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

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.

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Managers’ use of nursing workforce planning and deployment technologies: protocol for a realist synthesis of implementation and impact

Burton, C. et al. BMJ Open. 6:e013645

Introduction: Nursing staffing levels in hospitals appear to be associated with improved patient outcomes. National guidance indicates that the triangulation of information from workforce planning and deployment technologies (WPTs; eg, the Safer Nursing Care Tool) and ‘local knowledge’ is important for managers to achieve appropriate staffing levels for better patient outcomes. Although WPTs provide managers with predictive information about future staffing requirements, ensuring patient safety and quality care also requires the consideration of information from other sources in real time. Yet little attention has been given to how to support managers to implement WPTs in practice. Given this lack of understanding, this evidence synthesis is designed to address the research question: managers’ use of WPTs and their impacts on nurse staffing and patient care: what works, for whom, how and in what circumstances?

Methods and analysis :To explain how WPTs may work and in what contexts, we will conduct a realist evidence synthesis through sourcing relevant evidence, and consulting with stakeholders about the impacts of WPTs on health and relevant public service fields. The review will be in 4 phases over 18 months. Phase 1: we will construct an initial theoretical framework that provides plausible explanations of what works about WPTs. Phase 2: evidence retrieval, review and synthesis guided by the theoretical framework; phase 3: testing and refining of programme theories, to determine their relevance; phase 4: formulating actionable recommendations about how WPTs should be implemented in clinical practice.

Ethics and dissemination: Ethical approval has been gained from the study’s institutional sponsors. Ethical review from the National Health Service (NHS) is not required; however research and development permissions will be obtained. Findings will be disseminated through stakeholder engagement and knowledge mobilisation activities. The synthesis will develop an explanatory programme theory of the implementation and impact of nursing WPTs, and practical guidance for nurse managers.

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Dietary recommendations

As part of the Eatwell Guide policy tool, Public Health England has published Government dietary recommendations: government recommendations for food energy and nutrients for males and females aged 1-18 years and 19+ years.

This document provides the government’s recommendations for food energy and nutrients for the general population. Anyone with a medical condition should consult their GP or a registered dietitian for dietary advice.

Related: The Eatwell Guide

 

Local commissioning of community pharmacy services

The Royal Pharmaceutical Society has published Good practice examples: commissioning of community pharmacists outside of the core contract.

This document contains 13 examples showing community pharmacy services can integrate with the wider primary care and community health system. The examples cover working with GP practice, patients with long term conditions and mental health issues, enhanced out of hours provision, domiciliary care, pharmacists in GP Out of Hours services and support for health and social care integration.

Read the full document here

Improving the transition from primary care for people with neurological conditions

A report from the Neurological Alliance finds that GPs in England lack confidence in the care for people with neurological conditions.

GPs expressed doubts about the ability of local services and systems to manage neurology patients effectively and concern over unnecessary delays. The report sets out eight recommendations aimed at improving the primary care pathway for people with neurological conditions, including a call for the development of a “watch list” of the ten signs and symptoms GPs should be aware of during patient interactions in primary care settings.

Image source: http://www.neural.org.uk/

Read the full report here

Digital resource for carers

Carers UK has launched the Digital Resource for Carers, a solution that combines their own digital products and online resources with links to local information and support, providing a comprehensive online tool for carers’

The Digital Resource for Carers includes:

• About Me: building resilience for carers: an e-learning resource that helps carers identify and build networks of support and promotes their self-care.
• Jointly: a care co-ordination app for people sharing care.
• The role of good nutrition when caring for someone: an e-learning course that aims to help carers understand the role of nutrition both for themselves as well as the person they are looking after.
• Upfront Guide to Caring: a simple assessment tool to guide people new to caring or seeking support for the first time to navigate the Carers UK website.
• Looking after someone: Carers Rights Guide: which helps carers understand their rights as a carer and where to go for financial or practical help.
• Being Heard: a self-advocacy guide for carers: which helps carers develop the skills to self-advocate.

Download the brief guide to the Digital Resource for Carers for detailed information.

 

mage source: http://www.carersuk.org

Securing meaningful choice for patients: CCG planning and improvement guide

NHS England and NHS Improvement

This guide is intended to help CCGs comply with their duty to enable patients to make choices and to promote the involvement of patients in decision about their care and treatment.

The guide sets out a number of enablers for patient choice, and actions that can be taken to deliver each of these.The enablers are as follows:

1. Patients are aware of their choices, including their legal rights, and actively seek and take up the choices available to them

2. GPs/referrers are aware of, and want to support patients in exercising, the choices available to them

3. Patients and GPs/referrers have the relevant information to help patients make choices about their care and treatment

4. Commissioners and providers build choice into their commissioning plans, contracting arrangements and provision

5. Choice is embedded in referral models, protocols and clinical pathways; 6. Assurance and enforcement.

CCGs are encouraged to self-asses against these actions and develop an improvement plan to maximise opportunities for choice.

Image source: http://www.england.nhs.uk

Healthier food procurement

The Local Government Association has published Healthier food procurement.

Obesity is one of the most important public health issues currently being addressed by this country. It is a cause of chronic disease leading to early death. Two-thirds of English adults, more than one fifth of four to five-year old children and more than a third of 10 to 11-year-olds are obese or overweight.

This document provides details of the health challenge around obesity, the importance of diet, dietary advice and includes case studies covering local authority initiatives on healthier vending, ensuring healthier food and snacks are available in NHS organisations, healthier catering and making school foods healthier.

Download the document here

Poverty and mental health

The Mental Health Foundation has published Poverty and mental health: a review to inform the Joseph Rowntree Foundation’s anti-poverty strategy.

Image source: http://www.mentalhealth.org.uk

There is a close link between poverty and mental health: poverty can be a cause or consequence of mental ill health. There are a complex set of environmental factors which can significantly affect mental health and getting to the root of the problem requires engagement with this complexity.

This paper presents a conceptual framework for understanding the relationship between poverty and mental health and offers recommendations to improve the situation across the life course.

Tailored end-of-life care

In this case study from Leeds Teaching Hospitals NHS Trust,  find out how tailored training has helped staff to gain skills and confidence in:

Image source: http://www.nhsemployers.org/

• symptom management for patients
• facilitating end-of-life care at home
• recognising end of life
• knowledge of community services

Read previous end-of-life care case studies showing the different approaches that trusts use to deliver training.