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Flashcards in Treating Groups Deck (18)
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1
Q

How is the ageing population effecting NHS admissions

A
  • 2/3 of people admitted to hospital are >65yrs
  • Older people stay longer and more likely to be readmitted
  • Health expenditure on >75s is 13x greater than the rest of the population
  • Budget is shrinking
    • Planned 3.9% cut per year to public health funding until 2020/21 (Kings Fund, 2016)
2
Q

Name one goal of the NHS

A

equitable treatment for all

delivering better health for our communities through population-wide and individually focussed initiatives.

These aim to maximise health and wellbeing and prevent illness. It’s all about trying to keep people well, delivering better care through quick access to modern services.

3
Q

why has there recently been a drive towards group-based care

A

NHS funding cuts & evidence of group based interventions working well in some populations

4
Q

What is social prescribing

A

Social prescribing is a way for local agencies to refer people to a link worker.

Link workers give people time, focusing on ‘what matters to me’ and taking a holistic approach to people’s health and wellbeing.

They connect people to community groups and statutory services for practical and emotional support

5
Q

give 2 examples of 2 national socially prescribed groups

A
  • Obesity/weight management
  • Cardiac rehabilitation (physical activity groups)
  • National Childbirth Trust (NCT)
  • Stop smoking groups
  • Alcoholics Anonymous
6
Q

What did (Paul Ebhohimhen & Avenell, 2009) suggest about social prescribing

A
  • Assumption: groups are efficient and therefore cheaper-but lack of conclusive data
  • If the groups don’t work, then actually less cost-effective as not having the desired impact
7
Q

Why may current group based interventions not be as effective as expected?

A
  • Current use of groups in healthcare generally not informed by literature on group effects (e.g., “social cure” research)
    • Not currently drawing on the processes/literature for group-based interventions
    • Groups can bring health and wellbeing benefits but research has not been translated into practice
  • Failure to consider psychological reality of the group
8
Q

How is cot death an example of ‘translation’ failure from research to public health

A

In 1992, public health advice was issued around reducing risk.

Substantial studies had been reported 10-15 years prior to this, showing babies should sleep on their front to reduce SIDS.

But public health advice was delayed.

9
Q

What are the consquences of this translation failure of scientific evidence to public knowledge and practice

A
  • The design of group interventions is largely individually-focused
  • Group interventions have been developed largely independently
    • Even though they often target the same behaviours (e.g., physical activity)
    • Or processes (e.g., self-efficacy)
  • Heterogeneity in design and poorly reported (Borek et al., 2015, 2018)
    • Replication often impossible
    • Variability in effectiveness (“chance” element)
  • Variability of influence: group size, focus, who runs, how often they meet
    • Makes this hard to replicate
  • One intervention might work, but others don’t -lack of transparency contributes
10
Q

What is the major flaw of current obesity interventions

A

Current interventions do not include the dynamics of the group, even though literature states this is very important in the effectiveness

11
Q

What did the Booth (2016) Systematic Review find

A
  • Population: Adults/children receiving healthcare services for one or more chronic conditions
  • Intervention: delivery of one or more services to a group of patients by HCP (excluded peer-facilitated groups)
  • Comparison: Any other method of treatment organisation
  • Outcomes: Patient outcomes, health service outcomes, patient/carer satisfaction, resource use
    • N=13 SRs, 22 RCTs; 12 qual studies; mostly focused on diabetes groups in USA
  • Effectiveness on:
    • Patient outcomes (improved glycated haemoglobin; systolic BP; quality of life)
    • Patient satisfaction: valued socialisation, normalisation, information sharing
    • Mixed evidence for cost-effectiveness: additional cost of training in group facilitation
  • Conclusion: consistent and promising evidence for effectiveness of group clinics
  • But: limited generalisability (diabetes groups); US-based; NHS considerations?
  • Also, considerable variability in mode of delivery, “dose” etc.
12
Q

What did Borek et al. (2018) find: SR and meta-analysis of weight-management groups (RCTs)

A
  • N=49 studies included (18 “high quality”)
  • Limited information available on group content
  • But evidence that groups were better
  • Greater weight loss (BMI change) over time (up to 24mths)
  • Men-only groups (greater weight-loss) however programmes not based on BC theory!
    • Existing taxonomies are focused on individuals but not group context
    • Individually-focused content important?
13
Q

What did Tarrant et al. (2017) find: group-based “Tier 3” obesity care

A
  • Overarching theme: The group as a resource underpinning lifestyle change
  • Dependent on emergent group dynamics: psychological connections empowered patients to initiate and sustain change
14
Q

What does this show

A

Social identity as a part of a group was essential for achieving the desired lifestyle change/meeting the goals of a group in a clinical setting.

15
Q

What did Nackers et al. (2015) find

A
  • Groups “in conflict” are less effective:
    • Lower weight loss
    • Also impacts attendance and adherence (to diet / PA)
16
Q

What are these 6 hypotheses for

A

Group processes flow from shared social identity:

15 Hypotheses exists between social cure and health outcomes:

-These 6 are considered important for group interventions for health

17
Q

true or false: Group-based healthcare may not be suitable for everyone or every health condition

A

true - (see Greaves & Campbell, 2007)

18
Q

conclude the power that group treatments can have

A
  • Groups are clearly suitable for many people and potentially offer numerous health benefits
  • Benefits of enabling development of psychological connections: social identity
  • Pressure on healthcare system makes it inevitable that groups will increasingly be used in this way
  • Some patients don’t want to join a group (up to 50% in some settings: Wingham et al., 2006)
    • E.g., because of unwillingness to disclose sensitive information
    • But benefits may be realised only after joining (SPA)
  • Groups can be difficult to organise or it may be difficult to attend all sessions