What are the barriers and facilitators to seeking help for mental health in NHS doctors: a systematic review and qualitative study.

BACKGROUND: The mental health of healthcare professionals is reaching a breaking point, and the COVID-19 pandemic has exacerbated current mental health issues to unprecedented levels. Whilst some research has been carried out on the barriers that doctors face when seeking mental health help, there is little research into factors which may facilitate seeking help. We aimed to expand the research base on factors which act as barriers to seeking help, as well as gain insight into facilitators of help-seeking behaviour for mental health in NHS doctors. METHODS: We conducted a systematic literature review which identified the barriers and facilitators to seeking help for mental health in healthcare professionals. Following this, we conducted semi-structured interviews with 31 NHS doctors about their experiences with mental health services. Finally, through thematic analysis, key themes were synthesised from the data. RESULTS: Our systematic literature review uncovered barriers and facilitators from pre-existing literature, of which the barriers were: preventing actions, self-stigma, perceived stigma, costs of seeking treatment, lack of awareness and availability of support, negative career implications, confidentiality concerns and a lack of time to seek help. Only two facilitators were found in the pre-existing literature, a positive work environment and availability of support services. Our qualitative study uncovered additional barriers and facilitators, of which the identified barriers include: a negative workplace culture, lack of openness, expectations of doctors and generational differences. The facilitators include positive views about mental health, external confidential service, better patient outcomes, protected time, greater awareness and accessibility, open culture and supportive supervisors. CONCLUSION: Our study began by identifying barriers and facilitators to seeking mental health help in healthcare workers, through our systematic literature review. We contributed to these findings by identifying themes in qualitative data.. Our findings are crucial to identify factors preventing NHS doctors from seeking help for their mental health so that more can be done on a national, trust-wide and personal level to overcome these barriers. Likewise, further research into facilitators is key to encourage doctors to reach out and seek help for their mental health.

The Barriers and Facilitators to the Use of Lifestyle Apps: A Systematic Review of Qualitative Studies.

BACKGROUND: Mobile-health applications are revolutionising the way healthcare is being delivered. However, current research focusses on apps aimed at monitoring of conditions rather than the prevention of disease. Healthcare apps that prevent disease can be classified as lifestyle apps (LAs) and encompass mindfulness, exercise, and diet apps. In order for widespread implementation of these apps, perspectives of the user must be taken into consideration. Therefore, this systematic literature review identifies the barriers and facilitators to the use of LAs from a user's perspective. OBJECTIVE: To both identify the facilitators to the use of LAs from a user perspective as well as identify the barriers to the use of LAs from a user perspective. METHODS: A systematic literature review was conducted following PRISMA guidelines. Qualitative articles focussed on a healthy non-diseased population were obtained. Two independent researchers coded the articles, and themes were identified. RESULTS: Our results found that there were five barriers and five facilitators to app use. The facilitators included (1) motivational aspects to the user, (2) effective marketing and communication, (3) user-centred design and content, (4) humanising technology, and (5) accessibility. The five barriers identified were (1) a non-conducive, (2) poor marketing and branding, (3) controlling and invasive, (4) disengaging content, and (5) inaccessibility. CONCLUSIONS: By overcoming the barriers of LAs and encouraging the facilitators found, users are more likely to engage with this method of health promotion. Future research must be conducted on the barriers and facilitators to development and distribution of apps in order for LAs to be implemented in widespread healthcare practice.

AI in patient flow: applications of artificial intelligence to improve patient flow in NHS acute mental health inpatient units.

INTRODUCTION: Growing demand for mental health services, coupled with funding and resource limitations, creates an opportunity for novel technological solutions including artificial intelligence (AI). This study aims to identify issues in patient flow on mental health units and align them with potential AI solutions, ultimately devising a model for their integration at service level. METHOD: Following a narrative literature review and pilot interview, 20 semi-structured interviews were conducted with AI and mental health experts. Thematic analysis was then used to analyse and synthesise gathered data and construct an enhanced model. RESULTS: Predictive variables for length-of-stay and readmission rate are not consistent in the literature. There are, however, common themes in patient flow issues. An analysis identified several potential areas for AI-enhanced patient flow. Firstly, AI could improve patient flow by streamlining administrative tasks and optimising allocation of resources. Secondly, real-time data analytics systems could support clinician decision-making in triage, discharge, diagnosis and treatment stages. Finally, longer-term, development of solutions such as digital phenotyping could help transform mental health care to a more preventative, personalised model. CONCLUSIONS: Recommendations were formulated for NHS trusts open to adopting AI patient flow enhancements. Although AI offers many promising use-cases, greater collaborative investment and infrastructure are needed to deliver clinically validated improvements. Concerns around data-use, regulation and transparency remain, and hospitals must continue to balance guidelines with stakeholder priorities. Further research is needed to connect existing case studies and develop a framework for their evaluation.

Applications of artificial intelligence to improve patient flow on mental health inpatient units - Narrative literature review.

BACKGROUND: Despite a growing body of research into both Artificial intelligence and mental health inpatient flow issues, few studies adequately combine the two. This review summarises findings in the fields of AI in psychiatry and patient flow from the past 5 years, finds links and identifies gaps for future research. METHODS: The OVID database was used to access Embase and Medline. Top journals such as JAMA, Nature and The Lancet were screened for other relevant studies. Selection bias was limited by strict inclusion and exclusion criteria. RESEARCH: 3,675 papers were identified in March 2020, of which a limited number focused on AI for mental health unit patient flow. After initial screening, 323 were selected and 83 were subsequently analysed. The literature review revealed a wide range of applications with three main themes: diagnosis (33%), prognosis (39%) and treatment (28%). The main themes that emerged from AI in patient flow studies were: readmissions (41%), resource allocation (44%) and limitations (91%). The review extrapolates those solutions and suggests how they could potentially improve patient flow on mental health units, along with challenges and limitations they could face. CONCLUSION: Research widely addresses potential uses of AI in mental health, with some focused on its applicability in psychiatric inpatients units, however research rarely discusses improvements in patient flow. Studies investigated various uses of AI to improve patient flow across specialities. This review highlights a gap in research and the unique research opportunity it presents.

A qualitative inquiry into the barriers and facilitators to achieving home death.

OBJECTIVES: To explore the barriers and facilitators to patients achieving death at home. METHODS: In-depth, semistructured interviews with end-of-life care experts were conducted to develop an insight into the barriers and facilitators to achieving death at home. Thirty-three interviews were conducted compromising of a mixture of face-to-face and tele interviews. Experts included healthcare professionals working in the community, hospital and policy/academic settings. Thematic analysis was undertaken on interview transcripts. RESULTS: Three overarching themes, further divided into a total of 12 subthemes were identified. The three themes were 'managing people', 'education' and 'planning'. The 'managing people' theme included subthemes of patient preferences and family influences; the 'education' theme encompassed knowledge and training, perceptions of death and communication and the 'planning' theme contained seven subthemes including 'coordination', 'resources' and 'cost'. CONCLUSIONS: Multiple barriers and facilitators to achieving death at home were identified in this study. Of particular significance was the identification of the fear and stigma associated with death among doctors, patients and their families serving as a barrier to home death, not previously identified in the literature. Additionally, the importance of social networks and resource provision were highlighted as key in influencing patient death at home.

Medication Adherence Apps: Review and Content Analysis.

BACKGROUND: Medication adherence is an expensive and damaging problem for patients and health care providers. Patients adhere to only 50% of drugs prescribed for chronic diseases in developed nations. Digital health has paved the way for innovative smartphone solutions to tackle this challenge. However, despite numerous apps available claiming to improve adherence, a thorough review of adherence apps has not been carried out to date. OBJECTIVE: The aims of this study were to (1) review medication adherence apps available in app repositories in terms of their evidence base, medical professional involvement in development, and strategies used to facilitate behavior change and improve adherence and (2) provide a system of classification for these apps. METHODS: In April 2015, relevant medication adherence apps were identified by searching the Apple App Store and the Google Play Store using a combination of relevant search terms. Data extracted included app store source, app price, documentation of health care professional (HCP) involvement during app development, and evidence base for each respective app. Free apps were downloaded to explore the strategies used to promote medication adherence. Testing involved a standardized medication regimen of three reminders over a 4-hour period. Nonadherence features designed to enhance user experience were also documented. RESULTS: The app repository search identified a total of 5881 apps. Of these, 805 fulfilled the inclusion criteria initially and were tested. Furthermore, 681 apps were further analyzed for data extraction. Of these, 420 apps were free for testing, 58 were inaccessible and 203 required payment. Of the 420 free apps, 57 apps were developed with HCP involvement and an evidence base was identified in only 4 apps. Of the paid apps, 9 apps had HCP involvement, 1 app had a documented evidence base, and 1 app had both. In addition, 18 inaccessible apps were produced with HCP involvement, whereas 2 apps had a documented evidence base. The 420 free apps were further analyzed to identify strategies used to improve medication adherence. This identified three broad categories of adherence strategies, reminder, behavioral, and educational. A total of 250 apps utilized a single method, 149 apps used two methods, and only 22 apps utilized all three methods. CONCLUSIONS: To our knowledge, this is the first study to systematically review all available medication adherence apps on the two largest app repositories. The results demonstrate a concerning lack of HCP involvement in app development and evidence base of effectiveness. More collaboration is required between relevant stakeholders to ensure development of high quality and relevant adherence apps with well-powered and robust clinical trials investigating the effectiveness of these interventions. A sound evidence base will encourage the adoption of effective adherence apps, and thus improve patient welfare in the process.

Sequential simulation used as a novel educational tool aimed at healthcare managers: a patient-centred approach.

Background: A new challenge for healthcare managers is to improve the patient experience. Simulation is often used for clinical assessment and rarely for those operating outside of direct clinical care. Sequential simulation (SqS) is a form of simulation that re-creates care pathways, widening its potential use. Local problem: Numbers, outcome measures and system profiling are used to inform healthcare decisions. However, none of these captures the personal subtleties of a patient's experience. Intervention: 56 students attended a teaching module using SqS and facilitated workshops as part of their induction week on an MSc International Health Management course. The workshop was voluntary and was offered as an opportunity for the students to gain an insight into the UK health system through the medium of simulation. Methods: An evaluation survey incorporating quantitative and qualitative student feedback was conducted. Descriptive statistics were generated from the quantitative data, and thematic analysis was undertaken for the qualitative data. Results: There was strong agreement for the acceptability of the workshop approach in relation to the aims and objectives. Likert scale (1--5) mean total=4.49. Participants responded enthusiastically (revealed through the qualitative data) with ideas related to perspectives sharing, understanding healthcare management and processes and the consideration of feasibility and practicalities. They also suggested other applications that SqS could be used for. Conclusion: The SqS approach has demonstrated that simulation has a wider potential than for clinical assessment alone. Further studies are required to determine its potential uses and affordances beyond its current format.

Barriers and facilitators influencing death at home: A meta-ethnography.

BACKGROUND: In many countries, achieving a home death represents a successful outcome from both a patient welfare and commissioning viewpoint. Significant variation exists in the proportion of home deaths achieved internationally, with many countries unable to meet the wishes of a large number of patients. This review builds on previous literature investigating factors influencing home death, synthesising qualitative research to supplement evidence that quantitative research in this field may have been unable to reach. AIM: To identify and understand the barriers and facilitators influencing death at home. DESIGN: Meta-ethnography. DATA SOURCES: The review adhered to the PRISMA guidelines. A systematic literature search was conducted using five databases: PubMed, EMBASE, Ovid, CINAHL and PsycINFO. Databases were searched from 2006 to 2016. Empirical, UK-based qualitative studies were included for analysis. RESULTS: A total of 38 articles were included for analysis. Seven overarching barriers were identified: lack of knowledge, skills and support among informal carers and healthcare professionals; informal carer and family burden; recognising death; inadequacy of processes such as advance care planning and discharge; as well as inherent patient difficulties, either due to the condition or social circumstances. Four overarching facilitators were observed: support for patients and healthcare professionals, skilled staff, coordination and effective communication. CONCLUSION: Future policies and clinical practice should develop measures to empower informal carers as well as emphasise earlier commencement of advance care planning. Best practice discharge should be recommended in addition to addressing remaining inequity to enable non-cancer patients greater access to palliative care services.

Identifying Quality Indicators Used by Patients to Choose Secondary Health Care Providers: A Mixed Methods Approach.

BACKGROUND: Patients in health systems across the world can now choose between different health care providers. Patients are increasingly using websites and apps to compare the quality of health care services available in order to make a choice of provider. In keeping with many patient-facing platforms, most services currently providing comparative information on different providers do not take account of end-user requirements or the available evidence base. OBJECTIVE: To investigate what factors were considered most important when choosing nonemergency secondary health care providers in the United Kingdom with the purpose of translating these insights into a ratings platform delivered through a consumer mHealth app. METHODS: A mixed methods approach was used to identify key indicators incorporating a literature review to identify and categorize existing quality indicators, a questionnaire survey to formulate a ranked list of performance indicators, and focus groups to explore rationales behind the rankings. Findings from qualitative and quantitative methodologies were mapped onto each other under the four categories identified by the literature review. RESULTS: Quality indicators were divided into four categories. Hospital access was the least important category. The mean differences between the other three categories hospital statistics, hospital staff, and hospital facilities, were not statistically significant. Staff competence was the most important indicator in the hospital staff category; cleanliness and up-to-date facilities were equally important in hospital facilities; ease of travel to the hospital was found to be most important in hospital access. All quality indicators within the hospital statistics category were equally important. Focus groups elaborated that users find it difficult to judge staff competence despite its importance. CONCLUSIONS: A mixed methods approach is presented, which supported a patient-centered development and evaluation of a hospital ratings mobile app. Where possible, mHealth developers should use systematic research methods in order to more closely meet the needs of the end user and add credibility to their platform.

Requirements of a new communication technology for handover and the escalation of patient care: a multi-stakeholder analysis.

RATIONALE, AIMS AND OBJECTIVES: In order to enable safe and efficient information transfer between health care professionals during clinical handover and escalation of care, existing communication technologies must be updated. This study aimed to provide a user-informed guide for the development of an application-based communication system (ABCS), tailored for use in patient handover and escalation of care. METHODS: Current methods of inter-professional communication in health care along with information system needs for communication technology were identified through literature review. A focus group study was then conducted according to a topic guide developed by health innovation and safety researchers. Fifteen doctors and 11 nurses from three London hospitals participated in a mixture of homogeneous and heterogeneous sessions. The sessions were recorded and transcribed verbatim before being subjected to thematic analysis. RESULTS: Seventeen information system needs were identified from the literature review. Participants identified six themes detailing user perceptions of current communication technology, attitudes to smartphone technology and anticipated requirements of an application produced for handover and escalation of care. Participants were in favour of an ABCS over current methods and expressed enthusiasm for a system with integrated patient information and group-messaging functions. CONCLUSION: Despite concerns regarding confidentiality and information governance a robust guide for development and implementation of an ABCS was produced, taking input from multiple stakeholders into account. Handover and escalation of care are vital processes for patient safety and communication within these must be optimized. An ABCS for health care professionals would be a welcome innovation and may lead to improvements in patient safety.

Techniques to aid the implementation of novel clinical information systems: a systematic review.

BACKGROUND: This systematic review identifies and evaluates techniques that aid the implementation of novel clinical information systems (CIS) within healthcare. METHODS: We searched electronic databases (MEDLINE, EMBASE, PsycINFO and HMIC Health Management Information Consortium). Desktop reviews for all potentially eligible studies were also conducted via reference lists and forward citation searches. 14,198 abstracts were identified through the initial electronic search. 63 articles were retained following title and abstract reviews, and submitted for full text evaluation. Of these, 18 papers met eligibility criteria. RESULTS: The 5 techniques that emerged from the review and that can assist CIS implementation were: system piloting, eliciting acceptance, use of simulation, training and education, and provision of incentives. These techniques were evaluated with a range of study endpoints (including system utilisation, clinical effectiveness, user satisfaction, attitudes towards system training, and attitudes towards implementation). Consideration of the clinical context in which the CIS was implemented was a consistent theme in the evidence-base. CONCLUSIONS: Although some evidence is available for the effectiveness of the 5 implementation techniques found in this review, the variable endpoints and the non-comparable study designs mean that the evidence-base needs further developing. We discuss the potential role of simulation and clinical leadership, particularly in relation to surgeons, in CIS implementation and we propose practical advice for CIS implementation and evaluation within hospital settings.

The factors that influence attitudes toward organ donation for transplantation among UK university students of Indian and Pakistani descent.

BACKGROUND: The shortage of organs donated for transplantation is particularly severe among ethnic minorities. Previous work has often studied ethnic minorities in broad groups, failing to differentiate by age or country of education. We investigated the younger generation of UK-educated ethnically Indian and Pakistani students to determine their attitudes toward organ donation. METHODS: We conducted nine focus groups and eight semi-structured interviews. Participants were divided by ethnicity, gender, and medical/non-medical background. Interview transcripts were analyzed by thematic analysis. RESULTS: Six key factors influencing attitudes toward organ donation were found: religion, awareness of the importance of donation, impact of medical education, culture-specific factors, treatment of donors and their organs, and influence of family. The attitude of Islam to donation was highly relevant to Pakistani participants, more than other factors; for Indians, all six factors were similarly relevant. We found that medical education specifically had an important effect on shaping attitudes toward donation. Cultural changes suggested the younger generation may differ from their elders as they adopt British culture. Awareness of donation was universally low. CONCLUSIONS: Indian and Pakistani students are hesitant to donate organs because of multiple factors, which if addressed in a culturally relevant manner could substantially improve donation rates.

Clinical information transfer and data capture in the acute myocardial infarction pathway: an observational study.

RATIONALE, AIMS AND OBJECTIVES: Acute myocardial infarctions (MIs) or heart attacks are the result of a complete or an incomplete occlusion of the lumen of the coronary artery with a thrombus. Prompt diagnosis and early coronary intervention results in maximum myocardial salvage, hence time to treat is of the essence. Adequate, accurate and complete information is vital during the early stages of admission of an MI patient and can impact significantly on the quality and safety of patient care. This study aimed to record how clinical information between different clinical teams during the journey of a patient in the MI care pathway is captured and to review the flow of information within this care pathway. METHOD: A prospective, descriptive, structured observational study to assess (i) current clinical information systems (CIS) utilization and (ii) real-time information availability within an acute cardiac care setting was carried out. Completeness and availability of patient information capture across four key stages of the MI care pathway were assessed prospectively. RESULTS: Thirteen separate information systems were utilized during the four phases of the MI pathway. Observations revealed fragmented CIS utilization, with users accessing an average of six systems to gain a complete set of patient information. Data capture was found to vary between each pathway stage and in both patient cohort risk groupings. The highest level of information completeness (100%) was observed only in the discharge stage of the MI care pathway. The lowest level of information completeness (58%) was observed in the admission stage. CONCLUSION: The study highlights fragmentation, CIS duplication, and discrepancies in the current clinical information capture and data transfer across the MI care pathway in an acute cardiac care setting. The development of an integrated and user-friendly electronic data capture and transfer system would reduce duplication and would facilitate efficient and complete information provision at the point of care.

Modelling and performance analysis of clinical pathways using the stochastic process algebra PEPA.

BACKGROUND: Hospitals nowadays have to serve numerous patients with limited medical staff and equipment while maintaining healthcare quality. Clinical pathway informatics is regarded as an efficient way to solve a series of hospital challenges. To date, conventional research lacks a mathematical model to describe clinical pathways. Existing vague descriptions cannot fully capture the complexities accurately in clinical pathways and hinders the effective management and further optimization of clinical pathways. METHOD: Given this motivation, this paper presents a clinical pathway management platform, the Imperial Clinical Pathway Analyzer (ICPA). By extending the stochastic model performance evaluation process algebra (PEPA), ICPA introduces a clinical-pathway-specific model: clinical pathway PEPA (CPP). ICPA can simulate stochastic behaviours of a clinical pathway by extracting information from public clinical databases and other related documents using CPP. Thus, the performance of this clinical pathway, including its throughput, resource utilisation and passage time can be quantitatively analysed. RESULTS: A typical clinical pathway on stroke extracted from a UK hospital is used to illustrate the effectiveness of ICPA. Three application scenarios are tested using ICPA: 1) redundant resources are identified and removed, thus the number of patients being served is maintained with less cost; 2) the patient passage time is estimated, providing the likelihood that patients can leave hospital within a specific period; 3) the maximum number of input patients are found, helping hospitals to decide whether they can serve more patients with the existing resource allocation. CONCLUSIONS: ICPA is an effective platform for clinical pathway management: 1) ICPA can describe a variety of components (state, activity, resource and constraints) in a clinical pathway, thus facilitating the proper understanding of complexities involved in it; 2) ICPA supports the performance analysis of clinical pathway, thereby assisting hospitals to effectively manage time and resources in clinical pathway.

Can signalling theory and the semaphoric nature of information systems explain clinicians' ambivalence to informatics?

Investment in information systems has traditionally been justified in terms of productivity or value-added gain. From this point of view the slow rate of adoption of IT in the healthcare sector appears paradoxical because the rapid increase in medical costs has created an urgent need for productivity improvements. Spence's market signal theory may explain why some information system investment decisions are made and may, in part, explains the reluctance of clinicians to embrace informatics. Case studies are presented where we argue that information system investment was made primarily to send a market signal. We call information systems that are used primarily to send a market signal, semaphoric information systems. Characteristics of semaphoric information systems are presented. It is postulated that the therapeutic relationship between doctor and patient is central to current models of healthcare, and that the semaphoric 'message' of the current generation of IT systems may be detrimental to this relationship. This suggests that clinicians will continue to be reluctant to embrace information systems until information systems are developed that can send signals that enhance the doctor-patient relationship.

Facilitating stroke care planning through simulation modelling.

Stroke is a leading cause of death and long-term severe disability. A major difficulty facing stroke care provision in the UK is the lack of service integration between the many authorities, professionals and stakeholders involved in the process. The objective of this article is to describe a prototype model to support integrative planning for local stroke care services.The model maps the flow of care in the acute and community segments of the care pathway for stroke patients and allows exploring alternatives for care provision. Simulation modelling can help to develop an understanding of the systemic impact of service change and improve the design and targeting of future services.

The impact of electronic patient records on workflow in general practice.

The Patient Access to Electronic Healthcare Records System (PAERS) allows patients to register their arrival at a GP's surgery and to view their healthcare record electronically whilst in the waiting area. The research reported in this short article was carried out to identify potential changes in clinical and administrative workflow resulting from the introduction of the system. The study considers workflow pre and post the implementation of PAERS. It also makes comparisons between two UK London-based surgeries, one with PAERS (Wells Park Practice) and one without such a system (South Lewisham Group Practice). The impact of PAERS on workflow and the potential benefits for GPs, administrative staff and patients are highlighted.

Potential impacts of patient access to their electronic care records.

This paper examines the interest and expectations of patients having access to their electronic care records. Semi-structured prospective interviews were performed with 109 patients in a community setting in London where all records are stored digitally either as coded data, free text or scanned in from the paper original. A booth had recently been set up for patients to access their electronic records in the waiting room with secure access through fingerprint recognition technology. The interviews detailed history and levels of interest in access, impact on relationship with clinician, familiarity with digital media and issues of security and accuracy. Patients were more interested in seeing their electronic than their paper record; they felt it would improve their relationship with their clinician; they generally trusted in the security of their records; they anticipated that there would be some mistakes; they were enthusiastic about the idea of adding to the record themselves, but were divided about having access over the internet. Patients are confident in and anticipate the value of having access to their electronic records.

Evaluation of the impact of a PACS system on an intensive care unit.

Describes part of a wider evaluation exercise undertaken to assess the impact of the introduction of a picture-archiving and communication system (PACS) on the adult intensive care unit (AICU) at the Royal Brompton NHS Trust in London. The objectives of this research were to evaluate the perceptions of PACS of the medical and ancillary staff working within AICU as well as to undertake a preliminary assessment of its impact on the workload of radiographers. Questionnaires, interviews and a process analysis were undertaken. The research findings indicate that the overall perception of staff towards the introduction of the PACS was positive. The impact of the system on the workload of radiographers was significant, reducing the time taken to obtain an image from 90 to 60 minutes. However, lessons to be learned for future PACS implementations include the need to ensure compatibility with existing IT systems, adequate IT support and initiatives to ensure that the benefits of PACS are communicated to the hospital at large.