Literature Collection

BACKGROUND: Demand for paediatric allergy services has risen significantly over the past 20 years. National health datasets suggest almost 40% of children have an allergy diagnosis. Existing service standards from the Royal College of Paediatrics and Child Health (RCPCH) have focused on specific disease care pathways and the interface between primary and secondary care services. Given strategic changes to NHS children and young people's services, we undertook a collaborative project between RCPCH and the British Society of Allergy and Clinical Immunology (BSACI) to define service priorities for Paediatric Allergy Care accreditation in the UK. METHODS: A BSACI working group developed 29 potential service standards. A consultation was then undertaken amongst BSACI members to identify indicative priorities. Potential standards were then prioritised using methodology adapted from the James Lind Alliance, by 24 stakeholders representing patients/patient groups (9), commissioners (2) and healthcare professionals (13). RESULTS: Seventeen strategic priorities were identified, under the following 6 themes: service delivery, prevention, diagnostics, management, communication, maintaining standards/education. These included: setting a minimum staffing mix for multidisciplinary teams providing paediatric allergy care (medical specialist(s), specialist nurse, dietitian, health psychologist); prompt recognition and management of complex, multisystem allergic disease; working within a regional network to ensure access to specialist paediatric allergy services; use of integrated care pathways and supporting primary care accordingly; supporting early access to interventions proven to reduce the risk of atopic disease (with consideration to potential barriers to access, including language, cultural, socioeconomic factors and other communication barriers); offering a referral pathway for disease-modifying treatment where appropriate and effective transitioning to adult care. CONCLUSIONS: These priorities form a basis for the delivery of high-quality care to children and young people affected by allergic disease.

INTRODUCTION: The overcrowded and overstimulating Emergency Department (ED) is ill-suited to the needs of people experiencing a mental health crisis and risks exacerbating distress. To reduce ED presentations and facilitate care transitions, the role of Transition Coordinator (TC) nurse was created. However, people receiving case management continued to attend ED, experiencing mental distress and needing admission. AIM/QUESTION: This mixed methods study explores the lead-up to these admissions to identify barriers to proactive care transitions. METHOD: Retrospective review of community mental health service clinical records for the 12 months preceding all unexpected admissions via ED in 2023. RESULTS: Themes included difficulty engaging with services, gaps in knowledge of case managers, support workers, and systemic issues including limited hours of service and recent hospital discharge. DISCUSSION: The study highlights the need for integration between hospital and community mental health services, the importance of crisis management planning, and the need for services to work together to smooth care transitions. IMPLICATIONS: Understanding factors associated with unexpected mental health deterioration allows care providers to modify practice and develop services that facilitate seamless care transitions and provide care matched to individual need. RECOMMENDATIONS: Integrated mental health services should consider the quality of care transitions, communication between different arms of the service, early identification of people at risk of mental health crisis, and access to services outside business hours.

BACKGROUND: Specialist intervention in COPD is often reactive, resulting in inequalities in the provision of care. A proactive approach, in which individuals with modifiable disease are identified from primary care records, may help to tackle this inequality in access. AIM: To estimate the prevalence of "treatable traits" in COPD in a primary care research database and to assess health service usage. METHODS: We performed a secondary analysis of individuals with either 1) a primary care diagnosis of COPD or 2) obstructive spirometry and history of ever smoking in a large observational study recruiting individuals aged 40-69 years old in Leicestershire, UK. Spirometry, height, weight and smoking history were collected prospectively and linked to individuals' primary care records. "Treatable traits" were identified from primary care records (frequent exacerbations, current smoking, low body mass index, respiratory failure, severe breathlessness, potential suitability for lung volume reduction or psychological comorbidity). Differences in demographics and health usage between those with and without "treatable traits" were assessed. RESULTS: In total, of the 347 individuals with COPD, 186 had at least one "treatable trait". Compared to those without treatable traits, individuals with treatable traits were younger (61 vs 64 years, p<0.001), had more severe airflow obstruction (FEV(1) 86% vs 94% predicted, p=0.002), higher eosinophil count (0.32 vs 0.27 cells/μL, p=0.04) and were more socioeconomically deprived (UK Indices of Multiple Deprivation decile 4.3 vs 5.8, p<0.001). Individuals with treatable traits had a higher annual primary care health usage (47 vs 30 visits per year, p=0.001). Referrals rates to specialist respiratory services were low in both groups. CONCLUSION: Treatable traits are common in COPD and can be identified from routinely collected primary care data. Treatable traits are associated with younger age and greater deprivation. These individuals pose a significant burden to primary care yet are rarely referred to specialist respiratory services.

BACKGROUND: Adversity in childhood is increasing in the United Kingdom. Complex health and social problems affecting children cluster in families where adults also have high need, but services are rarely aligned to support the whole family. Household level segmentation can help identify households most needing integrated support. Thus, the aim was to develop a segmentation model to identify those households with children who have high levels of complex cross-sectoral needs, to use as a case-finding tool for health and social care services, and to describe characteristics of identified households, to inform service integration. METHOD: Working with stakeholders-in an English region of 2.7m population- we agreed a definition of families having complex needs which would benefit from service integration - including households with high intensity use, who had both physical and mental health problems amongst both adults and children and wider social risks. We then used individual and household linked data across multiple health and social care services to identify these households, providing an algorithm to be used in a case finding interface. Finally, to understand the needs of this segment, and to identify unmet need, to tailor support, we used descriptive statistics and Poisson regression to profile the segment and compare them with the rest of the population. RESULTS: Twenty one thousand and five hundreds twenty seven households (8% of the population of the region) were identified with complex needs, including 89,631 people (41,382 children), accounting for 34% of health and social care costs for families with children, £362 million in total, of which 42% was on children in care of local authorities. The households had contact with 3-4 different services, had high prevalence of mental health problems, most frequently co-morbid with respiratory problems, with high mental health emergency service use particularly amongst teenage girls many of whom had no prior elective treatment for conditions. CONCLUSION: Our model provides a potentially useful tool for identifying households that could benefit from better integration of services and targeted family support that can help break intergenerational transfer of adversity.