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Available. Open Access. Open Access
Article
Publication date: 28 November 2023

Georgia Watson, Cassie Moore, Fiona Aspinal, Andrew Hutchings, Rosalind Raine and Jessica Sheringham

Many countries have a renewed focus on health inequalities since COVID-19. In England, integrated care systems (ICSs), formed in 2022 to promote integration, are required to…

691

Abstract

Purpose

Many countries have a renewed focus on health inequalities since COVID-19. In England, integrated care systems (ICSs), formed in 2022 to promote integration, are required to reduce health inequalities. Integration is supported by population health management (PHM) which links data across health and care organisations to inform service delivery. It is not well-understood how PHM can help ICSs reduce health inequalities. This paper describes development of a programme theory to advance this understanding.

Design/methodology/approach

This study was conducted as a mixed-methods process evaluation in a local ICS using PHM. The study used Framework to analyse interviews with health and care professionals about a PHM tool, the COVID-19 vaccination uptake Dashboard. Quantitative data on staff Dashboard usage were analysed descriptively. To develop a wider programme theory, local findings were discussed with national PHM stakeholders.

Findings

ICS staff used PHM in heterogeneous ways to influence programme delivery and reduce inequalities in vaccine uptake. PHM data was most influential where it highlighted action was needed for “targetable” populations. PHM is more likely to influence decisions on reducing inequalities where data are trusted and valued, data platforms are underpinned by positive inter-organisational relationships and where the health inequality is a shared priority.

Originality/value

The COVID-19 pandemic accelerated a shift toward use of digital health platforms and integrated working across ICSs. This paper used an evaluation of integrated data to reduce inequalities in COVID-19 vaccine delivery to propose a novel programme theory for how integrated data can support ICS staff to tackle health inequalities.

Details

Journal of Integrated Care, vol. 31 no. 4
Type: Research Article
ISSN: 1476-9018

Keywords

Available. Open Access. Open Access
Book part
Publication date: 16 August 2023

Ross Coomber, Andrew Childs, Leah Moyle and Monica Barratt

The online sourcing, supply, and purchase of illicit drugs is fast transforming drug markets worldwide. Although the long-term development of simple communications technology over…

Abstract

The online sourcing, supply, and purchase of illicit drugs is fast transforming drug markets worldwide. Although the long-term development of simple communications technology over time (from pagers to mobile phones) continues to impact and extend local drug supply dynamics, it is the recent developments of dark web cryptomarkets, social media applications (like Instagram), encrypted messaging applications (like WhatsApp), and surface web platforms, such as LeafedOut, that are changing the drug supply landscape online. The use of technology in drug supply has tended to go hand in hand with improving the efficiency of supply and opportunities to reduce exchange-related risks for both buyers and sellers. In relation to app-mediated supply, for example, the use of encrypted messaging provides enhanced security for arranging purchases beyond the lurking surveillance of law enforcement. Despite the perception of improved safety, however, the use of social media apps and other online platforms can expose both buyers and sellers to risk scenarios they may not fully appreciate. Drawing on two recent studies on the use of social media apps and the online platform LeafedOut as mediators of drugs supply, this chapter will consider how these mid-range (between cryptomarkets and traditional telecommunications such as basic texting/calling and material ‘street’ markets) virtual spaces are being utilised for drug supply and the extent to which this is ‘just more of the same’ or provides new structures and experiences for those engaging with it and in what ways. Consideration will also be given to contradictions in the mid-range market space where the broad perception of reduced risk from the use of encrypted messaging can in fact produce greater levels of risk for some buyers and sellers depending on how they engage with the process/es.

Details

Digital Transformations of Illicit Drug Markets: Reconfiguration and Continuity
Type: Book
ISBN: 978-1-80043-866-8

Keywords

Available. Open Access. Open Access
Article
Publication date: 3 August 2021

Declan Bays, Hannah Williams, Lorenzo Pellis, Jacob Curran-Sebastian, Oscar O'Mara, PHE Joint Modelling Team and Thomas Finnie

In this work, the authors present some of the key results found during early efforts to model the COVID-19 outbreak inside a UK prison. In particular, this study describes outputs…

1032

Abstract

Purpose

In this work, the authors present some of the key results found during early efforts to model the COVID-19 outbreak inside a UK prison. In particular, this study describes outputs from an idealised disease model that simulates the dynamics of a COVID-19 outbreak in a prison setting when varying levels of social interventions are in place, and a Monte Carlo-based model that assesses the reduction in risk of case importation, resulting from a process that requires incoming prisoners to undergo a period of self-isolation prior to admission into the general prison population.

Design/methodology/approach

Prisons, typically containing large populations confined in a small space with high degrees of mixing, have long been known to be especially susceptible to disease outbreaks. In an attempt to meet rising pressures from the emerging COVID-19 situation in early 2020, modellers for Public Health England’s Joint Modelling Cell were asked to produce some rapid response work that sought to inform the approaches that Her Majesty’s Prison and Probation Service (HMPPS) might take to reduce the risk of case importation and sustained transmission in prison environments.

Findings

Key results show that deploying social interventions has the potential to considerably reduce the total number of infections, while such actions could also reduce the probability that an initial infection will propagate into a prison-wide outbreak. For example, modelling showed that a 50% reduction in the risk of transmission (compared to an unmitigated outbreak) could deliver a 98% decrease in total number of cases, while this reduction could also result in 86.8% of outbreaks subsiding before more than five persons have become infected. Furthermore, this study also found that requiring new arrivals to self-isolate for 10 and 14 days prior to admission could detect up to 98% and 99% of incoming infections, respectively.

Research limitations/implications

In this paper we have presented models which allow for the studying of COVID-19 in a prison scenario, while also allowing for the assessment of proposed social interventions. By publishing these works, the authors hope these methods might aid in the management of prisoners across additional scenarios and even during subsequent disease outbreaks. Such methods as described may also be readily applied use in other closed community settings.

Originality/value

These works went towards informing HMPPS on the impacts that the described strategies might have during COVID-19 outbreaks inside UK prisons. The works described herein are readily amendable to the study of a range of addition outbreak scenarios. There is also room for these methods to be further developed and built upon which the timeliness of the original project did not permit.

Details

International Journal of Prisoner Health, vol. 17 no. 3
Type: Research Article
ISSN: 1744-9200

Keywords

Available. Open Access. Open Access
Article
Publication date: 14 February 2025

Teresa Corbett, Ninna Meier and Jackie Bridges

The study aims to explore how healthcare workers (HCWs) navigate and experience time when caring for older cancer patients living with other illnesses.

5

Abstract

Purpose

The study aims to explore how healthcare workers (HCWs) navigate and experience time when caring for older cancer patients living with other illnesses.

Design/methodology/approach

This paper presents findings from a qualitative study of how HCWs conceptualise and navigate the temporal aspects of delivering personalised care to older people living with multimorbidity. Building on research from organisation studies and the sociology of time, we interviewed 19 UK HCWs about their experiences of delivering care to this patient group.

Findings

Our findings illustrate how the delivery of personalised care contradicts contemporary models for healthcare delivery defined by efficiency and standardisation. We found that HCWs engage with time as both a valuable commodity to be rationed and prioritised within a constrained context and as a malleable resource for managing workload and overcoming “turbulence” in the system. However, participants in this study also shared how the simultaneous multiplicity and lack of time had a profoundly personal impact on them through the emotional toll associated with “time debt” and “lost” time.

Originality/value

This research presents a unique analysis of how time is conceptualised and navigated in contemporary healthcare, offering valuable insights for policy improvement. We conclude that personalised models of healthcare are incompatible with many current temporal structures of treatment trajectories and work-practices, by nature of being centred around the person and not the system of delivery.

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