To determine the diagnostic accuracy of the Whooley questions in the identification of depression... more To determine the diagnostic accuracy of the Whooley questions in the identification of depression; and, to examine the effect of an additional 'help' question. Systematic review with random effects bivariate diagnostic meta-analysis. Search strategies included electronic databases, examination of reference lists, and forward citation searches. Studies were included that provided sufficient data to calculate the diagnostic accuracy of the Whooley questions against a gold standard diagnosis of major depression. Descriptive information, methodological quality criteria, and 2×2 contingency tables were extracted. Ten studies met inclusion criteria. Pooled sensitivity was 0.95 (95% CI 0.88 to 0.97) and pooled specificity was 0.65 (95% CI 0.56 to 0.74). Heterogeneity was low (I(2)=24.1%). Primary care subgroup analysis gave broadly similar results. Four of the ten studies provided information on the effect of an additional help question. The addition of this question did not consistently improve specificity while retaining high sensitivity as reported in the original validation study. The two-item Whooley questions have high sensitivity and modest specificity in the detection of depression. The current evidence for the use of an additional help question is not consistent and there is, as yet, insufficient data to recommend its use for screening or case finding. CRD42014009695.
Journal of health services research & policy, Jan 20, 2015
To assess what is known about effective patient and public engagement in health service reconfigu... more To assess what is known about effective patient and public engagement in health service reconfiguration processes and identify implications for further research and health care practice. Rapid systematic review of published and grey literature to identify methods or approaches to engagement in decisions about health service reconfiguration; and to examine how engagement has worked or not worked in specific examples of system change. Following a search for literature published in English from 2000 to March 2014, eight systematic reviews, seven primary studies and 24 case studies (of which 6 were exemplars) were included. We undertook a narrative synthesis to consider five aspects of engagement with health service reconfiguration. Engagement varied in nature and intensity, and efforts generally involved multiple methods. There was no evidence on the isolated impact of any particular engagement method or collection of methods. In general, engagement was most likely to be successful whe...
To determine the diagnostic accuracy of the Whooley questions in the identification of depression... more To determine the diagnostic accuracy of the Whooley questions in the identification of depression; and, to examine the effect of an additional 'help' question. Systematic review with random effects bivariate diagnostic meta-analysis. Search strategies included electronic databases, examination of reference lists, and forward citation searches. Studies were included that provided sufficient data to calculate the diagnostic accuracy of the Whooley questions against a gold standard diagnosis of major depression. Descriptive information, methodological quality criteria, and 2×2 contingency tables were extracted. Ten studies met inclusion criteria. Pooled sensitivity was 0.95 (95% CI 0.88 to 0.97) and pooled specificity was 0.65 (95% CI 0.56 to 0.74). Heterogeneity was low (I(2)=24.1%). Primary care subgroup analysis gave broadly similar results. Four of the ten studies provided information on the effect of an additional help question. The addition of this question did not consistently improve specificity while retaining high sensitivity as reported in the original validation study. The two-item Whooley questions have high sensitivity and modest specificity in the detection of depression. The current evidence for the use of an additional help question is not consistent and there is, as yet, insufficient data to recommend its use for screening or case finding. CRD42014009695.
As the UK population grows in size, it is becoming increasingly older (ONS, 2009). Between 1983 a... more As the UK population grows in size, it is becoming increasingly older (ONS, 2009). Between 1983 and, the number of people aged 65 years and over increased from 15 per cent in 1983 to 16 per cent in 2008, an increase of 1.5 million people in this older age group. Those aged 85 years and over, the 'oldest old', have witnessed the fastest population growth. Since 1983, the number of people aged 85 years and over has doubled -to 1.3 million in 2008. It is predicted that population ageing will continue for a considerable number of years to come. For example, by 2033, the number of people aged 85 and over is projected to increase to 3.2 million and represent five per cent of the total UK population. Nearly one-quarter (22 per cent) of the population will be aged 65 and over.
ABSTRACT UK NHS organisations are required to consult patients and the public about proposals for... more ABSTRACT UK NHS organisations are required to consult patients and the public about proposals for major changes to services. The evidence base for current UK guidance is unclear. Objectives To assess what is known about effective patient and public engagement in reconfiguration processes and to identify implications for further research. Design Rapid evidence synthesis. Setting Health services affected by reconfiguration proposals in the UK (particularly the English) NHS and similar health systems. Participants Members of the public and their representatives, patients and patient groups. Interventions Any intervention to encourage patients and the public and their representatives to be involved in discussions about proposals for major service change. Main outcome measures Any measure of ‘successful’ engagement as reported by health service decision-makers, patients and public representatives. We were also interested in the outcome of controversial reconfiguration proposals. Data sources We carried out separate searches for systematic reviews, primary research studies and grey literature. Database searches were limited to material published in English from 2000 to March 2014. Review methods Final decisions on study inclusion were made by two reviewers independently. We used EPPI-Reviewer 4 (Evidence for Policy and Practice Information and Co-ordinating Centre, University of London, London, UK) to record decisions and for data extraction and quality assessment. We carried out a narrative synthesis using multiple frameworks (including pre-specified research questions and current guidance). In synthesising the case studies, we selected a number of ‘exemplars’ based on quality of reporting and some evaluation of the process of engagement. Results Eight systematic reviews, seven empirical research studies and 24 case studies (six exemplars) were included. Methods of engagement varied in nature and intensity, and generally involved a mixed methods approach. There was no evidence on the isolated impact of any particular engagement method or collection of methods. In general, engagement was most likely to be successful when the process started at an early stage, offered opportunities for genuine interaction and was led and supported by clinicians involved in delivering the relevant services. The impact of engagement was variably measured and demonstrated. Impact was more frequently defined in terms of process measures than success or failure of reconfiguration. Little was reported on the potential negative impact of service user engagement. Conclusions Patients and the public could be engaged through a wide variety of methods. In selecting which methods to employ locally, decision-makers should take into account the nature of the local population and of the proposed service changes. Problems often arose because decision-makers paid insufficient attention to issues considered important by the public. NHS England guidance could be a helpful practical framework for future engagement activity. Future work Clearly reported evaluations of interventions are needed including those that test the sustainability of methods of engagement and their impact over time. The NHS England guidance on planning and delivering service change may provide a foundation for the design of future research. Funding Commissioned by the National Institute for Health Research Health Service and Delivery Research (HSDR) programme from the University of York HSDR Evidence Synthesis Centre (project no. 13/05/11).
Peripheral arterial disease (PAD) is a condition in which there is blockage or narrowing of the a... more Peripheral arterial disease (PAD) is a condition in which there is blockage or narrowing of the arteries that carry blood to the legs and arms. It is estimated to affect around 4.5% of people aged between 55 and 74 years within the UK. The most common symptom of PAD is intermittent claudication (IC), characterised by pain in the legs on walking that is relieved with rest. To assess the effectiveness and cost-effectiveness of cilostazol, naftidrofuryl oxalate, pentoxifylline and inositol nicotinate, compared with no vasoactive drugs, for IC due to PAD in adults whose symptoms continue despite a period of conventional management. Electronic bibliographic databases were searched during April to June 2010 (MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, The Cochrane Library databases, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Conference Proceedings Citation Index, BIOSIS Previews). Effectiveness outcomes sought were maximal walking distance (MWD), pain-free walking distance (PFWD), ankle-brachial pressure index, cardiovascular events, mortality, adverse events (AEs) and health-related quality of life (HRQoL). A narrative synthesis was provided for all outcomes and a network meta-analysis was undertaken for the walking distance outcomes. A Markov model was developed to assess the relative cost-effectiveness of the interventions from a NHS perspective over a lifetime. The model has three states: vasoactive drug treatment, no vasoactive drug treatment and death. Each 1-week cycle, patients may continue with the drug, discontinue the drug or die. Regression analysis was undertaken to model the relationship between MWD and utility so that a cost per quality-adjusted life-year (QALY) outcome measure could be presented. Univariate and probabilistic sensitivity analyses were undertaken. All costs and outcomes were discounted at 3.5%. Twenty-six randomised controlled trials were identified that met the inclusion criteria for the clinical effectiveness review. There was evidence that walking distance outcomes were significantly improved by both cilostazol and naftidrofuryl oxalate; the 95% credible intervals for the difference from placebo in the logarithm mean change MWD from baseline were 0.108 to 0.337 and 0.181 to 0.762, respectively. It was not possible to include inositol nicotinate within the meta-analysis of MWD and PFWD owing to the lack of 24-month data; however, the shorter-term data did not suggest a significant effect. AEs were minor for all drugs and included headaches and gastrointestinal difficulties. The incidence of serious adverse events (SAEs), including cardiovascular events and mortality, was not increased by the vasoactive drugs compared with placebo; however, most studies had a relatively short follow-up time to address this outcome. HRQoL data were limited. Two studies of limited quality were identified within the review of cost-effectiveness. The de novo model developed suggests that naftidrofuryl oxalate dominates cilostazol and pentoxifylline and has a cost per QALY gained of around £6070 compared with no vasoactive drug. This result is reasonably robust to changes within the key model assumptions. Inositol nicotinate was not included within the main analysis owing to lack of data. However, it is unlikely to be considered to be cost-effective due to its high acquisition cost (£900 vs £100-500 per year for the other drugs). Naftidrofuryl oxalate and cilostazol both appear to be effective treatments for this patient population, with minimal SAEs. However, naftidrofuryl oxalate is the only treatment that is likely to be considered cost-effective. The long-term effectiveness is uncertain and hence a trial comparing cilostazol, naftidrofuryl oxalate and placebo beyond 24 weeks would be beneficial. Outcomes associated with naftidrofuryl oxalate could also be compared with those associated with supervised exercise programmes and angioplasty.
Objective: To summarise evidence on the effectiveness of behaviour change interventions to encour... more Objective: To summarise evidence on the effectiveness of behaviour change interventions to encourage prescribing of generic forms of prescription drugs where clinically appropriate in the UK National Health Service (NHS) and similar settings.
ABSTRACT In 2009 the UK National Patient Safety Agency relaunched its Being Open framework to fac... more ABSTRACT In 2009 the UK National Patient Safety Agency relaunched its Being Open framework to facilitate the open disclosure of adverse events to patients in the NHS. The implementation of the framework has been, and remains, challenging in practice. Aim The aim of this work was to both critically evaluate and extend the current evidence base relating to open disclosure, with a view to supporting the implementation of a policy of open disclosure of adverse events in the NHS. Methods This work was conducted in three phases. The first phase comprised two focused systematic literature reviews, one summarising empirical research on the effectiveness of interventions to enhance open disclosure, and a second, broader scoping review, looking at reports of current opinion and practice and wider knowledge. The second phase involved primary qualitative research with the objective of generating new knowledge about UK-based stakeholders’ views on their role in and experiences of open disclosure. Stakeholder interviews were analysed using the framework approach. The third phase synthesised the findings from the first two phases to inform and develop a set of short pragmatic suggestions for NHS trust management, to facilitate the implementation and evaluation of open disclosure. Results A total of 610 papers met the inclusion criteria for the broad review. A large body of literature discussed open disclosure from a number of related, but sometimes conflicted, perspectives. Evidential gaps persist and current practice is based largely on expert consensus rather than evidence. There appears to be a tension between the existing pragmatic guidance and the more in-depth critiques of what being consistent and transparent in health care really means. Eleven papers met the inclusion criteria for the more focused review. There was little evidence for the effectiveness of disclosure alone on organisational or individual outcomes or of interventions to promote and support open disclosure. Interviews with stakeholders identified strong support for the basic principle of being honest with patients or relatives when someone was seriously harmed by health care. In practice however, the issues are complex and there is confusion about a number of issues relating to disclosure policies in the UK. The interviews generated insights into the difficulties perceived within health care at individual and institutional levels, in relation to fully implementing the Being Open guidance. Conclusions There are several clear strategies that the NHS could learn from to implement and sustain a policy of openness. Literature reviews and stakeholder accounts both identified the potential benefits of a culture that was generally more open (not just retrospectively open about serious harm). Future work could usefully evaluate the impact of disclosure on legal challenges within the NHS, best practice in models of support and training for open disclosure, embedding disclosure conversations in critical incident analysis and disclosure of less serious events. Funding The National Institute for Health Research Health Services and Delivery Research programme.
Journal of Health Services Research & Policy, 2010
ABSTRACT Several websites provide information about the health of the population including health... more ABSTRACT Several websites provide information about the health of the population including health indicators at regional and district levels. These allow health services researchers to access comparable statistics for different countries. This edition of ‘What's on the web’ lists some of the websites that provide easy access to reliable population health data and statistics.
Journal of Health Services Research & Policy, 2011
ABSTRACT ‘A picture is worth a thousand words’ captures the idea that well chosen images can incr... more ABSTRACT ‘A picture is worth a thousand words’ captures the idea that well chosen images can increase the successful dissemination of health care messages. This edition of ‘What's on the web’ explores sites that host images suitable for use in presentations and teaching. We have focused on sites that provide images that are in the public domain or have a creative commons license which generally allows non-commercial use. It is important to be careful, however, and it is recommended that you check the copyright situation before using any image from these sites.
Journal of Health Services Research & Policy, 2010
ABSTRACT Patient information websites have become one of the main means of providing advice and i... more ABSTRACT Patient information websites have become one of the main means of providing advice and information to individuals. The range of topics covered and the reliability of the information provided means that they can also be a valuable resource to practitioners and researchers. We first reviewed patient information websites in 2003 and this column updates that review. One of the developments since then is that information is now being presented using visual resources, such as podcasts and video clips, as well as text.
Journal of Health Services Research & Policy, 2011
ABSTRACT Issues concerning our impact on the environment are constantly in the news and people ar... more ABSTRACT Issues concerning our impact on the environment are constantly in the news and people are becoming more aware of the contribution of health care to the situation. This edition of ‘What's on the web’ reviews sites that provide information about the ways health care facilities can mitigate their effects on the environment.
Journal of Health Services Research & Policy, 2009
ABSTRACT Peer review is integral to assuring the quality of papers that are published in the scie... more ABSTRACT Peer review is integral to assuring the quality of papers that are published in the scientific literature. Many health professionals at some point in their career will be invited by a journal editor to review a manuscript that has been submitted for publication. What resources are available on the web to support reviewers in this task? This edition of ‘What's on the web’ pulls together some of the essential websites that provide guidance, tips, background information and current debates about the process of peer review.
To determine the diagnostic accuracy of the Whooley questions in the identification of depression... more To determine the diagnostic accuracy of the Whooley questions in the identification of depression; and, to examine the effect of an additional 'help' question. Systematic review with random effects bivariate diagnostic meta-analysis. Search strategies included electronic databases, examination of reference lists, and forward citation searches. Studies were included that provided sufficient data to calculate the diagnostic accuracy of the Whooley questions against a gold standard diagnosis of major depression. Descriptive information, methodological quality criteria, and 2×2 contingency tables were extracted. Ten studies met inclusion criteria. Pooled sensitivity was 0.95 (95% CI 0.88 to 0.97) and pooled specificity was 0.65 (95% CI 0.56 to 0.74). Heterogeneity was low (I(2)=24.1%). Primary care subgroup analysis gave broadly similar results. Four of the ten studies provided information on the effect of an additional help question. The addition of this question did not consistently improve specificity while retaining high sensitivity as reported in the original validation study. The two-item Whooley questions have high sensitivity and modest specificity in the detection of depression. The current evidence for the use of an additional help question is not consistent and there is, as yet, insufficient data to recommend its use for screening or case finding. CRD42014009695.
Journal of health services research & policy, Jan 20, 2015
To assess what is known about effective patient and public engagement in health service reconfigu... more To assess what is known about effective patient and public engagement in health service reconfiguration processes and identify implications for further research and health care practice. Rapid systematic review of published and grey literature to identify methods or approaches to engagement in decisions about health service reconfiguration; and to examine how engagement has worked or not worked in specific examples of system change. Following a search for literature published in English from 2000 to March 2014, eight systematic reviews, seven primary studies and 24 case studies (of which 6 were exemplars) were included. We undertook a narrative synthesis to consider five aspects of engagement with health service reconfiguration. Engagement varied in nature and intensity, and efforts generally involved multiple methods. There was no evidence on the isolated impact of any particular engagement method or collection of methods. In general, engagement was most likely to be successful whe...
To determine the diagnostic accuracy of the Whooley questions in the identification of depression... more To determine the diagnostic accuracy of the Whooley questions in the identification of depression; and, to examine the effect of an additional 'help' question. Systematic review with random effects bivariate diagnostic meta-analysis. Search strategies included electronic databases, examination of reference lists, and forward citation searches. Studies were included that provided sufficient data to calculate the diagnostic accuracy of the Whooley questions against a gold standard diagnosis of major depression. Descriptive information, methodological quality criteria, and 2×2 contingency tables were extracted. Ten studies met inclusion criteria. Pooled sensitivity was 0.95 (95% CI 0.88 to 0.97) and pooled specificity was 0.65 (95% CI 0.56 to 0.74). Heterogeneity was low (I(2)=24.1%). Primary care subgroup analysis gave broadly similar results. Four of the ten studies provided information on the effect of an additional help question. The addition of this question did not consistently improve specificity while retaining high sensitivity as reported in the original validation study. The two-item Whooley questions have high sensitivity and modest specificity in the detection of depression. The current evidence for the use of an additional help question is not consistent and there is, as yet, insufficient data to recommend its use for screening or case finding. CRD42014009695.
As the UK population grows in size, it is becoming increasingly older (ONS, 2009). Between 1983 a... more As the UK population grows in size, it is becoming increasingly older (ONS, 2009). Between 1983 and, the number of people aged 65 years and over increased from 15 per cent in 1983 to 16 per cent in 2008, an increase of 1.5 million people in this older age group. Those aged 85 years and over, the 'oldest old', have witnessed the fastest population growth. Since 1983, the number of people aged 85 years and over has doubled -to 1.3 million in 2008. It is predicted that population ageing will continue for a considerable number of years to come. For example, by 2033, the number of people aged 85 and over is projected to increase to 3.2 million and represent five per cent of the total UK population. Nearly one-quarter (22 per cent) of the population will be aged 65 and over.
ABSTRACT UK NHS organisations are required to consult patients and the public about proposals for... more ABSTRACT UK NHS organisations are required to consult patients and the public about proposals for major changes to services. The evidence base for current UK guidance is unclear. Objectives To assess what is known about effective patient and public engagement in reconfiguration processes and to identify implications for further research. Design Rapid evidence synthesis. Setting Health services affected by reconfiguration proposals in the UK (particularly the English) NHS and similar health systems. Participants Members of the public and their representatives, patients and patient groups. Interventions Any intervention to encourage patients and the public and their representatives to be involved in discussions about proposals for major service change. Main outcome measures Any measure of ‘successful’ engagement as reported by health service decision-makers, patients and public representatives. We were also interested in the outcome of controversial reconfiguration proposals. Data sources We carried out separate searches for systematic reviews, primary research studies and grey literature. Database searches were limited to material published in English from 2000 to March 2014. Review methods Final decisions on study inclusion were made by two reviewers independently. We used EPPI-Reviewer 4 (Evidence for Policy and Practice Information and Co-ordinating Centre, University of London, London, UK) to record decisions and for data extraction and quality assessment. We carried out a narrative synthesis using multiple frameworks (including pre-specified research questions and current guidance). In synthesising the case studies, we selected a number of ‘exemplars’ based on quality of reporting and some evaluation of the process of engagement. Results Eight systematic reviews, seven empirical research studies and 24 case studies (six exemplars) were included. Methods of engagement varied in nature and intensity, and generally involved a mixed methods approach. There was no evidence on the isolated impact of any particular engagement method or collection of methods. In general, engagement was most likely to be successful when the process started at an early stage, offered opportunities for genuine interaction and was led and supported by clinicians involved in delivering the relevant services. The impact of engagement was variably measured and demonstrated. Impact was more frequently defined in terms of process measures than success or failure of reconfiguration. Little was reported on the potential negative impact of service user engagement. Conclusions Patients and the public could be engaged through a wide variety of methods. In selecting which methods to employ locally, decision-makers should take into account the nature of the local population and of the proposed service changes. Problems often arose because decision-makers paid insufficient attention to issues considered important by the public. NHS England guidance could be a helpful practical framework for future engagement activity. Future work Clearly reported evaluations of interventions are needed including those that test the sustainability of methods of engagement and their impact over time. The NHS England guidance on planning and delivering service change may provide a foundation for the design of future research. Funding Commissioned by the National Institute for Health Research Health Service and Delivery Research (HSDR) programme from the University of York HSDR Evidence Synthesis Centre (project no. 13/05/11).
Peripheral arterial disease (PAD) is a condition in which there is blockage or narrowing of the a... more Peripheral arterial disease (PAD) is a condition in which there is blockage or narrowing of the arteries that carry blood to the legs and arms. It is estimated to affect around 4.5% of people aged between 55 and 74 years within the UK. The most common symptom of PAD is intermittent claudication (IC), characterised by pain in the legs on walking that is relieved with rest. To assess the effectiveness and cost-effectiveness of cilostazol, naftidrofuryl oxalate, pentoxifylline and inositol nicotinate, compared with no vasoactive drugs, for IC due to PAD in adults whose symptoms continue despite a period of conventional management. Electronic bibliographic databases were searched during April to June 2010 (MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, The Cochrane Library databases, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Conference Proceedings Citation Index, BIOSIS Previews). Effectiveness outcomes sought were maximal walking distance (MWD), pain-free walking distance (PFWD), ankle-brachial pressure index, cardiovascular events, mortality, adverse events (AEs) and health-related quality of life (HRQoL). A narrative synthesis was provided for all outcomes and a network meta-analysis was undertaken for the walking distance outcomes. A Markov model was developed to assess the relative cost-effectiveness of the interventions from a NHS perspective over a lifetime. The model has three states: vasoactive drug treatment, no vasoactive drug treatment and death. Each 1-week cycle, patients may continue with the drug, discontinue the drug or die. Regression analysis was undertaken to model the relationship between MWD and utility so that a cost per quality-adjusted life-year (QALY) outcome measure could be presented. Univariate and probabilistic sensitivity analyses were undertaken. All costs and outcomes were discounted at 3.5%. Twenty-six randomised controlled trials were identified that met the inclusion criteria for the clinical effectiveness review. There was evidence that walking distance outcomes were significantly improved by both cilostazol and naftidrofuryl oxalate; the 95% credible intervals for the difference from placebo in the logarithm mean change MWD from baseline were 0.108 to 0.337 and 0.181 to 0.762, respectively. It was not possible to include inositol nicotinate within the meta-analysis of MWD and PFWD owing to the lack of 24-month data; however, the shorter-term data did not suggest a significant effect. AEs were minor for all drugs and included headaches and gastrointestinal difficulties. The incidence of serious adverse events (SAEs), including cardiovascular events and mortality, was not increased by the vasoactive drugs compared with placebo; however, most studies had a relatively short follow-up time to address this outcome. HRQoL data were limited. Two studies of limited quality were identified within the review of cost-effectiveness. The de novo model developed suggests that naftidrofuryl oxalate dominates cilostazol and pentoxifylline and has a cost per QALY gained of around £6070 compared with no vasoactive drug. This result is reasonably robust to changes within the key model assumptions. Inositol nicotinate was not included within the main analysis owing to lack of data. However, it is unlikely to be considered to be cost-effective due to its high acquisition cost (£900 vs £100-500 per year for the other drugs). Naftidrofuryl oxalate and cilostazol both appear to be effective treatments for this patient population, with minimal SAEs. However, naftidrofuryl oxalate is the only treatment that is likely to be considered cost-effective. The long-term effectiveness is uncertain and hence a trial comparing cilostazol, naftidrofuryl oxalate and placebo beyond 24 weeks would be beneficial. Outcomes associated with naftidrofuryl oxalate could also be compared with those associated with supervised exercise programmes and angioplasty.
Objective: To summarise evidence on the effectiveness of behaviour change interventions to encour... more Objective: To summarise evidence on the effectiveness of behaviour change interventions to encourage prescribing of generic forms of prescription drugs where clinically appropriate in the UK National Health Service (NHS) and similar settings.
ABSTRACT In 2009 the UK National Patient Safety Agency relaunched its Being Open framework to fac... more ABSTRACT In 2009 the UK National Patient Safety Agency relaunched its Being Open framework to facilitate the open disclosure of adverse events to patients in the NHS. The implementation of the framework has been, and remains, challenging in practice. Aim The aim of this work was to both critically evaluate and extend the current evidence base relating to open disclosure, with a view to supporting the implementation of a policy of open disclosure of adverse events in the NHS. Methods This work was conducted in three phases. The first phase comprised two focused systematic literature reviews, one summarising empirical research on the effectiveness of interventions to enhance open disclosure, and a second, broader scoping review, looking at reports of current opinion and practice and wider knowledge. The second phase involved primary qualitative research with the objective of generating new knowledge about UK-based stakeholders’ views on their role in and experiences of open disclosure. Stakeholder interviews were analysed using the framework approach. The third phase synthesised the findings from the first two phases to inform and develop a set of short pragmatic suggestions for NHS trust management, to facilitate the implementation and evaluation of open disclosure. Results A total of 610 papers met the inclusion criteria for the broad review. A large body of literature discussed open disclosure from a number of related, but sometimes conflicted, perspectives. Evidential gaps persist and current practice is based largely on expert consensus rather than evidence. There appears to be a tension between the existing pragmatic guidance and the more in-depth critiques of what being consistent and transparent in health care really means. Eleven papers met the inclusion criteria for the more focused review. There was little evidence for the effectiveness of disclosure alone on organisational or individual outcomes or of interventions to promote and support open disclosure. Interviews with stakeholders identified strong support for the basic principle of being honest with patients or relatives when someone was seriously harmed by health care. In practice however, the issues are complex and there is confusion about a number of issues relating to disclosure policies in the UK. The interviews generated insights into the difficulties perceived within health care at individual and institutional levels, in relation to fully implementing the Being Open guidance. Conclusions There are several clear strategies that the NHS could learn from to implement and sustain a policy of openness. Literature reviews and stakeholder accounts both identified the potential benefits of a culture that was generally more open (not just retrospectively open about serious harm). Future work could usefully evaluate the impact of disclosure on legal challenges within the NHS, best practice in models of support and training for open disclosure, embedding disclosure conversations in critical incident analysis and disclosure of less serious events. Funding The National Institute for Health Research Health Services and Delivery Research programme.
Journal of Health Services Research & Policy, 2010
ABSTRACT Several websites provide information about the health of the population including health... more ABSTRACT Several websites provide information about the health of the population including health indicators at regional and district levels. These allow health services researchers to access comparable statistics for different countries. This edition of ‘What's on the web’ lists some of the websites that provide easy access to reliable population health data and statistics.
Journal of Health Services Research & Policy, 2011
ABSTRACT ‘A picture is worth a thousand words’ captures the idea that well chosen images can incr... more ABSTRACT ‘A picture is worth a thousand words’ captures the idea that well chosen images can increase the successful dissemination of health care messages. This edition of ‘What's on the web’ explores sites that host images suitable for use in presentations and teaching. We have focused on sites that provide images that are in the public domain or have a creative commons license which generally allows non-commercial use. It is important to be careful, however, and it is recommended that you check the copyright situation before using any image from these sites.
Journal of Health Services Research & Policy, 2010
ABSTRACT Patient information websites have become one of the main means of providing advice and i... more ABSTRACT Patient information websites have become one of the main means of providing advice and information to individuals. The range of topics covered and the reliability of the information provided means that they can also be a valuable resource to practitioners and researchers. We first reviewed patient information websites in 2003 and this column updates that review. One of the developments since then is that information is now being presented using visual resources, such as podcasts and video clips, as well as text.
Journal of Health Services Research & Policy, 2011
ABSTRACT Issues concerning our impact on the environment are constantly in the news and people ar... more ABSTRACT Issues concerning our impact on the environment are constantly in the news and people are becoming more aware of the contribution of health care to the situation. This edition of ‘What's on the web’ reviews sites that provide information about the ways health care facilities can mitigate their effects on the environment.
Journal of Health Services Research & Policy, 2009
ABSTRACT Peer review is integral to assuring the quality of papers that are published in the scie... more ABSTRACT Peer review is integral to assuring the quality of papers that are published in the scientific literature. Many health professionals at some point in their career will be invited by a journal editor to review a manuscript that has been submitted for publication. What resources are available on the web to support reviewers in this task? This edition of ‘What's on the web’ pulls together some of the essential websites that provide guidance, tips, background information and current debates about the process of peer review.
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Papers by Melissa Harden