Using an email advice line to connect care for children

Montgomery-Taylor, Sarah; Cotton, Rachel; Manek, Nishma; Watson, Mando; Klaber, Robert

doi:10.1136/archdischild-2015-308199

Cited by 4 publications

(7 citation statements)

References 4 publications

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“…185 Furthermore, the joint GP consultant clinics have reduced the follow-up rate, which is attributed to the presence of the GP in the consultation, allowing a joint plan to be agreed, and the awareness of easy connectivity for further paediatric input, should it be needed. Improved connectivity to specialist advice through the use of e-mail or telephone has shown a substantial opportunity to reduce the number of patients who are seen in outpatient clinics, 174,186 support the GP's management of the patient in primary care and identify potentially unnecessary referrals. 186 Similarly, where consultants have supported staff to work in extended roles through training sessions and ongoing support (telephone and by e-mail), a decrease in referrals has been reported, returning to pre-pilot levels after the pilot had finished.…”

Section: Cost-effectivenessmentioning

confidence: 99%

“…Improved connectivity to specialist advice through the use of e-mail or telephone has shown a substantial opportunity to reduce the number of patients who are seen in outpatient clinics, 174,186 support the GP's management of the patient in primary care and identify potentially unnecessary referrals. 186 Similarly, where consultants have supported staff to work in extended roles through training sessions and ongoing support (telephone and by e-mail), a decrease in referrals has been reported, returning to pre-pilot levels after the pilot had finished. 187 Specialist advice can also help to guide the referral to the most appropriate specialist for patients who are not suitable for community-based care, assisting the patient in getting to the right professional first time, saving duplicate appointments.…”

Section: Cost-effectivenessmentioning

confidence: 99%

“…187 Specialist advice can also help to guide the referral to the most appropriate specialist for patients who are not suitable for community-based care, assisting the patient in getting to the right professional first time, saving duplicate appointments. 186…”

Section: Cost-effectivenessmentioning

confidence: 99%

“…188 Physicians and nurses also report consistently high levels of satisfaction in response to pharmacists 159 and physician associates 166,181 working in primary care, and GPs using consultant e-mail advice highly value the ease of access and efficiency of the response. 186 Physician associates have also proved to be a flexible workforce resource to cover the work of nurses in the case of absence. 189 COMMUNITY-BASED, CO-ORDINATED CARE IS MORE ACCESSIBLE NIHR Journals Library www.journalslibrary.nihr.ac.uk…”

Section: Staff and Provider Experiencementioning

confidence: 99%

“…179 Funding will also provide diagnostics in the community where necessary. 187 As for adopting COMMUNITY-BASED, CO-ORDINATED CARE IS MORE ACCESSIBLE NIHR Journals Library www.journalslibrary.nihr.ac.uk new roles, the ability to embed new roles and the resources of funding and training provide primary care professionals with both the experience 149 and the confidence (reasoning) 179,186 to diagnose or treat more complex patients themselves in primary care, without onward referral to a hospital (outcome). 179,187 Similarly, notwithstanding limited evidence on care navigation in community-based settings, receptionists who are trained in care navigation (resource) and have increased awareness and knowledge of alternative services (reasoning), could facilitate a direct referral to new services, avoiding a GP consultation (outcome).…”

Section: Staff Factorsmentioning

confidence: 99%

See 4 more Smart Citations

The international knowledge base for new care models relevant to primary care-led integrated models: a realist synthesis

Turner¹,

Mulla²,

Aldridge³

et al. 2018

Health Serv Deliv Res

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BackgroundThe Multispecialty Community Provider (MCP) model was introduced to the NHS as a primary care-led, community-based integrated care model to provide better quality, experience and value for local populations.ObjectivesThe three main objectives were to (1) articulate the underlying programme theories for the MCP model of care; (2) identify sources of theoretical, empirical and practice evidence to test the programme theories; and (3) explain how mechanisms used in different contexts contribute to outcomes and process variables.DesignThere were three main phases: (1) identification of programme theories from logic models of MCP vanguards, prioritising key theories for investigation; (2) appraisal, extraction and analysis of evidence against a best-fit framework; and (3) realist reviews of prioritised theory components and maps of remaining theory components.Main outcome measuresThe quadruple aim outcomes addressed population health, cost-effectiveness, patient experience and staff experience.Data sourcesSearches of electronic databases with forward- and backward-citation tracking, identifying research-based evidence and practice-derived evidence.Review methodsA realist synthesis was used to identify, test and refine the following programme theory components: (1) community-based, co-ordinated care is more accessible; (2) place-based contracting and payment systems incentivise shared accountability; and (3) fostering relational behaviours builds resilience within communities.ResultsDelivery of a MCP model requires professional and service user engagement, which is dependent on building trust and empowerment. These are generated if values and incentives for new ways of working are aligned and there are opportunities for training and development. Together, these can facilitate accountability at the individual, community and system levels. The evidence base relating to these theory components was, for the most part, limited by initiatives that are relatively new or not formally evaluated. Support for the programme theory components varies, with moderate support for enhanced primary care and community involvement in care, and relatively weak support for new contracting models.Strengths and limitationsThe project benefited from a close relationship with national and local MCP leads, reflecting the value of the proximity of the research team to decision-makers. Our use of logic models to identify theories of change could present a relatively static position for what is a dynamic programme of change.ConclusionsMultispecialty Community Providers can be described as complex adaptive systems (CASs) and, as such, connectivity, feedback loops, system learning and adaptation of CASs play a critical role in their design. Implementation can be further reinforced by paying attention to contextual factors that influence behaviour change, in order to support more integrated working.Future workA set of evidence-derived ‘key ingredients’ has been compiled to inform the design and delivery of future iterations of population health-based models of care. Suggested priorities for future research include the impact of enhanced primary care on the workforce, the effects of longer-term contracts on sustainability and capacity, the conditions needed for successful continuous improvement and learning, the role of carers in patient empowerment and how community participation might contribute to community resilience.Study registrationThis study is registered as PROSPERO CRD42016039552.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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