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Sallis A.,Richmond House
Journal of Occupational Rehabilitation | Year: 2014

Purpose: The experience of employment with depression is explored to develop understanding of the mediators that may influence the management of depression-related sickness absence and improve theoretical understanding. Method: Data were collected from seven semi-structured interviews and Interpretative Phenomenological Analysis used to explore the data. Results: Three interrelated themes were drawn from the participants' accounts: (1) the interaction between depression and work; (2) illness beliefs; and (3) organisational context and depression. The analysis revealed that participants appeared to hold five key perceptions about their depression and work: low control in the workplace; lack of line manager support; diminishing ability to work; the need to address depressive symptoms; and perceptions of depression. Their strength resulted in individuals reaching sickness absence thresholds. The themes and participants' accounts of their work and sickness absence and return to work behaviour are discussed in relation to relevant theory and evidence to understand how these perceptions and beliefs mediate behaviour. Conclusion: Individuals' health (illness representations) and work beliefs (outcome expectancies and self-efficacy for work tasks and management of health at work) appear to influence individuals' sickness absence decisions and experiences and these are mediated by individuals' experiences of organisational policies, line manager support and the messages and actions of GPs. © 2013 Springer Science+Business Media New York.

Hallsworth M.,Imperial College London | Berry D.,Richmond House | Sanders M.,Behavioural Insights Team | Sanders M.,Harvard University | And 4 more authors.
PLoS ONE | Year: 2015

Background: Missed hospital appointments are a major cause of inefficiency worldwide. Healthcare providers are increasingly using Short Message Service reminders to reduce 'Did Not Attend' (DNA) rates. Systematic reviews show that sending such reminders is effective, but there is no evidence on whether their impact is affected by their content. Accordingly, we undertook two randomised controlled trials that tested the impact of rephrasing appointment reminders on DNA rates in the United Kingdom. Trial Methods: Participants were outpatients with a valid mobile telephone number and an outpatient appointment between November 2013 and January 2014 (Trial One, 10,111 participants) or March and May 2014 (Trial Two, 9,848 participants). Appointments were randomly allocated to one of four reminder messages, which were issued five days in advance. Message assignment was then compared against appointment outcomes (appointment attendance, DNA, cancellation by patient). Results: In Trial One, a message including the cost of a missed appointment to the health system produced a DNA rate of 8.4%, compared to 11.1% for the existing message (OR 0.74, 95% CI 0.61-0.89, P<0.01). Trial Two replicated this effect (DNA rate 8.2%), but also found that expressing the same concept in general terms was significantly less effective (DNA rate 9.9%, OR 1.22, 95% CI 1.00-1.48, P<0.05). Moving from the existing reminder to the more effective costs message would result in 5,800 fewer missed appointments per year in the National Health Service Trust in question, at no additional cost. The study's main limitations are that it took place in a single location in England, and that it required accurate phone records, which were only obtained for 20% of eligible patients. We conclude that missed appointments can be reduced, for no additional cost, by introducing persuasive messages to appointment reminders. Future studies could examine the impact of varying reminder messages in other health systems. © 2015 Hallsworth et al.

Nuttall D.,Richmond House | Parkin D.,Kings College London | Devlin N.,Office of Health Economics
Health Economics (United Kingdom) | Year: 2015

This paper describes the development of a methodology for the case-mix adjustment of patient-reported outcome measures (PROMs) data permitting the comparison of outcomes between providers on a like-for-like basis. Statistical models that take account of provider-specific effects form the basis of the proposed case-mix adjustment methodology. Indirect standardisation provides a transparent means of case mix adjusting the PROMs data, which are updated on a monthly basis. Recently published PROMs data for patients undergoing unilateral knee replacement are used to estimate empirical models and to demonstrate the application of the proposed case-mix adjustment methodology in practice. The results are illustrative and are used to highlight a number of theoretical and empirical issues that warrant further exploration. For example, because of differences between PROMs instruments, case-mix adjustment methodologies may require instrument-specific approaches. A number of key assumptions are made in estimating the empirical models, which could be open to challenge. The covariates of post-operative health status could be expanded, and alternative econometric methods could be employed. © 2013 Crown copyright.

Duerden B.,University of Cardiff | Fry C.,Richmond House | Johnson A.P.,Public Health England | Wilcox M.H.,Public Health England
Open Forum Infectious Diseases | Year: 2015

Methicillin-resistant Staphylococcus aureus (MRSA) blood stream infection (BSI) is a major healthcare burden in some but not all healthcare settings, and it is associated with 10%-20% mortality. The introduction of mandatory reporting in England of MRSA BSI in 2001 was followed in 2004 by the setting of target reductions for all National Health Service hospitals. The original national target of a 50% reduction in MRSA BSI was considered by many experts to be unattainable, and yet this goal has been far exceeded (~80% reduction with rates still declining). The transformation from endemic to sporadic MRSA BSI involved the implementation of serial national infection prevention directives, and the deployment of expert improvement teams in organizations failed to meet their improvement trajectory targets. We describe and appraise the components of the major public health infection prevention campaign that yielded major reductions in MRSA infection. There are important lessons and opportunities for other healthcare systems where MRSA infection remains endemic. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Societyof America.

Low E.L.,University College London | Simon A.E.,University College London | Lyons J.,Eve Appeal | Romney-Alexander D.,Richmond House | Waller J.,University College London
European Journal of Cancer | Year: 2012

Objective: To identify levels of cervical cancer risk factor and symptom awareness, as well as predictors of higher awareness in a United Kingdom (UK) female population. Design: Population based survey. Setting: Participants' homes in the UK. Sample: UK representative sample of females aged 16 years and over (n = 1392). Materials and methods: Respondents completed the Cervical Cancer Awareness Measure which included questions on awareness of cervical cancer symptoms and risk factors (both recalled and recognised). Linear regression analyses were used to identify predictors of higher symptom and risk factor recognition scores. Main outcome measures: Awareness of cervical cancer symptoms and risk factors. Results: Sixty-five percent of respondents were unable to recall any risk factors and 75% were unable to recall any symptoms. Awareness was higher when women were prompted (95% recognised at least one risk factor and 93% at least one symptom). Independent predictors of risk factor recognition were older age and higher education. Symptom recognition was associated with older age, White ethnicity, higher education and having a close experience of cervical cancer. Conclusions: To reduce inequalities in awareness, interventions should target younger women with lower education and those from ethnic minority groups. © 2012 Elsevier Ltd. All rights reserved.

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