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.