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3. Hospital to community in Wales: What is the value of optometrists playing a greater role in managing neovascular AMD and glaucoma in primary care?

Author

Ryan, Barbara, Jones, Mari, Anderson, Pippa, Reynolds, Rhiannon, Nicholls, Rebecca E. M., Cullen, Katherine, Davies, Mark, North, Rachel, Molik, Bablin, and Wallace, Carolyn

Subjects
DISCRETE event simulation, MACULAR degeneration, PRIMARY care, ELECTRONIC records, GLAUCOMA, MEDICAL care wait times
Abstract

Purpose: To evaluate the value of enhanced optometric services for managing neovascular age‐related macular degeneration (nAMD) and glaucoma in primary care optometry services, instead of hospital eye services (HES). Methods: Seven enhanced optometric service pathways in primary care in Wales were assessed with a mixed‐methods approach: three for nAMD and four for glaucoma. The methods were a patient‐related experience measure (PREM), a Realist Review and Evaluation involving both patients and staff, a discrete event simulation model estimating the economic impact of the pathways and a workforce survey of optometrists to gauge capability and capacity. Results: Patient‐related experience measure responses (802) indicated that primary care experience was comparable to that of HES. Utilising enhanced optometric services in primary care resulted in reduced wait times compared with HES, with suspected nAMD shortened to 4–5 days and glaucoma monitoring to 5 days. Waiting lists were dramatically reduced with primary care‐based services to just three people waiting for nAMD and five for glaucoma, compared with 216 and 5691 people, respectively, in HES. Consultant ophthalmologist time was reduced from 57% to 15%–16% for nAMD services and from 48% to 22%–23% for glaucoma services. Integrating enhanced optometric services into primary care incurred a similar cost. The workforce survey confirms that optometrists possess the skills and qualifications and are willing to deliver these enhanced optometric services. The Realist Review and Evaluation revealed that clear patient communication, effective coordination and strong interprofessional communication between optometrists and ophthalmologists along with a shared electronic record are crucial to the success of this change. Conclusion: Providing enhanced optometric services in primary care for nAMD and glaucoma brings substantial benefits for the UK National Health Service and patients, including reduced waiting times, waiting lists and released HES capacity. The success of this transition hinges on clear patient communication, administrative co‐ordination and effective interprofessional communication. [ABSTRACT FROM AUTHOR]

Published
2025
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4. A classification of primary care streaming pathways in UK emergency departments: Findings from a multi-methods study comprising cross-sectional survey; site visits with observations, semi-structured and informal interviews

Author

Edwards, Michelle, Cooper, Alison, Hughes, Thomas, Davies, Freya, Sherlock, Rebecca, Anderson, Pippa, Evans, Bridie, Carson-Stevens, Andrew, Cooke, Matthew, Dale, Jeremy, Hibbert, Peter, Harrington, Barbara, Hepburn, Julie, Porter, Alison, Rainer, Timothy, Siriwardena, Aloysius Niroshan, Snooks, Helen, and Edwards, Adrian

Published
2021
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5. Senior clinical and business managers’ perspectives on the influence of different funding mechanisms, and barriers and enablers to implementing models of employing General Practitioners in or alongside emergency departments: Qualitative study

Author

Choudhry, Mazhar, Edwards, Michelle, Cooper, Alison, Anderson, Pippa, Carson-Stevens, Andrew, Cooke, Matthew, Dale, Jeremy, Hibbert, Peter, Hughes, Thomas, Porter, Alison, Rainer, Timothy, Siriwardena, Aloysius Niroshan, and Edwards, Adrian

Published
2021
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6. Grasping the nettle and enduring the pain : healthcare priority setting and disinvestment in the context of prudent healthcare

Author

Anderson, Pippa, Phillips, Ceri, and Fitzsimmons, Deborah

Abstract

Since the financial crisis of 2008 economic pressures mean that healthcare budgets were and still are substantially constrained. The NHS in Wales has had to face the reality of rationing healthcare. Implementation of fair and equitable rationing is a challenge, however. This is a situation where the economic concepts of scarcity, opportunity cost and the margin can support effective prioritisation and resource reallocation decisions. In this context, the aim of this research was to develop pragmatic prioritisation and resource reallocation frameworks for the Welsh Health Specialised Services Committee (WHSSC) who commission highly specialised technologies for Wales and commissioning boards in Abertawe Bro Morgannwg University Health Board (ABMUHB). The prioritisation and resource reallocation methods for WHSSC were developed over a series of prioritisation meetings resulting in a framework based on based on multi-criteria decision analysis methods. In ABMUHB, programme budgeting marginal analysis (PBMA) was the approach used and two pilot PBMAs run in different service areas. Disinvestment and 'doing less' to invest in more beneficial activities within budget were accomplished in one pilot project; the other project managed resource reallocation but revealed issues in achieving service standards. Both pilots enabled development of a PBMA Framework for ABMUHB. Group decision support methods were an important feature of implementation of decision making in all three projects. The research conducted for this thesis has shown it has been possible to develop and deliver robust, evidence based, effective and practical frameworks based on economic concepts for prioritisation, disinvestment and resource reallocation. Both organisations have taken 'ownership' of the frameworks and will make them a 'way of working' for the future rather than an academic exercise. A key learning of the research was that pragmatism must prevail if prioritisation and resource reallocation methods are to gain traction and become embedded in commissioning.

Published
2017
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7. Evaluation of different models of general practitioners working in or alongside emergency departments: a mixed-methods realist evaluation

Author

Davies, Freya, primary, Edwards, Michelle, additional, Price, Delyth, additional, Anderson, Pippa, additional, Carson-Stevens, Andrew, additional, Choudhry, Mazhar, additional, Cooke, Matthew, additional, Dale, Jeremy, additional, Donaldson, Liam, additional, Evans, Bridie Angela, additional, Harrington, Barbara, additional, Harris, Shaun, additional, Hepburn, Julie, additional, Hibbert, Peter, additional, Hughes, Thomas, additional, Hussain, Faris, additional, Islam, Saiful, additional, Pockett, Rhys, additional, Porter, Alison, additional, Siriwardena, Aloysius Niroshan, additional, Snooks, Helen, additional, Watkins, Alan, additional, Edwards, Adrian, additional, and Cooper, Alison, additional

Published
2024
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8. Programme theories to describe how different general practitioner service models work in different contexts in or alongside emergency departments (GPED): realist evaluation.

Author

Cooper, Alison, Edwards, Michelle, Davies, Freya, Price, Delyth, Anderson, Pippa, Stevens, Andrew Carson, Cooke, Matthew, Dale, Jeremy, Donaldson, Liam, Evans, Bridie Angela, Harrington, Barbara, Hepburn, Julie, Hughes, Peter HibbertThomas C., Porter, Alison, Siriwardena, Aloysius Niroshan, Watkins, Alan, and Snooks, Helen

Published
2024
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10. Emergency department clinical leads’ experiences of implementing primary care services where GPs work in or alongside emergency departments in the UK: a qualitative study

Author

Edwards, Michelle, Cooper, Alison, Davies, Freya, Sherlock, Rebecca, Carson-Stevens, Andrew, Price, Delyth, Porter, Alison, Evans, Bridie, Islam, Saiful, Snooks, Helen, Anderson, Pippa, Siriwardena, Aloysius Niroshan, Hibbert, Peter, Hughes, Thomas, Cooke, Matthew, Dale, Jeremy, and Edwards, Adrian

Published
2020
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12. Programme theories to describe how different general practitioner service models work in different contexts in or alongside emergency departments (GP-ED): realist evaluation

Author

Cooper, Alison, Edwards, Michelle, Davies, Freya, Price, Delyth, Anderson, Pippa, Carson-Stevens, Andrew, Cooke, Matthew, Dale, Jeremy, Donaldson, Liam, Evans, Bridie Angela, Harrington, Barbara, Hepburn, Julie, Hibbert, Peter, Hughes, Thomas C, Porter, Alison, Siriwardena, Aloysius Niroshan, Watkins, Alan, Snooks, Helen, and Edwards, Adrian

Abstract

BackgroundAddressing increasing patient demand and improving ED patient flow is a key ambition for NHS England. Delivering general practitioner (GP) services in or alongside EDs (GP-ED) was advocated in 2017 for this reason, supported by £100 million (US$130 million) of capital funding. Current evidence shows no overall improvement in addressing demand and reducing waiting times, but considerable variation in how different service models operate, subject to local context.MethodsWe conducted mixed-methods analysis using inductive and deductive approaches for qualitative (observations, interviews) and quantitative data (time series analyses of attendances, reattendances, hospital admissions, length of stay) based on previous research using a purposive sample of 13 GP-ED service models (3 inside-integrated, 4 inside-parallel service, 3 outside-onsite and 3 with no GPs) in England and Wales. We used realist methodology to understand the relationship between contexts, mechanisms and outcomes to develop programme theories about how and why different GP-ED service models work.ResultsGP-ED service models are complex, with variation in scope and scale of the service, influenced by individual, departmental and external factors. Quantitative data were of variable quality: overall, no reduction in attendances and waiting times, a mixed picture for hospital admissions and length of hospital stay. Our programme theories describe how the GP-ED service models operate: inside the ED, integrated with patient flow and general ED demand, with a wider GP role than usual primary care; outside the ED, addressing primary care demand with an experienced streaming nurse facilitating the ‘right patients’ are streamed to the GP; or within the ED as a parallel service with most variability in the level of integration and GP role.ConclusionGP-ED services are complex . Our programme theories inform recommendations on how services could be modified in particular contexts to address local demand, or whether alternative healthcare services should be considered.

Published
2024
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13. If you build it, will they come? Realist analysis of whether Emergency Departments with primary care services generate ‘provider-induced demand’.

Author

Joy, McFadzean Isobel, primary, Edwards, Michelle, additional, Davies, Freya, additional, Cooper, Alison, additional, Price, Delyth, additional, Carson-Stevens, Andrew, additional, Hughes, Thomas, additional, Porter, Alison, additional, Harrington, Barbara, additional, Evans, Bridie Angela, additional, Siriwardena, Aloysius Niroshan, additional, Anderson, Pippa, additional, Edwards, Adrian, additional, and Dale, Jeremy, additional

Published
2022
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17. PP19 Primary care streaming in emergency departments- contexts and mechanisms associated with perceived effectiveness outcomes: a realist evaluation

Author

Edwards, Michelle, primary, Cooper, Alison, additional, Davies, Freya, additional, Stevens, Andrew Carson, additional, Edwards, Adrian, additional, Hughes, Thomas, additional, Snooks, Helen, additional, Anderson, Pippa, additional, Porter, Alison, additional, Evans, Bridie, additional, Dale, Jeremy, additional, Cooke, Matthew, additional, Hibbert, Peter, additional, and Siriwardena, Aloysius Niroshan, additional

Published
2021
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18. PP18 Is there provider induced demand at emergency departments with primary care services? Patient, local and wider system factors described to influence demand for primary care in emergency departments: realist evaluation

Author

Edwards, Michelle, primary, Cooper, Alison, additional, Stevens, Andrew Carson, additional, Edwards, Adrian, additional, Hughes, Thomas, additional, Snooks, Helen, additional, Anderson, Pippa, additional, Porter, Alison, additional, Evans, Bridie, additional, Dale, Jeremy, additional, Cooke, Matthew, additional, Hibbert, Peter, additional, and Siriwardena, Aloysius Niroshan, additional

Published
2021
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20. Identifying safe care processes when GPs work in or alongside emergency departments: a realist evaluation

Author

Cooper, Alison, primary, Carson-Stevens, Andrew, additional, Edwards, Michelle, additional, Davies, Freya, additional, Donaldson, Liam J, additional, Anderson, Pippa, additional, Cooke, Matthew, additional, Dale, Jeremy, additional, Evans, Bridie Angela, additional, Harrington, Barbara, additional, Hepburn, Julie, additional, Hibbert, Peter, additional, Hughes, Thomas, additional, Porter, Alison, additional, Siriwardena, Aloysius Niroshan, additional, Snooks, Helen, additional, and Edwards, Adrian, additional

Published
2021
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28. Additional file 1 of Emergency department clinical leads’ experiences of implementing primary care services where GPs work in or alongside emergency departments in the UK: a qualitative study

Author

Edwards, Michelle, Cooper, Alison, Davies, Freya, Sherlock, Rebecca, Carson-Stevens, Andrew, Price, Delyth, Porter, Alison, Evans, Bridie, Saiful Islam, Snooks, Helen, Anderson, Pippa, Siriwardena, Aloysius Niroshan, Hibbert, Peter, Hughes, Thomas, Cooke, Matthew, Dale, Jeremy, and Edwards, Adrian

Subjects
Data_FILES
Abstract

Additional file 1. Key informant interview questions.

Published
2020
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29. Chronic Conditions and Behavioural Change Approaches to Medication Adherence: Rethinking Clinical Guidance and Recommendations

Author

Read, Simon, Morgan, James, Gillespie, David, Nollett, Claire, Weiss, Marjorie, Allen, Davina, Anderson, Pippa, and Waterman, Heather

Subjects
RM, knowledge translation, Patient Preference and Adherence, behavioural change, H1, clinical guidance, RE, adherence, chronic conditions, RA, RS, Perspectives
Abstract

Simon Read,1 James Morgan,2 David Gillespie,3 Claire Nollett,3 Marjorie Weiss,4 Davina Allen,1 Pippa Anderson,5 Heather Waterman1 1School of Healthcare Sciences, Cardiff University, Cardiff, Wales, UK; 2Cardiff and Vale University Health Board, Cardiff, Wales, UK; 3Centre for Trials Research, Cardiff University, Cardiff, Wales, UK; 4School of Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK; 5Swansea Centre for Health Economics, Swansea University, Swansea, Wales, UKCorrespondence: Simon ReadCardiff University, Room 12.14, Eastgate House, 35-43 Newport Road, Cardiff CF24 0AB, Wales, UKTel +44 2920 688930Email readsm@cardiff.ac.ukAbstract: Patient adherence to medication is an ongoing concern for clinicians, obfuscating treatment efficacy and resulting in wastage of medicine, reduced clinical benefit, and increased mortality. Despite this, procedural guidance on how clinicians should best engage patients regarding their medicine-taking is limited in the United Kingdom. Adherence for chronic conditions is notably complex, requiring clear education, communication, and behavioural shifts to initiate and sustain daily regimens successfully. This article explores current clinician guidance on assuring patient adherence to medication within the National Health Service, comparing it to that provided for healthcare workers in the field of behavioural change. Outlining the inertia of the former and the progress of the latter, we consider what steps should be taken to address this deficit, including greater focus on patient concerns, as well as knowledge translation for healthcare professionals in future adherence research. Current United Kingdom clinical guidance for assuring patient adherence is largely outdated based on inconclusive evidence for best practice. However, efforts to encourage behavioural change in the public health setting demonstrate evidence-based success. Integrating knowledge generated around adherence behaviour and the practical application of adherence and behavioural change research, as well as funding for longer-term studies with a focus on clinical outcomes, may help to solidify the NICE guidance on adherence and further progress the field. This would require close involvement from patient groups and networks informing ethical aspects of study design and clinical implementation.Keywords: adherence, chronic conditions, behavioural change, clinical guidance, knowledge translation

Published
2019

30. Wet Age Related Macular Degeneration services in the community: A pathfinder evaluation - Final Report

Author

North, Rachel, Anderson, Pippa, Harris, Shaun, Kenkre, Joyce, Wallace, Sarah, and Wallace, Carolyn

Subjects
genetic structures, sense organs, eye diseases
Abstract

This report summarises our evaluation of four different pathfinder services for people with wet Age Related Macular Degeneration (wet AMD). They are provided in the community setting rather than the hospital. Based on our findings we make recommendations about the delivery and sustainability for the future of such community based services for people with wet AMD in Wales.

Published
2019

31. Chronic Conditions and Behavioural Change Approaches to Medication Adherence: Rethinking Clinical Guidance and Recommendations

Author

Read,Simon, Morgan,James, Gillespie,David, Nollett,Claire, Weiss,Marjorie, Allen,Davina, Anderson,Pippa, Waterman,Heather, Read,Simon, Morgan,James, Gillespie,David, Nollett,Claire, Weiss,Marjorie, Allen,Davina, Anderson,Pippa, and Waterman,Heather

Abstract

Simon Read,1 James Morgan,2 David Gillespie,3 Claire Nollett,3 Marjorie Weiss,4 Davina Allen,1 Pippa Anderson,5 Heather Waterman1 1School of Healthcare Sciences, Cardiff University, Cardiff, Wales, UK; 2Cardiff and Vale University Health Board, Cardiff, Wales, UK; 3Centre for Trials Research, Cardiff University, Cardiff, Wales, UK; 4School of Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK; 5Swansea Centre for Health Economics, Swansea University, Swansea, Wales, UKCorrespondence: Simon ReadCardiff University, Room 12.14, Eastgate House, 35-43 Newport Road, Cardiff CF24 0AB, Wales, UKTel +44 2920 688930Email readsm@cardiff.ac.ukAbstract: Patient adherence to medication is an ongoing concern for clinicians, obfuscating treatment efficacy and resulting in wastage of medicine, reduced clinical benefit, and increased mortality. Despite this, procedural guidance on how clinicians should best engage patients regarding their medicine-taking is limited in the United Kingdom. Adherence for chronic conditions is notably complex, requiring clear education, communication, and behavioural shifts to initiate and sustain daily regimens successfully. This article explores current clinician guidance on assuring patient adherence to medication within the National Health Service, comparing it to that provided for healthcare workers in the field of behavioural change. Outlining the inertia of the former and the progress of the latter, we consider what steps should be taken to address this deficit, including greater focus on patient concerns, as well as knowledge translation for healthcare professionals in future adherence research. Current United Kingdom clinical guidance for assuring patient adherence is largely outdated based on inconclusive evidence for best practice. However, efforts to encourage behavioural change in the public health setting demonstrate evidence-based success. Integrating knowledge generated around adherence behaviour and the practical application

Published
2020

33. The impact of general practitioners working in or alongside emergency departments: a rapid realist review

Author

Cooper, Alison, primary, Davies, Freya, additional, Edwards, Michelle, additional, Anderson, Pippa, additional, Carson-Stevens, Andrew, additional, Cooke, Matthew W, additional, Donaldson, Liam, additional, Dale, Jeremy, additional, Evans, Bridie Angela, additional, Hibbert, Peter D, additional, Hughes, Thomas C, additional, Porter, Alison, additional, Rainer, Tim, additional, Siriwardena, Aloysius, additional, Snooks, Helen, additional, and Edwards, Adrian, additional

Published
2019
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34. cre-2017-6520-File002_(1) – Supplemental material for Home-based pre-surgical psychological intervention for knee osteoarthritis (HAPPiKNEES): a feasibility randomized controlled trial

Author

Nair, Roshan Das, Mhizha-Murira, Jacqueline R, Anderson, Pippa, Carpenter, Hannah, Clarke, Simon, Groves, Sam, Leighton, Paul, Scammell, Brigitte E, Gogem Topcu, Walsh, David A, and Nadina B Lincoln

Subjects
FOS: Clinical medicine, 110604 Sports Medicine, FOS: Health sciences, 110904 Neurology and Neuromuscular Diseases, 110314 Orthopaedics
Abstract

Supplemental material, cre-2017-6520-File002_(1) for Home-based pre-surgical psychological intervention for knee osteoarthritis (HAPPiKNEES): a feasibility randomized controlled trial by Roshan das Nair, Jacqueline R Mhizha-Murira, Pippa Anderson, Hannah Carpenter, Simon Clarke, Sam Groves, Paul Leighton, Brigitte E Scammell, Gogem Topcu, David A Walsh and Nadina B Lincoln in Clinical Rehabilitation

Published
2018
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35. The Health and Economic Impacts of Structural Energy Performance Investments in Wales: An Evaluation of the Arbed Programme

Author

Johnson, Rhodri, Rodgers, Sarah, Watkins, Alan, Poortinga, Wouter, Grey, Charlotte, Jiang, Shiyu, Anderson, Pippa, and Lyons, Ronan A

Subjects
lcsh:HB848-3697, lcsh:Demography. Population. Vital events, Article
Abstract

Objectives Over £68M was invested in a housing regeneration programme (Arbed) in 2010-2011 to improve the energy performance of houses in a number of deprived areas across Wales. Houses within the areas were retrofitted with measures, such as external wall insulation, solar hot water systems, solar panels and air source heat pumps. The study aims to establish whether such interventions improve residents’ physical and mental health, and the economic impact of change in health outcomes. Approach Address and intervention data were collected from 28 administrative centres and anonymously linked within the SAIL (Secure Anonymised Information Linkage) databank. Two comparator groups were created, one consisting of social houses, another from properties situated in the most deprived areas of Wales. Individuals with continuous residence of at least 60 days over a 10 year period were selected to create a dynamic cohort. Data on emergency hospital admissions and primary care records were extracted from SAIL to assess the impact of investments on healthcare utilisation for cardiovascular and respiratory conditions. Healthcare utilisation data also contributed towards an economic evaluation and excess winter admissions analyses. Results The final dataset comprises data from over half a million people contributing more than 3 million person years of exposure time to build up trends of hospital admissions across the study period. The intervention cohort consists of over 35,000 people, with about 7,000 separate hospital admissions recorded for our primary outcome. The analysis is based on a pooled time series regression using a difference-in-difference approach to estimate the health impact of the programme. Conclusion Retrospective analysis of such a natural experiment using routinely collected health data is possible using data linkage techniques. Final results will show whether social programmes to improve energy efficiency to homes in fuel poor areas have a wider impact on the healthcare resource utilisation of residents. We discuss the requirement for more standardised, accurate and timely data capture at the time of such economic investments to ensure the future feasibility of such studies. This project was funded by the National Institute for Health Research, Public Health Research (PHR) program (project number 11/3020/05) (http://www.nets.nihr.ac.uk/projects/phr/11302005).

Published
2017

36. Health impact, and economic value, of meeting housing quality standards: a retrospective longitudinal data linkage study

Author

Rodgers, Sarah E, primary, Bailey, Rowena, additional, Johnson, Rhodri, additional, Poortinga, Wouter, additional, Smith, Robert, additional, Berridge, Damon, additional, Anderson, Pippa, additional, Phillips, Ceri, additional, Lannon, Simon, additional, Jones, Nikki, additional, Dunstan, Frank D, additional, Morgan, Jonathan, additional, Evans, Sandra Y, additional, Every, Pam, additional, and Lyons, Ronan A, additional

Published
2018
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38. Home-based pre-surgical psychological intervention for knee osteoarthritis (HAPPiKNEES): a feasibility randomized controlled trial

Author

das Nair, Roshan, primary, Mhizha-Murira, Jacqueline R, additional, Anderson, Pippa, additional, Carpenter, Hannah, additional, Clarke, Simon, additional, Groves, Sam, additional, Leighton, Paul, additional, Scammell, Brigitte E, additional, Topcu, Gogem, additional, Walsh, David A, additional, and Lincoln, Nadina B, additional

Published
2018
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40. Debt Counselling for Depression in Primary Care: an adaptive randomised controlled pilot trial (DeCoDer study)

Author

Gabbay, Mark B, primary, Ring, Adele, additional, Byng, Richard, additional, Anderson, Pippa, additional, Taylor, Rod S, additional, Matthews, Caryn, additional, Harris, Tirril, additional, Berry, Vashti, additional, Byrne, Paula, additional, Carter, Elliot, additional, Clarke, Pam, additional, Cocking, Laura, additional, Edwards, Suzanne, additional, Emsley, Richard, additional, Fornasiero, Mauro, additional, Frith, Lucy, additional, Harris, Shaun, additional, Huxley, Peter, additional, Jones, Siw, additional, Kinderman, Peter, additional, King, Michael, additional, Kosnes, Liv, additional, Marshall, Daniel, additional, Mercer, Dave, additional, May, Carl, additional, Nolan, Debbie, additional, Phillips, Ceri, additional, Rawcliffe, Tim, additional, Sardani, Alexandra V, additional, Shaw, Elizabeth, additional, Thompson, Sam, additional, Vickery, Jane, additional, Wainman, Brian, additional, and Warner, Mark, additional

Published
2017
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43. Investigating the feasibility of an enhanced contact intervention in self-harm and suicidal behaviour: a protocol for a randomised controlled trial delivering a Social support and Wellbeing Intervention following Self Harm (SWISH)

Author

Ahmed, Nilufar, primary, John, Ann, additional, Islam, Saiful, additional, Jones, Richard, additional, Anderson, Pippa, additional, Davies, Charlotte, additional, Khanom, Ashra, additional, Harris, Shaun, additional, and Huxley, Peter, additional

Published
2016
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