Almost a year on from my last post here and I’ve done a lot of work on my developing my research proposal – reading, learning, literature reviewing – but sadly not a lot has changed for people with dementia in acute hospitals. My desire to improve the quality of care, especially at meal times has certainly grown.
Having conversations about the best course of action in the event a person’s condition deteriorates is difficult for everyone involved, whether it is the patient themselves, their family or carer and the clinician.
After an initial study on Advance Care Planning (A. Richardson, S. Lund1), research into the current application of treatment escalation plans across the country, and early engagement with some of the acute trusts in the Wessex region, it was apparent there was a desire to improve this process.
Previously I have written about using a detailed computer model to ask ‘what-if’ an emergency department could be run differently. Hidden away in complex models like these are important rules of thumb that tell us how to efficiently manage patient flow.
My colleagues and I recently published a paper which describes how we created a model to show how people with diabetes become less dependent on primary care and more able self-managers.
We used maps created by general practice staff to show how their patients progress through the system following diagnosis.
In the current system, once treatment has been decided on, the frequency of appointments decreases and people are expected to self-manage with support from regular review appointments. Seeing the model and talking it through with GPs and others helped us to consider some of the shortfalls in the system.
I’ve been a clinician in mental health for many (many) years I have heard tales of woe and distress. They have often been so devastating, and at the same time, inspirational as one hears about the efforts people make to overcome the most extreme situations. I have always felt a sense of privilege at being allowed into these stories and as a researcher this privilege feels somehow even more intense.
Professor Anne Rogers explains how weaker social ties play a role in helping people manage a long term illness.
With ever more attention on the NHS and how many nurses and doctors are needed to give people the best care, one part of the health equation is going unnoticed – What attention is being paid to the role of the patient and their extended network of relationships? In early 70s West Coast America a piece of research by Anselm Strauss and colleagues examined a set of questions on ‘self-care’.
Dr Tom Monks puzzles the opportunities and pitfalls of modelling large parts of the health care system and how this might help patients waiting to leave hospital.
I work as a modeller for CLAHRC Wessex. In part that means I spend a lot of time speaking to health care professionals and commissioners about their priorities and teasing out if modelling could help. More and more often I am asked “can we model the whole health care system?”.
In our work looking at how people’s social networks help them in living with a long-term condition, we have been able to show the vital role carers play in keeping people actively engaged with social activities. We know that having a diverse range of support and activities are important for health and wellbeing and carers are the key link in helping those they care for access enjoyable social events by providing both encouragement and transport.
So it’s been a few months since the last update on our work, so where are we now?
Well our Younger Onset Dementia Assessment project is now starting to interview patients, carers and clinicians about their experiences of care in younger onset dementia. This will help define our assessment toolkit for testing and implementation in a wider group of people with younger onset dementia. An important part of this study will be to improve the recording of quality of life (QoL) in people with younger dementia, and helping better understand what factors influence QoL in this particular group of patients and their carers.
Last month saw the publication by the NIHR of the final report on our study evaluating England’s first 100% single room hospital at Pembury, part of the Maidstone and Tunbridge wells trust, which opened in 2011 (1).