Treating Groups Flashcards
How is the ageing population effecting NHS admissions
- 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)
Name one goal of the NHS
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.
why has there recently been a drive towards group-based care
NHS funding cuts & evidence of group based interventions working well in some populations
What is social prescribing
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
give 2 examples of 2 national socially prescribed groups
- Obesity/weight management
- Cardiac rehabilitation (physical activity groups)
- National Childbirth Trust (NCT)
- Stop smoking groups
- Alcoholics Anonymous
What did (Paul Ebhohimhen & Avenell, 2009) suggest about social prescribing
- 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
Why may current group based interventions not be as effective as expected?
- 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
How is cot death an example of ‘translation’ failure from research to public health
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.
What are the consquences of this translation failure of scientific evidence to public knowledge and practice
- 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
What is the major flaw of current obesity interventions
Current interventions do not include the dynamics of the group, even though literature states this is very important in the effectiveness
What did the Booth (2016) Systematic Review find
- 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.
What did Borek et al. (2018) find: SR and meta-analysis of weight-management groups (RCTs)
- 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?
What did Tarrant et al. (2017) find: group-based “Tier 3” obesity care
- Overarching theme: The group as a resource underpinning lifestyle change
- Dependent on emergent group dynamics: psychological connections empowered patients to initiate and sustain change
What does this show
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.
What did Nackers et al. (2015) find
- Groups “in conflict” are less effective:
- Lower weight loss
- Also impacts attendance and adherence (to diet / PA)
What are these 6 hypotheses for
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
