Ways of integrating care that better coordinate services may benefit patients
New integrated care models can increase patient satisfaction, perceived quality of care and improve access to services. It is less clear whether there may be effects on hospital admissions, appointments or healthcare costs. Strong leadership and patient engagement are among factors influencing successful implementation.
The NHS is undergoing reconfiguration to better coordinate services around patients. This NIHR-funded review looked at the international literature to understand how new care mo...
Structured training improves skills of wheelchair users
Structured wheelchair skills training increases wheelchair users’ skills when compared with no training, standard care or education controls. The training, as developed in Canada, is more effective for new wheelchair users than experienced users. It includes difficult everyday challenges from wheeling through gravel to negotiating high curbs.
Links have been found previously between wheelchair skills capacity (reflecting what the user can do) and: independent mobility, reduced reliance on...
Case managers improve outcomes for people with dementia and their carers
Using a case manager to coordinate health and social care improves the challenging behaviour of people with dementia and reduces the burden on caregivers. Quality of life of caregivers improves the most when case managers have a professional background in nursing.
This NIHR-funded review compared the effectiveness of standard community treatment and interventions with case managers overseeing the interventions for people living with dementia. It considered evidence from 14 trials in a number of...
Multi-morbidity predicted to increase in the UK over the next 20 years
Two-thirds of adults aged over 65 are expected to be living with multiple health conditions (multi-morbidity) by 2035. Seventeen percent would be living with four or more diseases, double the number in 2015. One-third of these people would have a mental illness like dementia or depression.
Increased life expectancy by around three years for both men and women means people will spend longer living with multi-morbidity.
This study, partly supported by NIHR, ran a computer model using data on ove...
Additional therapy helps social recovery from first episode psychosis
Social recovery therapy increases structured activity, such as work, education or sport, by eight hours per week for people with severe social withdrawal following a first episode of psychosis. This cognitive behavioural type of treatment was added to other early interventions and might be particularly useful for those lacking motivation or living with other conditions that prevent them engaging with mental health services.
This NIHR-funded trial included 154 young adults with first episode of ...
Social exclusion heightens risk of death across many health conditions
Socially excluded men have a mortality rate that is nearly eight times higher than the average for other men, and it is almost 12 times higher for excluded women. These health inequities in outcomes exist across a wide range of health conditions, particularly in infectious diseases and mental health. These findings suggest the need for a joined-up approach across sectors to support inclusive services and policies.
Populations who experience social exclusion included in the NIHR-supported study ...
Parental training improves a child’s disruptive behaviours regardless of socio-economic disadvantage or ethnicity
Children from low-income families, or with an unemployed or single parent, benefitted as much as did economically advantaged groups. The Incredible Years programme worked better for children with more severe behaviour problems or a parent with depression.
This NIHR-funded review pooled individual-level data for pre-school and primary aged children with persistent disruptive behaviours. The 14 European trials, including eight studies in the UK, took place in diverse settings including schools, c...
Supported employment helps people with severe mental illness to obtain work
Adults with schizophrenia and other psychosis receiving supported employment were more than twice as likely to obtain a job in the competitive labour market as those receiving pre-job training, sheltered employment or psychiatric care only. Supported employment seemed most effective when augmented with other interventions such as social or cognitive skills training.
Many people with severe mental illnesses would like to work, and employment can improve their quality of life. This Cochrane revie...
Comprehensive assessment when older people are in hospital improves their chances of getting home and living independently
Older people who received comprehensive geriatric assessment when in hospital were slightly more likely to be living in their own homes one year later. Sixty percent were discharged to independent living compared with 56% receiving standard ward care. People who had received this proper assessment were also 20% less likely to be in a nursing home after three months or more.
Older people often have multiple complex conditions combined with frailty and are more likely to lose independence after i...
Simple preventive actions by parents linked to fewer child injuries
Education is promoted as a way to tackle the scale of avoidable injuries to young children. Children have two to five times the risk of an accident leading to injury if a parent leaves them on a raised surface, places hot drinks within reach, or does not put medicines away straight after use.
For example, children are also more than twice as likely to attend hospital for falling on stairs if their parent leaves stair gates open or does not use them.
In this NIHR-funded study, parental behaviou...