Josephine Exley

• London School of Hygiene and Tropical Medicine

The evidence underpinning integrated care remains uncertain, with numerous examples of evaluations finding little robust evidence of intended impacts on health or reporting conflicting results. Reasons for this include problems with the design and implementation of integrated care initiatives and issues with integrated care evaluations themselves,...

Background Long coronavirus disease (COVID) presents a significant health challenge. Long-term monitoring is critical to support understanding of the condition, service planning and evaluation. We sought to identify and examine longitudinal health data collected on long COVID to inform potential decisions in England regarding the rationale for data...

Background The advent of new chronic conditions such as long COVID-19 raises the question of whether and, if so, how best to establish new disease registries for such conditions. Prompted by the potential need for a long COVID-19 registry, we examined experiences of existing UK disease registries to understand barriers and enablers to establishing...

Background: The advent of new chronic conditions such as long COVID-19 raises the question of whether and, if so, how best to establish new disease registers for such conditions. Prompted by the potential need for a long COVID-19 register, we examined experiences of existing UK disease registers to understand barriers and enablers to establishing a...

Purpose Achieving greater health and social care integration is a policy priority in many countries, but challenges remain. We focused on governance and accountability for integrated care and explored arrangements that shape more integrated delivery models or systems in Italy, the Netherlands and Scotland. We also examined how the COVID-19 pandemic...

Background There is considerable opportunity to draw on other countries experiences to (better) understand the challenges facing the further development of innovative delivery systems and to identify ways to address them.We analysed the governance and accountability arrangements that influence integration efforts in Italy, the Netherlands and Scotl...

Background The increasing difficulty experienced by general practices in meeting patient demand is leading to new approaches being tried, including greater use of telephone consulting. Objectives To evaluate a ‘telephone first’ approach, in which all patients requesting a general practitioner (GP) appointment are asked to speak to a GP on the tele...

Background: To better manage patient demand, some general practices have implemented a 'telephone first' approach in which all patients seeking a face-to-face appointment first have to speak to a GP on the telephone. Previous studies have suggested that there is considerable scope for this new approach, but there remain significant concerns. Aim:...

Objectives To estimate the impact on hospital utilisation and costs of a multi-faceted primary care intervention for older people identified as being at risk of avoidable hospitalisation. Design Observational study: controlled time series analysis and estimation of costs and cost consequences of the Programme. General practitioner (GP)’s practice...

Objective To understand patients’ views on a ‘telephone-first’ approach, in which all appointment requests in general practice are followed by a telephone call from the general practitioner (GP). Design Qualitative interviews with patients and carers. Setting Twelve general practices in England. Participants 43 patients, including 30 women, nine...

Background: Long-term conditions place a substantial burden on primary care services, with drug therapy being a core aspect of clinical management. However, the ideal frequency for issuing repeat prescriptions for these medications is unknown. Aim: To examine the impact of longer-duration (2-4 months) versus shorter-duration (28-day) prescriptio...

Background: Walking is a good way to meet physical activity guidelines. We examined the effectiveness of walking in groups compared with walking alone or inactive controls in physically healthy adults on physical activity and quality of life. (PROSPERO CRD42016033752). Methods: We searched Medline, Embase, Cinahl, Web of Knowledge Science Citation...

Background To reduce expenditure on, and wastage of, drugs, some commissioners have encouraged general practitioners to issue shorter prescriptions, typically 28 days in length; however, the evidence base for this recommendation is uncertain. Objective To evaluate the evidence of the clinical effectiveness and cost-effectiveness of shorter versus...

BACKGROUND: To reduce expenditure on, and wastage of, drugs, some commissioners have encouraged general practitioners to issue shorter prescriptions, typically 28 days in length; however, the evidence base for this recommendation is uncertain. OBJECTIVE: To evaluate the evidence of the clinical effectiveness and cost-effectiveness of shorter versus...

Appendix 3: Further details of results

Appendix 4: Practice manager survey

Appendix 2: Patient questionnaire

Appendix 1: Further details of analytical methods

Objective To evaluate a “telephone first” approach, in which all patients wanting to see a general practitioner (GP) are asked to speak to a GP on the phone before being given an appointment for a face to face consultation. Design Time series and cross sectional analysis of routine healthcare data, data from national surveys, and primary survey da...

Objective. To evaluate a ‘telephone first’ approach, in which all patients wanting to see a GP are asked to speak to a GP on the phone before being given an appointment for a face to face consultation. Design Time-series and cross-sectional analysis of routine healthcare data, data from national surveys, and primary survey data. Participants 147 ge...

Background The lack of availability of skilled providers in low- and middle- income countries is considered to be an important barrier to achieving reductions in maternal and child mortality. However, there is limited research on programs increasing the availability of skilled birth attendants in developing countries. We study the implementation of...

Purpose: Patient-reported data are playing an increasing role in health care. In oncology, data from quality of life (QoL) assessment tools may be particularly important for those with limited survival prospects, where treatments aim to prolong survival while maintaining or improving QoL. This paper examines the use and impact of using QoL measure...

Background: Limited availability of skilled health providers in developing countries is thought to be an important barrier to achieving maternal and child health-related MDG goals. Little is known, however, about the extent to which scaling-up supply of health providers will lead to improved pregnancy and birth outcomes. We study the effects of th...

Background The Nigerian Midwives Service Scheme (MSS) is an ambitious human resources project created in 2009 to address supply side barriers to accessing care. Key features include the recruitment and deployment of newly qualified, unemployed and retired midwives to rural primary healthcare centres (PHCs) to ensure improved access to skilled care....

The Department of Health's Innovation, Health and Wealth (IHW) strategy aimed to introduce a more strategic approach to the spread of innovation across the NHS. This study represents the first phase of a three-year evaluation and aims to map progress towards the IHW strategy and its component actions. This evaluation used a combination of quantitat...

The Department of Health's Innovation, Health and Wealth (IHW) strategy aimed to introduce a more strategic approach to the spread of innovation across the NHS. This study represents the first phase of a three-year evaluation and aims to map progress towards the IHW strategy and its component actions. This evaluation used a combination of quantitat...

RAND Europe undertook a systematic review of the evidence of effectiveness and cost effectiveness on changing the public's risk related behaviour pertaining to antimicrobial use to inform the development of a NICE public health guideline aimed at delaying antimicrobial resistance (AMR). The review considered educational interventions targeting indi...

http://www.rand.org/pubs/research_reports/RR1143.html

Bryn Garrod, Josephine Exley, Emma Harte, Celine Miani, Jennifer Newbould, Catherine L. Saunders, Tom Ling. An evaluation of the first phase of Q: Engaging the founding cohort in a co-designed approach to health care improvement. Santa Monica, CA: RAND Corporation, 2016. http://www.rand.org/pubs/research_reports/RR1517.html.

The Nigerian Midwives Service Scheme (MSS) was not as effective as expected: The MSS was intended to improve the health of mothers and newborns in Nigeria by increasing access to trained midwives achieved some increases in use of maternal health care services but did not improve a number of other key outcomes, according to a new RAND Corporation s...

The European Bathing Directive (2006/7/EC) stipulates water quality standards for recreational bathing waters based on specified limits of faecal indicator organisms (FIOs). Presence of FIOs above the limits is considered to be indicative of poor water quality and to present a risk to bathers' health. The European Bathing Directive (2006) is to be...

Public Health England (PHE) commissioned RAND Europe to undertake a horizon scanning study exploring the future of public health and related scientific services. This work was intended to help inform thinking at the strategic level within PHE, firstly in relation to the wider vision of the Agency (which was only established in April 2013) and, seco...

This study aimed to assess whether the MDG classifications and JMP sanitation ladder corresponded to hygienic proxies. Latrines were purposively sampled in urban and rural Tanzania. Three hygienic proxies were measured: E. coli on points of hand contact, helminth at point of foot contact and number of flies. Additionally samples were collected from...

Available evidence on effective interventions to reduce length of stay in hospital is wide-ranging and complex, with underlying factors including those acting at the health system, organisational and patient levels, and the interface between these. There is a need to better understand the diverse literature on reducing the length of hospital stay....

The extent to which health care makes a difference to population health outcomes continues to be debated among researchers and practitioners alike. The National Health Service (NHS) in the UK provides an important natural experiment to study this association. In this study we aimed to quantify it using mortality from causes considered amenable to h...

Background A range of instruments can be used to achieve public health objectives, from statutory regulations to entirely voluntary initiatives. The Public Health Responsibility Deal (PHRD) in England is a voluntary public-private partnership that aims to contribute to public health objectives. Focusing on the alcohol labelling and salt reduction...

Background The Public Health Responsibility Deal (PHRD) in England is a public-private partnership that brings together government, academic experts, and commercial and voluntary organisations to contribute to meeting public health objectives. In this study we examine how other countries have sought to address public health problems targeted by the...

Available evidence on effective interventions to reduce length of stay in hospital is wide-ranging and complex, with underlying factors including those acting at the health system, organisational and patient levels, and the interface between these. There is a need to better understand the diverse literature on reducing the length of hospital stay....