Experiences of implementing the 'Making Every Contact Count' initiative into a UK integrated care system: an interview study.

BACKGROUND: The 'Making Every Contact Count' (MECC) approach is in line with the current National Health Service (NHS) strategy to improve and prevent health conditions in England. Despite its importance and value for preventative healthcare, implementation of MECC varies. The aim of this study was to explore the barriers and facilitators of implementing MECC and MECC training into an integrated care system (ICS). METHODS: Remote semi-structured interviews were conducted with staff across an ICS in the North West of England who were involved in implementing and delivering MECC across the region. Data were analysed initially using an inductive thematic analysis approach and then interpreted using the 'Capability, Opportunity, Motivation = Behaviour' (COM-B) model of behaviour change. RESULTS: We interviewed nine stakeholders and identified three superordinate themes: (1) macro-level barriers and facilitators, e.g. funding; (2) organizational level barriers and facilitators, e.g. time and resource; and (3) individual-level barriers/facilitators for both MECC trainers and MECC agents. CONCLUSIONS: MECC has potential to meet the needs of the public's health, but barriers to its implementation exist. MECC must be successfully embedded into organizations and regions in which it is implemented, which relies on further development of an appropriate infrastructure including sustainable funding and a shift in culture to value preventative healthcare.

Survey on Availability of Domiciliary Dental Care under 16-km Rule.

In Japan, domiciliary care fees are only covered by the public health insurance system if the clinic concerned is located within 16 km of the patient's residence. This nationwide rule does not take local conditions into account and therefore may not be appropriate. The goal of the present study was to assess the current state of domiciliary dental care nationwide in view of this restriction to clarify the current situation and any inherent problems. Six dental institutions providing domiciliary dental care were selected by location (urban or mountainous area) and size. Travel time from clinics to the 16 km points and the longest time required for the journey from clinics were investigated. Two of the dental clinics were located in depopulated areas with few dental institutions. These clinics had to provide domiciliary dental care not only in the 16-km area around the clinic, but also in areas over 16 km away. Travel time to the 16-km points was between 52 and 90 min. On the other hand, the longest time for actual visiting was between 30 and 60 min. In some areas, no domiciliary dental care was available within the 16 km limit. This indicates that the 16-km area is too wide to be covered by one dental institution alone and that it poses a problem in areas with few dental institutions. This suggests that it would be preferable to consider time required to visit rather than geographical distance in forming policy. The 16-km limit often spans multiple residential areas, indicating that greater coordination is needed between the Community-based Integrated Care System and dental offices.

DASC-21: a novel geriatric assessment for discriminating best supportive care in older patients with inoperable advanced non-small cell lung cancer.

OBJECTIVE: This study investigated whether the Dementia Assessment Sheet for the Community-based Integrated Care System is useful for decision-making or problem detection in the treatment and care of older patients with inoperable advanced non-small cell lung cancer compared with the current standard model using performance status. METHODS: This study retrospectively examined 1595 cases admitted to the Department of Respiratory Medicine at the Tokyo Metropolitan Geriatric Hospital between 26 July 2016 and 28 January 2020. Among these, 29 and 31 patients who received pharmacotherapies and best supportive care were extracted, respectively. The performance in identifying best supportive care using the Dementia Assessment Sheet for the Community-based Integrated Care System was evaluated in comparison with performance status. The ability to detect impairments in each Dementia Assessment Sheet for the Community-based Integrated Care System domain was also assessed. RESULTS: The Dementia Assessment Sheet for the Community-based Integrated Care System total score had an area under the curve of 0.831 (95% confidence interval, 0.694-0.914), which was statistically equivalent to performance status. The discriminatory cut-off value for identification of best supportive care was set at 29 with a sensitivity and specificity of 0.742 and 0.897, respectively. Dementia Assessment Sheet for the Community-based Integrated Care System total score showed good concordance with performance status especially when reported by family members or caregivers. Deficits other than activities of daily living were recognized (2.8-19.4%) in patients with good performance status. Impairments were more frequently detected when reported by family members or caregivers. CONCLUSIONS: The Dementia Assessment Sheet for the Community-based Integrated Care System discriminates the best supportive care for older patients with inoperable advanced non-small cell lung cancer. Moreover, it can identify vulnerabilities especially when reported by family members or caregivers that cannot be detected by performance status.

Shorter Interval between Onset and Admission to Convalescent Rehabilitation Wards Is Associated with Improved Outcomes in Ischemic Stroke Patients.

As Japan's population ages, there is a growing interest in regional health care coordination. Our study aimed to evaluate whether the interval between onset and admission to convalescent rehabilitation wards (onset-admission) was associated with outcomes in ischemic stroke patients. We conducted a retrospective cohort study in a single rehabilitation hospital. Ischemic stroke patients consecutively admitted to the wards were eligible to enroll. Outcomes included Functional Independence Measure (FIM)-motor gain, the Food Intake Level Scale (FILS) and a discharge rate to home. FIM assesses functional independence, including motor (FIM-motor) and cognitive domains, and is a measure of activities of daily living (ADLs). The FIM-motor gain indicates the difference between the FIM-motor scores at admission and discharge. FILS is a 10-point observer-rated scale to measure swallowing. After enrollment, 481 patients (mean age 74.4 years; 45.7% women) were included. The median [interquartile range] onset-admission interval was 13 [10-20] days and the median National Institute of Health Stroke Scale score, a measure of stroke severity, was 8 [3-13]. In multivariate analysis, the onset-admission interval was independently associated with FIM-motor gain (ß = -0.107, p = 0.024), FILS score at discharge (ß = -0.159, p = 0.041), and the rate of discharge to home (odds ratio: 0.946, p = 0.032). In conclusion, a shorter interval between stroke onset and admission to convalescent rehabilitation wards contributes to improved outcomes, including ADLs, dysphagia, and a discharge rate to home, in ischemic stroke patients, regardless of stroke severity.

A retrospective study on the diagnosis and treatment of dementia in patients referred to the Sagamihara Municipal Medical Center for Dementia for consultation.

AIM: In Japan, the Orange Plan was formulated in 2013 to promote community-based integrated care systems, and in 2015, it was revised as the New Orange Plan. Since the introduction of these programmes, adequate research has not been carried out on how these measures affect regional dementia care. The aim of this study was to investigate the state of community-based dementia treatment through a survey of medical consultation pathways, including dementia diagnosis, at the Sagamihara Municipal Medical Center for Dementia. METHODS: The participants included 1480 patients (585 men, 895 women) who presented for consultation at the Sagamihara Municipal Medical Center for Dementia for a differential diagnosis or treatment of dementia. The relationship between the path leading to medical consultation before pharmacotherapy and post-consultation diagnosis was investigated. RESULTS: Significantly more participants who presented for consultation without a referral were not diagnosed with dementia than diagnosed. Furthermore, among participants referred from a non-psychiatric clinic, significantly more patients were diagnosed with dementia than not. A significant difference was observed in a comparison of facility types and the use or non-use of anti-dementia drugs. Notably, the rate of anti-dementia drug prescriptions was significantly higher in psychiatric hospitals and non-psychiatric clinics. Furthermore, it is possible that approximately 30% of anti-dementia drugs prescribed at each facility were not covered by insurance. CONCLUSION: Community-based integrated care systems aim to promote collaboration within each region aimed. However, appropriate pharmacotherapy methods for dementia patients have not been adequately communicated to non-specialist physicians and local residents. For this reason, human resource solutions are needed to help medical staff deepen their understanding of dementia so that they can better provide dementia support to patients.

[Examining attitudes toward mutual support in daily life and their associated factors within a community-based integrated care system: Findings of the "Survey to Enrich the Lives of Miyamae Ward Residents"].

Objectives　This study aimed to examine current relationships with neighbors among city dwellers and determine the factors associated with providing and accepting support in daily life.Methods　The "Survey to Enrich the Lives of Miyamae Ward Residents" was conducted with 1,000 people aged ≥30 years residing in Miyamae Ward, Kawasaki City. The survey items included baseline characteristics (e.g., sex, age, and residential status), relationships with neighbors, inclination to share personal information, and inclination to provide/accept support for the instrumental activities of daily living (IADL). To identify the factors associated with providing and accepting support for IADL, logistic regression analyses were performed with the following independent variables: baseline characteristics, neighborly relationships, inclination to share personal information, and inclination to provide support for the IADL.Results　We analyzed 407 respondents with complete responses. Among the different levels of neighborly relationships, 11.8% of the respondents were "cooperative with neighbors in daily life," 33.3% would "only stand and talk," 46.0% would "only exchange greetings," and 9.0% had "no relationships with neighbors." Among those willing to provide support, the highest proportions of responses were for "Calling on/watching over others" (60.1%) and "Helping to throw out garbage" (51.7%). In contrast, less than 30% of respondents were willing to seek support from neighbors and volunteers for these two activities. The factors significantly associated with a willingness to provide support were women and relationships with neighbors at the "stand and talk" level or higher. A disinclination to share personal information was inhibitory to providing support. The factors significantly associated with a willingness to accept support were women and the inclination to provide support according to IADL. Home ownership was inhibitory to accepting support.Conclusion　Fixed residential status and longer residence durations did not necessarily contribute to closer relationships with neighbors in urban areas. Although the respondents generally only exchanged greetings with neighbors, closer relationships are needed to facilitate a willingness to provide support to others. While many respondents were willing to provide simple assistance in daily life, rather fewer would seek help for the same activities. However, the acceptance of support was associated with the inclination to provide support, indicating a correlation between these two attitudes. In order to further encourage mutual support in daily life in urban areas, it is necessary to not only improve the level of relationships with neighbors, but also to implement initiatives that increase opportunities for people to gain experience providing support.

Integrated care in mental health: next steps after the NHS Long Term Plan.

Health and social care face growing and conflicting pressures: mounting complex needs of an ageing population, restricted funding and a workforce recruitment and retention crisis. In response, in the UK the NHS Long Term Plan promises increased investment and an emphasis on better 'integrated' care. We describe key aspects of integration that need addressing.Declaration of interestD.K.T. and S.S.S. are on the editorial board of the British Journal of Psychiatry and executives of the Academic Faculty at the Royal College of Psychiatrists. A.J.B.J., H.P. and Z.M. have roles at the Royal College of Psychiatrists that include evaluation of integrated care systems. A.J.B.J. is married to Dr Sarah Wollaston, Member of Parliament for Totnes and Chair of the Health Select Committee.

[Role of Visiting Nursing Care in Japanese Home Healthcare].

Taiwan's rapidly aging society is expected to make it a super-aged society in 2026. By 2060, people aged 65 or older will account for 40% of the population, a ratio that will approximate that in Japan. In Japan, the elderly population was 27.3% in 2016. By 2025, when the baby-boomers become 75 years old in Japan, issues of long-term care and end-of-life care will be more important and challenging. Since 1976, more Japanese have died in hospital settings than in home settings. Although the percentage of people dying at home increased slightly to 12.7% in 2016, after the recent introduction and promotion of home healthcare, Japan will face a significant challenge to deal with the healthcare 'tsunami' of high natural death rates, which is expected to impose a heavy death burdened on society by 2040, when the death rate is expected to reach 1,670,000/year. Therefore, the Japanese authorities have begun to promote the Community-based Integrated Care System, in which home healthcare and visiting nursing play crucial roles. This article summarizes the historical trend and current situation of visiting nursing in Japan. Japan uses a hybrid payment system for visiting nursing that is financially supported both through private medical insurance policies and Kaigo insurance (Japanese long-term care insurance). The total of 8613 visiting nursing stations that were active in community settings in 2016 cooperated with 14,000 support clinics for home healthcare and cared for 570,000 patients in home settings. We believe that visiting nursing will play an important role in home healthcare in Taiwan in the future.

Development and verification of community development index for improving functioning of aged people in rural districts (third report): data collection and analysis system on social mutual aid are desired for community development for elderly persons living in rural districts.

Objective: The author conducted a survey on social mutual aid and the social stimulative effect of older adults living in a rural district, and compared young old and old-old persons to clarify the roles of public health nurses in promoting community development. Materials and Methods: A cross-sectional study based on Andersen's Behavioral Model of Health Care Utilization was conducted with 2,500 residents aged 65 years or older of City A in Akita Prefecture. The study was conducted from April 8 to May 15, 2017. Participants were administered a questionnaire containing items on "social mutual aid in the rural district". Responses were recorded on a Likert scale. Results: As a result of factor analysis, the following four factors were extracted; [Blessing of a rural district and mutual help and assistance unique to a rural district], [Closeness of healthcare welfare service and family doctors in conjunction with their own health], [Decline of culture and community unique to rural districts accompanied by depopulation] and [Closeness of the town where they live]. Differences were observed in the closeness of social mutual aid and local societal stimulative effects, even between generations of old and old-old persons. In young-old persons, a negative correlation was observed between [Closeness of the town where they live] and other factors. In old-old persons, a negative correlation was found between [Decline of culture and community unique to rural districts accompanied by depopulation] and other factors. Conclusion: Since not only individual health indices but also local social mutual aid, which relates to individuals' influence on the construction of a Community-based Integrated Care System in a rural district, the author posits that a data collection and analysis system on social mutual aid would be beneficial for community development for older adults living in rural districts.

Categorization using the Dementia Assessment Sheet for Community-Based Integrated Care System 8-items (DASC-8) based on cognitive function and activities of daily living predicts frailty, disability and mortality in older adults.

AIM: This longitudinal study aimed to determine whether categorization by the Dementia Assessment Sheet for Community-based Integrated Care System 8-items (DASC-8) is associated with risk of frailty onset, disability, and mortality. METHODS: We analyzed longitudinal data from outpatients aged 65 years and older evaluated for the DASC-8 at the Frailty Clinic. The outcomes during the 3-year follow-up period were (Study A) frailty onset (Kihon Checklist ≥8) and (Study B) disability (new certification of nursing care needs) or mortality. Multivariate Cox regression analyses were performed to examine independent associations between the DASC-8 category and outcomes, and hazard ratios and 95% confidence intervals (CIs) were calculated after adjustment for age, sex, and the presence or absence of diabetes, hypertension, and dyslipidemia. RESULTS: (Study A) Out of the 216 patients without frailty in Categories I or II at baseline, 40 (20.4%) and 11 (55.0%) developed frailty, respectively. The adjusted hazard ratio was 3.62 (95% CI: 1.69-7.76, P < 0.001). (Study B) Out of the 350 patients who did not require long-term care at baseline, disability or death occurred for 20 (7.3%) in Category I, 14 (23.0%) in Category II, and 9 (56.3%) in Category III. The adjusted hazard ratios were 2.40 (Category I vs. II; 95% CI: 1.13-5.11, P = 0.023) and 5.43 (Category I vs. III; 95% CI: 2.23-13.3, P < 0.001). CONCLUSION: Categorization according to DASC-8 is associated with the risk of frailty, disability, and mortality in older patients. Geriatr Gerontol Int 2024; 24: 150-155.

Association between Cognitive Impairment Severity and Polypharmacy in Older Patients with Atrial Fibrillation: A Retrospective Study Using Inpatient Data from a Specialised Geriatric Hospital.

This study aimed to investigate the association between cognitive impairment and polypharmacy in patients with atrial fibrillation prone to cognitive decline, and to elucidate if the Dementia Assessment Sheet for Community-based Integrated Care System 21-Items (DASC-21) severity classification indicates drug adjustment. This retrospective cohort study used the DASC-21 and Diagnosis Procedure Combination data at a specialised geriatric hospital with patients hospitalised between April 2019 and March 2022. The association between cognitive severity evaluated using the DASC-21 and polypharmacy was investigated using a multivariate logistic regression model. Data of 1191 inpatients (44.3% aged ≥85 years, 49.0% male) were analysed. Compared with severe cognitive impairment, mild (odds ratio [OR]: 3.33, 95% confidence interval [CI]: 1.29-8.57) and moderate (OR: 2.46, 95% CI: 1.06-5.72) impairments were associated with concurrent use of ≥6 medications. Antithrombotics were related to polypharmacy. The ORs did not change with 6, 8, or 10 medications (2.11 [95% CI: 1.51-2.95, p < 0.001], 2.42 [95% CI: 1.79-3.27, p < 0.001], and 2.01 [95% CI: 1.46-2.77, p < 0.001], respectively). DASC-21 severity was associated with polypharmacy in patients with atrial fibrillation, with a trend toward decreased polypharmacy from moderate to severe. The DASC-21 may serve as an indicator for drug adjustment in clinical practice.

The relationship between DASC-8 categories and the effectiveness of education on insulin self-injection techniques in elderly patients with diabetes.

Aim: Education on insulin self-injection techniques is important for good glycemic control, but its effectiveness in some elderly patients is limited due to loss of cognitive function and impaired activities of daily living. We hypothesized that classification using the Dementia Assessment Sheet for Community-based Integrated Care System 8-items (DASC-8) would help identify elderly patients with diabetes who effectively learn self-injection techniques. Methods: Diabetes patients aged ≥ 65 years who used a self-injection insulin pen were administered the DASC-8 and a questionnaire to evaluate insulin self-injection techniques, and then received technical education. The questionnaire was administered again 4 months later, and patients were classified into the education-effective and education-ineffective groups. The achievement of HbA1c targets defined for each patient according to guidelines based on DASC-8 category was examined over 12 months. Results: 76 Japanese patients (median age 72.0 years and 53.9% female) with DASC-8 categories I (n = 55), II (n = 13), and III (n = 8) were enrolled. In the education-effective group, the percentage of patients in category I was significantly higher than that of patients in category II or III (92.0% to 23.8%, P < 0.001). Category I was independently associated with education effectiveness (odds ratio 14.50, 95% confidence interval: 2.110-100.0, P = 0.007). Category I patients in the education-effective group showed significantly improved achievement of target HbA1c from baseline to the 12th month (from 27.6% to 62.1%, P = 0.008). Conclusions: The DASC-8 was a useful indicator for identifying elderly patients who would benefit from education on self-injection techniques. Supplementary Information: The online version contains supplementary material available at 10.1007/s13340-024-00710-z.

Validation and Clinical Application of the Japanese Version of the Patient-Reported Experience Measures for Intermediate Care Services: A Cross-Sectional Study.

Older adult patients account for 70% of all hospitalized patients in Japan, and intermediate care based on patient-centered care (PCC) that ensures continuity and quality of care at the interface between home services and acute care services and restores patient's independence and confidence is necessary for them to continue living independently. At present, no concept of intermediate care is established in Japan, and the implementation of PCC has been delayed. Thus, in this study, a Japanese version of the intermediate care evaluation index (patient-reported experience measure (PREM)) was created on the basis of the original PREM developed in the UK, and data in wards with intermediate care functions in Japan were collected to confirm internal consistency and validity from 2020 to 2022. The Japanese version of PREM was found to have a factor structure with two potential factors. Given the clear correlation with the shared decision-making evaluation index, which is the pinnacle of PCC, the theoretical validity of the Japanese version of PREM, which is based on PCC as a theoretical basis, was confirmed.

The role of community nurse in the implementation of health policy for the elderly in Thailand.

In the implementation of the policy for the elderly, the nurses who have the competency to pull out their potential power to continue living with several stakeholders' support are required to provide care in the community. Community nurse in Thailand has the responsibility to deliver adequate medical care and also social care for the elderly. The study aimed to identify the role of community nurse in the implementation of Thai health policy for the elderly. Codes regarding the role of community nurse in the implementation of Thai health policy for the elderly were extracted from descriptive data interviewed with 15 policy implementors in Thailand. The codes were categorized by similarities using thematic analysis. The role of community nurse was 16 categories and 102 codes out of factors promoting implementation of Thai health policy for the elderly, with 27 categories and 416 codes. The main roles were Coordination, Service delivery, and Monitoring and evaluation, composing seven categories and 45 codes, eight categories and 51 codes, and one category and six codes, respectively. It was conspicuous in coordination mechanisms, especially between the organizations and disciplines in providing Primary Health Care. Both health promotion activities and medical treatment were crucial roles for community nurses. The role of community nurse was one of promoting factors of Thai health policy for the elderly. The community nurse acts as a lubricant between the hospital and the community, which means that the community nurse implements seamless service delivery for the elderly integrating medical care and welfare.

Perceptions and attitudes of users and non-users of mental health services concerning mental illness and services in Japan.

Objectives: There is a global movement to develop and implement community-based integrated mental health systems. The present study attempted to clarify the perceptions and attitudes of users and non-users of mental health services concerning mental illness and services in Japan. Methods: A new questionnaire was developed for this internet survey. Data from 500 outpatients with depression and 500 healthy subjects were sampled according to the demographics of the Japanese population. Results: Over 90% of healthy subjects and over 70% of patients were unaware of the common age of onset or lifetime prevalence of mental illness. Over 90% of the healthy subjects and about 70% of the patients could not describe any services where they would feel comfortable discussing mental health problems. In both groups, "adolescents and young adults" were ranked first as a target population for mental health and illness policies. The top requirement for the integrated care systems was the promotion and awareness of correct knowledge of mental illness in both the healthy subjects and patients. Conclusion: Societal requirements could include disseminating correct knowledge, awareness-raising actions for society, and implementing services where people, especially young people, can easily consult and receive support in the community.

Primary care in the world of integrated care systems: education and training for general practice.

Here, we discuss the required education and training for the emergent and evolving roles of GPs and other healthcare professionals within Integrated Care Systems (ICSs). We underscore the importance of collaborative skills for all medical specialties, and the need for interprofessional education and leadership development in undergraduate and postgraduate medical training. We also argue for a paradigm shift in medical education, away from traditional siloed approaches and toward comprehensive training that prepares practitioners to excel in integrated and multidisciplinary healthcare environments, within which expert generalists (GPs) and specialists collaborate in individual patient care and concurrently co-develop innovative system pathways for chronic medical conditions, including complexity and frailty. We highlight the need to align workforce development with evolving healthcare systems and the existing obstacles hindering this alignment.

Predicting three categories of Dementia Assessment Sheet for Community-based Integrated Care System 8-items score-based glycemic targets using the number of animal names recalled.

AIMS/INTRODUCTION: The Dementia Assessment Sheet for Community-based Integrated Care System 8-items (DASC-8) assesses memory, orientation, instrumental activities of daily living and basic activities of daily living. Category I (DASC-8 score ≤10), category II (11 ≤ DASC-8 score ≤16) and category III (DASC-8 score ≥17) have been defined. Based on these categories, the glycemic targets in diabetes patients aged ≥65 years have been proposed by the Japan Diabetes Society and the Japan Geriatrics Society Joint Committee. DASC-8 is difficult to apply to patients without family members or supportive persons. We propose a verbal fluency test as the screening tool. MATERIALS AND METHODS: We enrolled 69 inpatients aged ≥65 years with type 2 diabetes, who were administered the DASC-8 and VF tests, which included recalling animal names and common nouns starting with a specified letter in 1 min. The relationship between DASC-8 and verbal fluency test scores was investigated. RESULTS: Animal fluency correlated with DASC-8 scores after adjustment for patient characteristics. Animal scores correlated with orientation, instrumental activities of daily living and basic activities of daily living scores of DASC-8, and tended to show a relationship with DASC-8 memory scores. An animal score ≥8 predicted category I with a sensitivity of 89% and a specificity of 57%. An animal score ≤6 predicted category III with a sensitivity of 85% and a specificity of 67%. CONCLUSIONS: Animal scores would be useful in predicting the categories of DASC-8. Animal fluency could be a screening tool of DASC-8 when a patient's family member or supportive person is absent.

Good to know - This is PPIE! Development of a training tool for public and patient involvement and engagement in pediatric oncological research.

BACKGROUND: Public and Patient Involvement and Engagement (PPIE) in research is still a poorly understood and infrequently practiced concept, although the literature stresses clear benefits for quality of care and research as well as patient satisfaction and empowerment. AIM: The presently described project aimed at using different PPIE methods to evaluate the current state of knowledge about and attitude toward PPIE in research among different stakeholders of pediatric oncology in Europe. Based on the findings a tailored training tool directed toward the different stakeholders will be designed. METHODS AND RESULTS: An interdisciplinary steering group developed a mixed-method 3-stage process to (1) investigate the current knowledge and attitudes about PPIE using a Europe-wide cross-sectional online survey directed toward health care professionals (n = 134) and the patient group (patients, survivors, family members, …) (n = 168). The results were analyzed quantitatively, focusing on group comparisons (t-tests, X2 tests). (2) In a live workshop with n = 36 participants (HCPs and patient group) dual moderation teams (HCPs and patient experts) guided the exploration of effective ways for practicing PPIE. Despite classifying PPIE as relevant, both HCPs and patients indicated a low level of knowledge about the concept and terminology (patients: t(334) = -2.82, p = .004; HCPs: t(270) = -2.88, p = .004). While HCPs assumed to already be involving patients in many research areas, this was not perceived by the patient group (X2 (1, N = 304) = 42.70, p < .001). HCPs and patients named similar obstacles for implementing PPIE in research, though numerous creative solutions were found during the workshop (engagement). (3) The outcomes were integrated into a training tool (White-Board movie). CONCLUSION: Although HCPs and patients acknowledge the benefit of PPIE, the presented results highlight the lack of awareness about the concept, and the need for effective tools for researchers to integrate PPIE throughout the entire research process, thereby contributing to a sustainable change within the scientific culture.

Reporting radiographer academy training model; an evaluation of the impact for trainees and clinical service.

INTRODUCTION: Demand on imaging services continues to increase on a background of complex issues and barriers to care. Collaborative cross organisational working through the development of imaging networks is recommended to address these issues including managing reporting workloads. Standardisation of reporting practices and collaborative cross region reporting radiographer training has been recommended to be supported by a regional reporting radiographer academy model to achieve these aims. This research explores the perceptions of trainees and their managers/mentor who undertook radiographer academy training model with a view to integrated imaging network formalisation in the region. METHODS: An online questionnaire was designed to capture qualitative and quantitative data with three phases; 1) trainees perception of the academy model, 2) trainees perception of the differences in training models and 3) the perceptions of the managers/mentors related to the academy model. RESULTS: There were overwhelmingly positive opinions of the academy training model from both cohorts in this study, with the two main benefits emerging being the protected study time away from clinical departments and minimal disruption to clinical services due to reduced onus on the local mentors. Peer support was also highlighted as a positive aspect of the model which would facilitate future integrated imaging network working. CONCLUSION: The academy model has been well received by both cohorts in this study with positive outcomes highlighted and the model being seen as promoting and facilitating integrated imaging network working between departments. The small sample size of the study requires consideration when extrapolating the results to wider academy models, however some themes may be applicable. IMPLICATIONS FOR PRACTICE: Investment in the reporting radiographer academy model is justified and provides a practical alternative to the traditional model.

Knowledge sharing of health technology among clinicians in integrated care system: The role of social networks.

Promoting clinicians' knowledge sharing of appropriate health technology within the integrated care system (ICS) is of great vitality in bridging the technological gap between member institutions. However, the role of social networks in knowledge sharing of health technology is still largely unknown. To address this issue, the study aims to clarify the influence of clinicians' social networks on knowledge sharing of health technology within the ICS. A questionnaire survey was conducted among the clinicians in the Alliance of Liver Disease Specialists in Fujian Province, China. Social network analysis was conducted using NetDraw and UCINET, and the quadratic assignment procedure (QAP) multiple regression was used to analyze the influencing factors of knowledge sharing of health technology. The results showed that the ICS played an insufficient role in promoting overall knowledge sharing, especially inter-institutional knowledge sharing. Trust, emotional support, material support, and cognitive proximity positively influenced knowledge sharing of health technology, while the frequency of interaction and relationship importance had a negative impact on it. The finding extended the research scope of social network theory to the field of healthcare and will bridge the evidence gap in the influence of the clinicians' social networks on their knowledge sharing within the ICS, providing new ideas to boost knowledge sharing and diffusion of appropriate health technology.