Dataset Information

Interventions by healthcare professionals to improve management of physical long-term conditions in adults who are homeless: a systematic review protocol.

ABSTRACT:

Introduction

People experiencing homelessness are at increased risk of, and have poorer outcomes from, a range of physical long-term conditions (LTCs). It is increasingly recognised that interventions targeting people who are homeless should be tailored to the specific needs of this population. This systematic review aims to identify, describe and appraise trials of interventions that aim to manage physical LTCs in homeless adults and are delivered by healthcare professionals.

Methods and analysis

Seven electronic databases (Medline, EMBASE, Cochrane Central Register of Controlled Trials, Assia, Scopus, PsycINFO and CINAHL) will be searched from 1960 (or inception) to October 2016 and supplemented by forward citation searching, handsearching of reference lists and searching grey literature. Two reviewers will independently review titles, abstract and full-texts using DistillerSR software. Inclusion criteria include (1) homeless adults with any physical LTC, (2) interventions delivered by a healthcare professional (any professional trained to provide any form of healthcare, but excluding social workers and professionals without health-related training), (3) comparison with usual care or an alternative intervention, (4) report outcomes such as healthcare usage, physical and psychological health or well-being or cost-effectiveness, (5) randomised controlled trials, non-randomised controlled trials, controlled before-after studies. Quality will be assessed using the Cochrane EPOC Risk of Bias Tool. A meta-analysis will be performed if sufficient data are identified; however, we anticipate a narrative synthesis will be performed.

Ethics and dissemination

This review will synthesise existing evidence for interventions delivered by healthcare professionals to manage physical LTCs in adults who are homeless. The findings will inform the development of future interventions and research aiming to improve the management of LTCs for people experiencing homelessness. Ethical approval will not be required for this systematic review as it does not contain individual patient data. We will disseminate the results of this systematic review via conference presentations, healthcare professional networks, social media and peer-reviewed publication.

Trial registration number

PROSPERO registration number: CRD42016046183.

SUBMITTER: Hanlon P

PROVIDER: S-EPMC5629632 | biostudies-literature | 2017 Aug

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Interventions by healthcare professionals to improve management of physical long-term conditions in adults who are homeless: a systematic review protocol.

Hanlon Peter P Yeoman Lynsey L Esiovwa Regina R Gibson Lauren L Williamson Andrea E AE Mair Frances S FS Lowrie Richard R

BMJ open 20170821 8

<h4>Introduction</h4>People experiencing homelessness are at increased risk of, and have poorer outcomes from, a range of physical long-term conditions (LTCs). It is increasingly recognised that interventions targeting people who are homeless should be tailored to the specific needs of this population. This systematic review aims to identify, describe and appraise trials of interventions that aim to manage physical LTCs in homeless adults and are delivered by healthcare professionals.<h4>Methods ...[more]

PMID: 28827259

Similar Datasets

Project description:OBJECTIVE:Identify, describe and appraise trials of interventions delivered by healthcare professionals to manage non-communicable diseases (NCDs) and communicable diseases that require long-term care or treatment (LT-CDs), excluding mental health and substance use disorders, in homeless adults. DESIGN:Systematic review of randomised controlled trials (RCTs), non-RCTs and controlled before-after studies. Interventions characterised using Effective Practice and Organisation of Care (EPOC) taxonomy. Quality assessed using EPOC risk of bias criteria. DATA SOURCES:Database searches (MEDLINE, Embase, PsycINFO, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Applied Social Sciences Index and Abstracts (ASSIA) and Cochrane Central Register of Controlled Trials), hand searching reference lists, citation searches, grey literature and contact with study authors. SETTING:Community. PARTICIPANTS:Adults (?18 years) fulfilling European Typology of Homelessness criteria. INTERVENTION:Delivered by healthcare professionals managing NCD and LT-CDs. OUTCOMES:Primary outcome: unscheduled healthcare utilisation. SECONDARY OUTCOMES:mortality, biological markers of disease control, adherence to treatment, engagement in care, patient satisfaction, knowledge, self-efficacy, quality of life and cost-effectiveness. RESULTS:11 studies were included (8 RCTs, 2 quasi-experimental and 1 feasibility) involving 9-520 participants (67%-94%?male, median age 37-49 years). Ten from USA and one from UK. Studies included various NCDs (n=3); or focused on latent tuberculosis (n=4); HIV (n=2); hepatitis C (n=1) or type 2 diabetes (n=1). All interventions were complex with multiple components. Four described theories underpinning intervention. Three assessed unscheduled healthcare utilisation: none showed consistent reduction in hospitalisation or emergency department attendance. Six assessed adherence to specific treatments, of which four showed improved adherence to latent tuberculosis therapy. Three concerned education case management, all of which improved disease-specific knowledge. No improvements in biological markers of disease (two studies) and none assessed mortality. CONCLUSIONS:Evidence for management of NCD and LT-CDs in homeless adults is sparse. Educational case-management interventions may improve knowledge and medication adherence. Large trials of theory-based interventions are needed, assessing healthcare utilisation and outcomes as well as assessment of biological outcomes and cost-effectiveness.

Project description:IntroductionConscience is central to moral decision making. In the context of morally pluralistic workplaces today, healthcare professionals' conscience may prompt them to make moral decisions to refrain from providing services they morally disagree with. However, such decisions are largely viewed as contentious, giving rise to polarising arguments for and against healthcare professionals' freedom of conscience. Yet, little work has been done to understand and support healthcare professionals' conscience. Instead, the rising polarity related to healthcare professionals' freedom of conscience stems from a central lack of understanding of what conscience is and the relevance it holds for healthcare professionals' clinical practice. Therefore, the degree and extent to which healthcare professionals are supported to understand and use their conscience is unknown. The objective of this review is to critically analyse the scholarly evidence available to ascertain the effectiveness of interventions that support healthcare professionals to understand and use their conscience in care practice.Methods and analysesAt least two reviewers will systematically review 10 interdisciplinary, scholarly databases to examine qualitative, quantitative and mixed-methods studies including clinical trials pertaining to interventions related to conscience for healthcare professionals. Databases to be searched include: the Cochrane Controlled Register of Trials, Medline, EMBASE, PsycINFO, Cumulative Index for Nursing and Allied Health Literature (CINAHL), Academic Search Complete, ATLA Religion Database, Religion and Philosophy Collection, PhilPapers and Scopus. Databases were searched in May 2021. Study screening, selection, extraction and risk of bias assessments on each study using the Mixed Methods Appraisal Tool will be independently conducted by independent reviewers. Descriptive data synthesis will be carried out. Statistical analysis and meta-analysis will be conducted as relevant, based on homogeneity of findings. The quality of the aggregate evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluations criteria.Ethics and disseminationEthical approval is not required for this review. This protocol will not involve individual patient information endangering participant rights. The results will be reported in a peer-reviewed journal and disseminated at conferences.Prospero registration numberCRD42021256943.

Project description:BackgroundLong-Term Conditions are physical health issues which profoundly impact physical and psychological outcomes and have reached epidemic worldwide levels. An increasing evidence-base has developed for utilizing Supported Self-Management to ensure Health, Social Care & Voluntary staff are knowledgeable, skilled, and experienced to enable patients to have the confidence and capability to self-manage their conditions. However, despite Health Psychology theories underpinning chronic care models demonstrating beliefs are crucially associated with intention and behaviour, staff beliefs towards Supported Self-Management have received little attention. Therefore, the study aimed to explore healthcare professionals' beliefs towards Supported Self-Management for Long-Term Conditions using the Theory of Planned Behaviour.MethodsA mixed-methods approach was conducted within a single UK local government authority region in 2 phases: (1) Qualitative focus group of existing Supported Self-Management project staff (N = 6); (2) Quantitative online questionnaire of general Long-Term Conditions staff (N = 58).Results(1) Eighty two utterances over 20 theme sub-codes demonstrated beliefs that Supported Self-Management improves healthcare outcomes, but requires enhancements to patient and senior stakeholder buy-in, healthcare culture-specific tailoring, and organizational policy and resources; (2) Mean scores indicated moderate-strength beliefs that Supported Self-Management achieves positive healthcare outcomes, but weak-strength intentions to implement Supported Self-Management and beliefs it is socially normative and perceived control over implementing it. Crucially, regression analyses demonstrated intentions to implement Supported Self-Management were only associated with beliefs that important others supported it and perceived control over, or by whether it was socially encouraged.ConclusionsHealthcare professionals demonstrated positive attitudes towards Supported Self-Management improving healthcare outcomes. However, intentions towards implementing this approach were low with staff only slightly believing important others (including patients and clinicians) supported it and that they had control over using it. Future Supported Self-Management projects should seek to enhance intention (and consequently behaviour) through targeting beliefs that important others do indeed actually support this approach and that staff have control over implementing it, as well as enhancing social encouragement.

Project description:BackgroundComorbid distress in adolescents and young adults with physical long-term conditions (LTCs) is common but can be difficult to identify and manage. Self-directed self-management interventions to reduce distress and improve wellbeing may be beneficial. It is unknown, however, which intervention characteristics are successful in supporting young people. This rapid review aimed to identify characteristics of self-directed self-management interventions that aimed, in whole or part, to address distress, wellbeing or self-efficacy in this population.MethodsA systematic search was conducted for relevant controlled studies in six databases. Data on study settings, population, intervention characteristics, outcome measures, process measures and summary effects were extracted. The risk of bias was assessed using the Cochrane Risk of Bias tool v1, and the strength of evidence was rated (informed by Grading of Recommendations, Assessment, Development and Evaluations). Patient and public involvement members supported the review process, including interpretation of results. The rapid review was registered with PROSPERO (ID: CRD42021285867).ResultsFourteen studies were included, all of which were randomised trials. Heterogeneity was identified in the health conditions targeted; type of intervention; outcome measures; duration of intervention and follow-up. Three had distress, wellbeing or self-efficacy as their primary outcome. Four modes of delivery were identified across interventions-websites, smartphone applications, text messages and workbooks; and within these, 38 individual components. Six interventions had a significant benefit in mental health, wellbeing or self-efficacy; however, intervention characteristics were similar for beneficial and non-beneficial interventions.ConclusionsThere is a paucity of interventions directly targeting distress and wellbeing in young people with physical LTCs. In those identified, the heterogeneity of interventions and study design makes it difficult to identify which characteristics result in positive outcomes. We propose the need for high-quality, evidence-based self-management interventions for this population; including (1) more detailed reporting of intervention design, content and delivery; (2) robust process evaluation; (3) a core outcome set for measuring mental health and wellbeing for self-management interventions and (4) consistency in follow up periods.Public contributionSeven young people with an LTC were involved throughout the rapid review, from the development of the review protocol where they informed the focus and aims, with a central role in the interpretation of findings.

Project description:IntroductionCoexisting multiple health conditions is common among older people, a population that is increasing globally. The potential for polypharmacy, adverse events, drug interactions and development of additional health conditions complicates prescribing decisions for these patients. Artificial intelligence (AI)-generated decision-making tools may help guide clinical decisions in the context of multiple health conditions, by determining which of the multiple medication options is best. This study aims to explore the perceptions of healthcare professionals (HCPs) and patients on the use of AI in the management of multiple health conditions.Methods and analysisA qualitative study will be conducted using semistructured interviews. Adults (≥18 years) with multiple health conditions living in the West Midlands of England and HCPs with experience in caring for patients with multiple health conditions will be eligible and purposively sampled. Patients will be identified from Clinical Practice Research Datalink (CPRD) Aurum; CPRD will contact general practitioners who will in turn, send a letter to patients inviting them to take part. Eligible HCPs will be recruited through British HCP bodies and known contacts. Up to 30 patients and 30 HCPs will be recruited, until data saturation is achieved. Interviews will be in-person or virtual, audio recorded and transcribed verbatim. The topic guide is designed to explore participants' attitudes towards AI-informed clinical decision-making to augment clinician-directed decision-making, the perceived advantages and disadvantages of both methods and attitudes towards risk management. Case vignettes comprising a common decision pathway for patients with multiple health conditions will be presented during each interview to invite participants' opinions on how their experiences compare. Data will be analysed thematically using the Framework Method.Ethics and disseminationThis study has been approved by the National Health Service Research Ethics Committee (Reference: 22/SC/0210). Written informed consent or verbal consent will be obtained prior to each interview. The findings from this study will be disseminated through peer-reviewed publications, conferences and lay summaries.

Project description:There is a growing need for interventions to improve well-being in healthcare workers, particularly since the onset of COVID-19.ObjectivesTo synthesise evidence since 2015 on the impact of interventions designed to address well-being and burnout in physicians, nurses and allied healthcare professionals.DesignSystematic literature review.Data sourcesMedline, Embase, Emcare, CINAHL, PsycInfo and Google Scholar were searched in May-October 2022.Eligibility criteria for selecting studiesStudies that primarily investigated burnout and/or well-being and reported quantifiable preintervention and postintervention outcomes using validated well-being measures were included.Data extraction and synthesisFull-text articles in English were independently screened and quality assessed by two researchers using the Medical Education Research Study Quality Instrument. Results were synthesised and presented in both quantitative and narrative formats. Meta-analysis was not possible due to variations in study designs and outcomes.ResultsA total of 1663 articles were screened for eligibility, with 33 meeting inclusion criterium. Thirty studies used individually focused interventions, while three were organisationally focused. Thirty-one studies used secondary level interventions (managed stress in individuals) and two were primary level (eliminated stress causes). Mindfulness-based practices were adopted in 20 studies; the remainder used meditation, yoga and acupuncture. Other interventions promoted a positive mindset (gratitude journaling, choirs, coaching) while organisational interventions centred on workload reduction, job crafting and peer networks. Effective outcomes were reported in 29 studies, with significant improvements in well-being, work engagement, quality of life and resilience, and reductions in burnout, perceived stress, anxiety and depression.ConclusionThe review found that interventions benefitted healthcare workers by increasing well-being, engagement and resilience, and reducing burnout. It is noted that the outcomes of numerous studies were impacted by design limitations that is, no control/waitlist control, and/or no post intervention follow-up. Suggestions are made for future research.

Dataset Information

Interventions by healthcare professionals to improve management of physical long-term conditions in adults who are homeless: a systematic review protocol.

Introduction

Methods and analysis

Ethics and dissemination

Trial registration number

Publications

Interventions by healthcare professionals to improve management of physical long-term conditions in adults who are homeless: a systematic review protocol.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets