Lindsay Blank - Academia.edu (original) (raw)

Papers by Lindsay Blank

Health Services and Delivery Research, 2015

ABSTRACT Background Demand management describes any method used to monitor, direct or regulate pa... more ABSTRACT Background Demand management describes any method used to monitor, direct or regulate patient referrals. Several strategies have been developed to manage the referral of patients to secondary care, with interventions targeting primary care, specialist services, or infrastructure. Objective This research aimed to conduct an inclusive systematic review and logic model synthesis in order to better understand factors impacting on the effectiveness of interventions targeting referral between primary and secondary medical health care. Design The approach combined systematic review with logic modelling synthesis techniques to develop an evidence-based framework of factors influencing the pathway between interventions and system-wide changes. Setting Primary health care. Main outcome measures Referral from primary to secondary care. Review methods Systematic searches were undertaken to identify recent, relevant studies. Quality of individual studies was appraised, with consideration of overall strength of evidence. A narrative synthesis and logic model summary of the data was completed. Results From a database of 8327 unique papers, 290 were included in the review. The intervention studies were grouped into four categories of education interventions (n = 50); process change interventions (n = 49); system change interventions (n = 38); and patient-focused interventions (n = 3). Effectiveness was assessed variously in these papers; however, there was a gap regarding the mechanisms whereby these interventions lead to demand management impacts. The findings suggest that, although individual-level interventions may be popular, the stronger evidence relates only to peer-review and feedback interventions. Process change interventions appeared to be more effective when the change resulted in the specialist being provided with more or better quality information about the patient. System changes including the community provision of specialist services by general practitioners, outreach provision by specialists and the return of inappropriate referrals appeared to have evidence of effect. The pathway whereby interventions might lead to service-wide impact was complex, with multiple factors potentially acting as barriers or facilitators to the change process. Factors related, first, to the doctor (including knowledge, attitudes and beliefs, and previous experiences of a service), second, to the patient (including condition and social factors) and, third, to the influence of the doctor–patient relationship. We also identified a number of potentially influential factors at a local level, such as perceived waiting times and the availability of a specialist. These elements are key factors in the pathway between an intervention and intended demand management outcomes influencing both applicability and effectiveness. Conclusions The findings highlight the complexity of the referral process and multiple elements that will impact on intervention outcomes and applicability to a local area. Any interventions seeking to change referral practice need to address factors relating to the individual practitioner, the patient and also the situation in which the referral is taking place. These conclusions apply especially to referral management in a UK context where this whole range of factors/issues lies well within the remit of the NHS. This work highlights that intermediate outcomes are important in the referral pathway. It is recommended that researchers include measure of these intermediate outcomes in their evaluation of intervention effectiveness in order to determine where blocks to or facilitators of system-wide impact may be occurring. Study registration The study is registered as PROSPERO CRD42013004037. Funding The National Institute for Health Research Health Services and Delivery Research programme.

The British journal of general practice : the journal of the Royal College of General Practitioners, 2014

Demand management defines any method used to monitor, direct, or regulate patient referrals. Stra... more Demand management defines any method used to monitor, direct, or regulate patient referrals. Strategies have been developed to manage the referral of patients to secondary care, with interventions that target primary care, specialist services, or infrastructure. To review the international evidence on interventions to manage referral from primary to specialist care. Systematic review. Iterative, systematic searches of published and unpublished sources public health, health management, management, and grey literature databases from health care and other industries were undertaken to identify recent, relevant studies. A narrative synthesis of the data was completed to structure the evidence into groups of similar interventions. The searches generated 8327 unique results, of which 140 studies were included. Interventions were grouped into four intervention categories: GP education (n = 50); process change (n = 49); system change (n = 38); and patient-focused (n = 3). It is clear that t...

QJM, 2005

Provision of renal dialysis varies between UK regions. To analyse these differences in provision ... more Provision of renal dialysis varies between UK regions. To analyse these differences in provision and investigate their causes. Questionnaire-based survey. A questionnaire was posted to all renal provider units and renal commissioning groups in the UK. Questions covered issues such as dialysis modalities and patient choice. Data were collected by telephone interview (or post in some cases) and analysed using SPSS. All renal provider units in the UK responded. A full range of modalities was provided by the majority of units. Clear variations in the level and quality of dialysis provision were seen between the UK regions. These included variation in choice of dialysis modality, provision of high-cost drugs, vascular access waiting times, number of support staff and availability of spare dialysis slots. The considerable variation between UK regions in the provision of adult renal dialysis services cannot be entirely explained by age or ethnic variation, and is in part due to limited bed space, dialysis machines and support staff, as well as changes in commissioning arrangements. To meet the requirements of the renal national service framework in most regions, changes to policy and funding will be required, such that the relatively new commissioning groups implement more appropriate funding structures in closer dialogue with their provider units.

Journal of Advanced Nursing, 2012

& N I C H O L L J. ( 2 0 1 2 ) The appropriateness of, and compliance with, telephone triage deci... more & N I C H O L L J. ( 2 0 1 2 ) The appropriateness of, and compliance with, telephone triage decisions: a systematic review and narrative synthesis.

Health Technology Assessment, 2016

Despite many years of research, there is no certainty regarding the cause of stuttering. Although... more Despite many years of research, there is no certainty regarding the cause of stuttering. Although numerous interventions have been developed, a broad-based systematic review across all forms of intervention for adults and children was needed including views and perceptions of people who stutter. The aims of the study were to report the clinical effectiveness of interventions for people who stutter (or clutter), to examine evidence regarding the views of people who stutter and the views of professionals regarding interventions. A systematic review of quantitative and qualitative literature was carried out between August 2013 and April 2014. The following electronic databases were searched: (1) MEDLINE, (2) EMBASE, (3) The Cochrane Library (including The Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, Health Technology Assessment Database and NHS Economic Evaluations Database), (4) PsycINFO, (5) Science Citation Index, (6) Social Science Citation Index, (7) Cumulative Index to Nursing and Allied Health Literature, (8) ASSIA, (9) Linguistics and Language Behavior Abstracts, (10) Sociological Abstracts and (11) the EPPI Centre. Reference lists of included papers and other reviews were screened and also key journals in the subject area were hand-searched. The searches aimed to identify (1) evidence of clinical effectiveness in populations of pre-school children, school-aged children, adolescents and adults, and (2) data relating to perceptions of barriers and facilitators to intervention clinical effectiveness among staff and people who stutter. A metasynthesis of the two linked elements via development of a conceptual model was also carried out to provide further interpretation of the review findings. A systematic search of the literature identified a large number of potentially relevant studies. Of these, 111 studies examining the clinical effectiveness of interventions, 25 qualitative papers and one mixed-methods paper met the criteria for inclusion in this review. Review of the effectiveness literature indicated evidence of positive outcomes across all types of interventions. Virtually all evidence we identified reported at least some positive effect for some participants. However, there was evidence of considerable individual variation in outcome for study participants. The qualitative literature highlighted the need for programmes to be tailored to individual need with variation at the levels of the intervention, the individual and interpersonal/social elements. Metasynthesis of the data highlighted the complexity of elements that need to be considered in evaluation of long-term impacts following stuttering interventions. Around two-thirds of the studies were considered to be at higher risk of bias. The heterogeneous nature and variability in outcomes meant that we were unable to complete a meta-analysis. Although much of the evidence we identified was from studies at risk of bias, it is suggested that most available interventions for stuttering may be of benefit to at least some people who stutter. There is a requirement for greater clarity regarding what the core outcomes following stuttering intervention should be and also enhanced understanding of the process whereby interventions effect change. Further analysis of those for whom interventions have not produced a significant benefit may provide additional insights into the complex intervention-outcomes pathway. This study is registered as PROSPERO CRD42013004861. The National Institute for Health Research Health Technology Assessment programme.

L:\Interventions\Mental Wellbeing of Young People -Secondary\Evidence\Consultation\Consultation d... more L:\Interventions\Mental Wellbeing of Young People -Secondary\Evidence\Consultation\Consultation documents\Promoting young people's social and emotional wellbeing in secondary edcuation -Mapping review.doc Review 1A: Mapping review of current policy practice and evaluation. Searching: Mindmap Searching for the mapping review of current English policy, practice and evaluation was undertaken using Internet based sources and developed using mind mapping software (Free Mind). A mind map of information was developed using FreeMind by the information specialist (a pdf of the mind map is given in Appendix 1). This classified the documents retrieved by a search of Google in terms of whether they were policy related or related to practice and the evaluation of practice. Where possible, the mindmap linked to full text versions of the documents to facilitate the narrative of the review (not available in Appendix 1). A list of sources is given in Appendix 2. The content of the mapping review...

International journal of language & communication disorders / Royal College of Speech & Language Therapists, Jan 30, 2015

A range of interventions have been developed to treat stuttering in recent years. The effectivene... more A range of interventions have been developed to treat stuttering in recent years. The effectiveness of these interventions has largely been assessed in studies focusing on the impact of specific types of therapy on patient outcomes. Relatively little is known about the factors that influence how the delivery and impact of different types of intervention may be experienced from the perspective of both people who deliver as well as those who receive interventions. To synthesize the available evidence in relation to factors that might enhance or mitigate against successful outcomes following interventions for stuttering by identifying and synthesizing relevant qualitative research that explored the experiences of people delivering and receiving interventions that aim to improve fluency. We carried out a systematic review including research that had used in-depth interviews and focus groups and conducted a substantive qualitative analysis of the data collected. Included study population...

Microbiology (Reading, England), 2002

Escherichia coli possesses two well-characterized aconitases (AcnA and AcnB) and a minor activity... more Escherichia coli possesses two well-characterized aconitases (AcnA and AcnB) and a minor activity (designated AcnC) that is retained by acnAB double mutants and represents no more than 5% of total wild-type aconitase activity. Here it is shown that a 2-methylcitrate dehydratase (PrpD) encoded by the prpD gene of the propionate catabolic operon (prpRBCDE) is identical to AcnC. Inactivation of prpD abolished the residual aconitase activity of an AcnAB-null strain, whereas inactivation of ybhJ, an unidentified acnA paralogue, had no significant effect on AcnC activity. Purified PrpD catalysed the dehydration of citrate and isocitrate but was most active with 2-methylcitrate. PrpD also catalysed the dehydration of several other hydroxy acids but failed to hydrate cis-aconitate and related substrates containing double bonds, indicating that PrpD is not a typical aconitase but a dehydratase. Purified PrpD was shown to be a monomeric iron-sulphur protein (M(r) 54000) having one unstable [2...

International journal for equity in health, 2006

There are large variations in mental health prescribing in UK populations. However the underlying... more There are large variations in mental health prescribing in UK populations. However the underlying reasons for these differences, which may be related to differences in prevalence, cultural expectations or practical difficulties in access to treatment, remain uncertain. Linear modelling was used to investigate whether population characteristics or access to primary care account for variations in mental health prescribing across 39 deprived neighbourhoods. The proportion of sampled respondents whose first language was not English and the ratio of general practitioners to population explained 61% of variation. Deprivation and mental health status were not significant predictors of prescribing in these relatively deprived communities. These findings suggest that mental health prescribing, within deprived areas, as well as reflecting cultural and social differences in prescribing, may also be a proxy measure of access to care.

The European Journal of Contraception and Reproductive Health Care, 2011

The high rate of teenage pregnancy in the United Kingdom continues to be a concern. Factors such ... more The high rate of teenage pregnancy in the United Kingdom continues to be a concern. Factors such as living in a deprived area, poor educational attainment, and living in state-provided care homes have been associated with a greater risk of young motherhood. This study aimed to examine the literature describing perceptions of young people, with a view to gaining a greater understanding of individual contraceptive use and risk factors for young motherhood. A systematic review of studies reporting qualitative data was undertaken. Data were synthesised to develop key themes. Thirty-four papers using qualitative or mixed methods were included in the review. Five key themes are reported; they relate to: use or non-use of contraceptives; attitude to pregnancy; views regarding different forms of contraception; influences on views; gender differences. The review highlights that individual conceptions of risk, differing perceptions of benefits and concerns regarding the forms of contraception, and varying attitudes towards pregnancy, continue to present obstacles to changing behaviour, particularly in high risk groups. There seems to be a need for interventions to further address negative perceptions of contraceptives, and place a greater emphasis on exploring value judgements regarding contraception and young motherhood.

This study sought to establish what evidence exists for demand management in the published academ... more This study sought to establish what evidence exists for demand management in the published academic literature.

Mental Health Review Journal, 2010

Abstract This paper reports on a systematic review of the published literature on the effectivene... more Abstract This paper reports on a systematic review of the published literature on the effectiveness of whole-school behavioural interventions, which aim to promote emotional and social well-being among young people in secondary education. The findings are based on 27 studies of ...

Seizure, 2013

Purpose: The number of older patients with epilepsy has been increasing steadily, however older a... more Purpose: The number of older patients with epilepsy has been increasing steadily, however older adults have been shown to be referred less commonly to specialist epilepsy services than younger individuals. The aim of this study was to explore staff perceptions of why older adults may be under-represented in epilepsy clinics. Method: We conducted 19 interviews with potential referrers and staff providing services including GPs, geriatricians, neurologists, service and clinical managers and epilepsy nurses. Data were analysed using principles of thematic analysis to identify and examine recurring views and perceptions. Results: Seven key factors were suggested as leading to under-referral of older adults: patient difficulties accessing hospital; patient reluctance to attend clinics; unclear referral pathway; complex differential diagnosis; gaps in referrer knowledge; the length of time since onset; and particular characteristics of older patients. Conclusion: While recognising the limitations of the study we believe that it provides valuable further understanding of referral patterns to specialist epilepsy services. Future studies will need to determine whether the assumptions made by the interviewees about the thoughts and wishes of older people with epilepsy were correct or not. To understand this issue more clearly, we plan to sample the views of patients directly. Of particular concern are assumptions regarding older patient's willingness to attend appointments and about the impact of seizures on the life of an older adult.

Quality and Safety in Health Care, 2005

Problem: Healthcare organisations are expected both to monitor inequalities in access to health s... more Problem: Healthcare organisations are expected both to monitor inequalities in access to health services and also to act to improve access and increase equity in service provision. Design: Locally developed action research projects with an explicit objective of reducing inequalities in access. Setting: Eight different health care services in the Yorkshire and Humber region, including community based palliative care, general practice asthma care, hospital based cardiology clinics, and termination of pregnancy services. Key measures for improvement: Changes in service provision, increasing attendance rates in targeted groups. Strategies for change: Local teams identified the population concerned and appropriate interventions using both published and grey literature. Where change to service provision was achieved, local data were collected to monitor the impact of service change. Effects of change: A number of evidence based changes to service provision were proposed and implemented with variable success. Service uptake increased in some of the targeted populations. Lessons learnt: Interventions to improve access must be sensitive to local settings and need both practical and managerial support to succeed. It is particularly difficult to improve access effectively if services are already struggling to meet current demand. Key elements for successful interventions included effective local leadership, identification of an intervention which is both evidence based and locally practicable, and identification of additional resources to support increased activity. A ''toolkit'' has been developed to support the identification and implementation of appropriate changes.

Public Health Nutrition, 2008

Objective: Parents' child-feeding behaviours have been implicated in children's food choices and ... more Objective: Parents' child-feeding behaviours have been implicated in children's food choices and weight, but little is known about the social class distribution of parent's child-feeding behaviours in the UK. The present study compares parents' self-reported child-feeding behaviours in two socio-economically contrasting areas. Design: A cross-sectional survey using the Parental Feeding Style Questionnaire. Mean scores were calculated for five child-feeding behaviours: control over eating, emotional feeding, encouragement/prompting, instrumental feeding and restriction. Parents' self-reported child-feeding behaviours were compared with their sociodemographic characteristics. Setting: Three primary schools in two contrasting electoral wards of Sheffield, UK. Subjects: Two hundred and ten parents of children aged 4 to 11 years, recruited from a convenience sample. Results: Parents in the least deprived ward reported using all five types of childfeeding behaviour more frequently than parents in the most deprived ward. After adjusting for parent sex, parent age, single parent status, employment status and level of education, emotional feeding was the only behaviour showing any evidence of a difference between wards. The most frequently used behaviours were control, encouragement and restriction -behaviours that might be used to directly influence children's food intake and weight. Conclusions: Child-feeding behaviours differ between areas within a single city and within a largely white population, and this distribution is related to socioeconomic and educational factors. Experimental and longitudinal studies are needed to further investigate the potential role of child-feeding behaviours in childhood overweight and obesity.

Occupational Medicine, 2008

Univariate logistic regression analysis of the retrospective study produced odds ratios with 95% ... more Univariate logistic regression analysis of the retrospective study produced odds ratios with 95% confidence intervals for each question (where P # 0.05) and a C-index was then constructed for their predictive power. Five questions holding the greatest predictive power were subjected to multivariate analysis and in the final model had a high C-index of 0.90 (0.5 5 no predictive power, 1.0 5 perfect prediction). They formed the screening tool. The questions cover self-assessment of ability to return to work after current sick leave, of ability to do current job in 6 months' time, sick leave in past year, current age and whether awaiting a consultation or treatment.

Molecular Microbiology, 1999

We have identified the promoter/operator region of the zntA gene of Escherichia coli and shown th... more We have identified the promoter/operator region of the zntA gene of Escherichia coli and shown that Zn(II) is the primary inducer of expression of this Zn(II)/ Cd(II) export gene. The promoter PzntA shows sequence similarities to the promoters of mercury resistance (mer ) operons, including a long spacer region containing an inverted repeat sequence. The gene encoding the transcriptional regulator of PzntA, designated zntR, has been identified from genome sequence data, by expression of the gene product and by insertional inactivation/complementation. The ZntR product is a member of the MerR family of transcriptional regulators and appears to act as a hypersensitive transcriptional switch. A hybrid MerR/ZntR protein has been constructed and indicates that the C-terminal region of ZntR recognizes Zn(II).

Journal of Public Health, 2007

Background Parents have some responsibility for children's dietary habits and they are often the ... more Background Parents have some responsibility for children's dietary habits and they are often the focus of public health interventions designed to improve children's diets and thereby reduce the prevalence of childhood obesity. The current UK interventions promote awareness of healthy food choices, but offer little guidance for parents on child-feeding behaviours.