. Little research has considered the lived experience of people on waiting lists for specialist care.
Methods: 46,000 individual patients on waiting lists at a major tertiary referral centre in the West Midlands, United Kingdom were sent a survey to understand their experiences of waiting for specialist care whilst remaining in the community context. Patients were contacted via SMS initially with a link to a web-portal with follow up contact via letter for those who did not complete the initial survey. This work is linked to/informed by extensive, commissioned, independent deliberative patient and public involvement work looking at waiting list management previously completed for this organization. This was approved locally as a service evaluation.
Results: 20,741 responses were received, representing a 45% response rate. 62% of response were received via the website, with 38% via letter. 1,633 patients (7.9%) wished to be removed form the waiting list. 18.5% felt that being on the waiting list was severely stopping them from carrying out normal tasks, 17.7% reported that being on the waiting list was severely impacting their ability to work and 14.0% reported that being on the waiting list severely impacted their ability to care for others. 20.7% felt their condition had got severely worse whilst on the list. Impact of being on the waiting list was most notable for those in the most deprived population groups, with 25% of patients in the most deprived areas having been severely impacted by the wait time, compared with 14% in the least deprived areas. There was additional variation on the impact of waiting based on ethnicity, age and work status.
Discussion: High healthcare demands result in an inevitability of patients waiting for specialist services. This work demonstrates the diversity of lived experiences for patients on elective care waiting lists, stressing differences between key population groups including those with protected characteristics. Patient cohorts within specialist waiting lists must be seen as diverse and dynamic. Much promised prioritisation and active waiting initiatives must be individualised to meet the diverse needs of the people on the waiting lists and recognise further work is needed to better understand how to engage with these groups.
Funding received from: West Midlands Academic Health Science Network: Safety Innovation and Improvement Fund