Shaping research for people living with co-existing mental and physical health conditions: A research priority setting initiative from the United Kingdom.

INTRODUCTION: Those with severe and enduring mental ill health are at greater risk of long-term physical health conditions and have a reduced life expectancy as a result. Multiple factors compound this health inequality, and the need for setting research priorities in this area is highlighted with physical and mental healthcare services being separate, and limited multimorbidity research. METHODS: The aim of this exercise was to work in partnership with healthcare professionals and carers, family, friends and individuals with lived experience of both mental and physical health conditions, to set research priorities to help people with mental health conditions to look after their physical health. The exercise was guided by the James Lind Alliance approach. For this, a steering group was set up, two surveys were completed and a final priority workshop was conducted. RESULTS: This priority setting exercise guided by people's needs and lived experience has produced a set of well-defined research topics. Initially, 555 research questions were suggested in the first survey, which were refined to 54 questions for the second survey. A priority setting workshop was then conducted to get the final 10 priorities. CONCLUSIONS: Taking these topics forward to improve services and treatment for both mental and physical ill health may in turn improve physical health and lessen the reduced life expectancy of those living with mental ill health. PATIENT OR PUBLIC CONTRIBUTION: This work was completed in collaboration with people who have lived experience of mental ill health and physical health conditions, as well as carers, family and friends. Their contribution has been significant for this work from piloting surveys, amending language used and educating the researchers and contributing to this paper. The initial work was completed with a steering group and continued with surveys and workshops.

The policy landscape and challenges of disaster risk financing: navigating risk and uncertainty.

A more anticipatory, pre-agreed response is a shared goal of many in the disaster management and humanitarian communities. This paper considers the emerging policy landscape of disaster risk financing (DRF), which is taken here to include mechanisms that allow agencies to act in advance of disasters occurring, as well as those that aim to respond earlier to disasters which have already happened. What they both have in common is no longer waiting for needs to become apparent before responding; however, this creates a challenge for practitioners because of the potential for acting erroneously. This paper provides a more cohesive way of understanding approaches in this policy area through the shared challenge of decision-making under the condition of uncertainty. Drawing on expert interviews and science and technology studies theory, it sets out some recommendations on how practitioners can navigate risk and uncertainty better within DRF and in a more nuanced way.

Program Implementation Approaches to Build and Sustain Health Care Coordination for Type 2 Diabetes.

BACKGROUND: As more people enter the U.S. health care system under the Affordable Care Act (ACA), it is increasingly critical to deliver coordinated, high-quality health care. The ACA supports implementation and sustainability of efficient health care models, given expected limits in available resources. This article highlights implementation strategies to build and sustain care coordination, particularly ones consistent with and reinforced by the ACA. It focuses on disease self-management programs to improve the health of patients with type 2 diabetes, exemplified by grantees of the Alliance to Reduce Disparities in Diabetes. METHOD: We conducted interviews with grantee program representatives throughout their 5-year programs and conducted a qualitative framework analysis of data to identify key themes related to care coordination. RESULTS: The most promising care coordination strategies that grantee programs described included establishing clinic-community collaborations, embedding community health workers within care management teams, and sharing electronic data. Establishing provider buy-in was crucial for these strategies to be effective. DISCUSSION: This article adds new insights into strategies promoting effective care coordination. The strategies that grantees implemented throughout the program align with ACA requirements, underscoring their relevance to the changing U.S. health care environment and the likelihood of further support for program sustainability.

A review of the efficacy and effectiveness of using telehealth for paediatric speech and language assessment.

We reviewed the literature relating to the use of telehealth for paediatric speech and language assessment. Four databases, and relevant reference lists, were searched for articles published between January 2004 and July 2014. A total of 180 articles were identified, of which only five were relevant. All studies assessed efficacy using method comparison techniques; no studies assessed effectiveness. The method comparison studies investigated the validity and/or reliability of speech and language assessment via telehealth, when compared with face-to-face assessment. Studies varied in terms of participant group, assessment tools, statistical analysis and telehealth equipment. The papers reviewed presented some evidence that telehealth can be used to make valid assessments of oromotor function, speech intelligibility and language. Articulation screening via telehealth was found to be valid, but there was conflicting evidence about full articulation assessment. Intra- and inter-rater reliability was good for all speech and language tasks, with the exception of oromotor assessment, which also had reduced reliability when assessed face-to-face. There were discrepancies between the two modalities for individual oromotor tasks, judgement of individual speech sounds, detection of pluralisation, and discriminating between similar sounding words; these have the potential to be clinically important. Evidence regarding satisfaction was extremely limited, with only one study reporting parental satisfaction, and no studies reporting child or clinician satisfaction. Although there is limited evidence to support the validity and reliability of speech and language assessment via telehealth, it is probably not yet sufficient to influence clinical practice or policy development.

Speech pathology services to children with cancer and nonmalignant hematological disorders.

Children with cancer and nonmalignant hematological disorders may require speech pathology (SP) support; however, limited evidence is available describing prevalence and severity of swallowing/feeding and communication impairments in this population. A retrospective chart review of 70 children referred to SP at the newly formed Queensland Children's Cancer Centre was conducted to describe the prevalence and severity of swallowing/feeding and communication dysfunction, and the association between impairment, oncology and hematology diagnosis, and service utilization (time and occasions of service). Swallowing/feeding disorders were the most commonly observed impairments at initial assessment (58.6%). Children with central nervous system tumors (P = .03) and nonmalignant hematological disorder (P = .03) had significantly higher rates of feeding impairment than other oncology and hematology diagnostic groups. Children with central nervous system tumors had the highest rates of oral phase (P = .01) and pharyngeal phase (P = .01) dysphagia (swallowing disorder). No significant difference was found between diagnostic groups for intensity of SP service delivery. Prospective research is required to examine prevalence and severity of disorders, and service utilization in a more established clinic, and to investigate interactions between cancer treatment and swallowing/feeding and communication dysfunction.