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Poor access to healthcare and increasing demand for services represent a management dilemma how to balance between needs and costs. Scrutinising the concept of demand management and using a case study from Finnish primary care, the purpose of this paper is to examine the complexities of managing demand for health services.

Convenience has explained the popularity of walk-in clinics (WIC), making it an attractive demand management tool. By analysing the quantitative service utilisation data of frequent attenders at WIC, the paper exemplifies what enhanced access to care means for demand management of public welfare services.

High user rates and satisfaction indicate demand for this type of service; however, the establishment of WIC provided supplementary care for the high users of health services, most suffering chronic diseases.

Better understanding of the structure of service demand is needed in order to develop a more coordinated service system and to manage demand for public welfare services.

The study demonstrates the importance of identifying service utilisation patterns in managing demand. Instead of single solutions, a wider system-level perspective is essential.

Managing demand and facilitating access are core primary care attributes but there is little evidence about the impact of demand management strategies. The paper ties together important healthcare management issues: how to control demand and improve the access? Moreover, few studies have examined the frequent attendance at WIC. This paper presents a practical illustration of demand management tool and indicates some demand management problems to be considered in healthcare management.

An extant of literature has demonstrated an apparent connection between religiosity and physical and psychological health, yet there is a scarcity of studies focussing on the impact of religion on health among children and adolescents. The current study examined associations between self‐report data on self‐image, physical and psychological health and death‐related cognitions in a large representative sample of German high‐school students. Almost 1,000 German adolescents (aged 14‐18 years) were administered a comprehensive series of questionnaires aimed at assessing anxiety/depression, trait addiction, smoking and drinking behaviour, physical ill‐health reports, and self‐perception of self‐image, parental acceptance and educational attainment. Several statements were incorporated to assess self‐injury and suicidal ideation. Just over half of the adolescents (56.9 per cent) did not attend church at all. Level of school influenced church attendance with secondary school adolescents attending least. Religious denomination also exerted a major role on church attendance with Muslims attending most regularly followed by Roman Catholics and then Protestants. Males were more likely to be non‐attendees. Regular church attendees tended to adopt more healthy life‐styles, they exercised more regularly, smoked less, were more likely to display higher school grades in linguistic – but not mathematical – competency. Conversely, there was some indication that negative affect, reflected by higher scores on the social problems scale was higher among church attenders. Religiosity was scarcely related to suicidal ideation among adolescents.

There is a proportion of psychiatric service users whose needs are not met by existing models of care. This can lead to a reliance on acute and crisis services. These service users may be considered high intensity users (HIUs). The purpose of this research is to evaluate the Crisis Plus model, an intervention designed to better support HIUs in the community and reduce dependency on acute and crisis services.

Forty-seven HIUs were involved in Crisis Plus. The core intervention of Crisis Plus was an Anticipatory Management Plan (AMP), produced in collaboration with service users, their families and their care coordinators. AMPs were shared with relevant services and attached to electronic patient notes to ensure a uniform, psychologically informed approach to care.

HIU service use was compared pre and post-AMP. On average, number of inpatient admissions, number of days spent on the ward, accepted psychiatric liaison referrals and accepted home treatment team (HTT) referrals decreased significantly.

Crisis Plus has taken a collaborative, proactive approach to engage HIUs, their families and the services that care for them. Crisis interventions that emphasise collaborative working and service user agency are key.

The provision of dedicated psychological support to HIUs and their professional and personal network is crucial to reduce reliance on acute and crisis care. Crisis Plus is unique in that it instigates co-production and active consultation with HIUs and services to improve clinical outcomes, in addition to reducing NHS expenditure.

Frequent attendance at emergency departments (ED) has been identified in adult protection reviews as a potential warning sign of the escalation of someone’s vulnerability. Concern has been expressed about the engagement of the National Health Service (NHS) in adult protection and the small number of NHS adult protection referrals. More specifically ED departments have been identified as an area of high patient through put where there has been little evidence around how well adult support and protection (ASP) was being delivered. The paper aims to discuss these issues.

A series of audits were undertaken in three different hospitals across a large Scottish Health Board accessing ED at different times of day on different days of the week to test out whether NHS staff working in EDs are identifying adults who meet the criteria of “an adult at risk”.

The audits identified a total of 11 patients from a total sample of 552 records examined who may have met the criteria to be considered an adult at risk, although further information would have been required to make a fully informed decision.

The main study limitation is that the hospitals are all within a single Health Board. The EDs have a large number of admissions and it is possible that a less pressurised area, might have a lower threshold of “risk” than the practitioners involved in the audits. The decision as to whether an adult was considered to meet the three-point test by the three people undertaking the audit was dependent on the quality of information recorded on the patients’ electronic hospital record.

It is essential that NHS Boards proactively support practice in ED settings so staff are able to identify adults at risk of harm under the ASP legislation so that ED staff are responsive to ASP needs.

The research evidence around adult protection in the UK is still emerging. The development of good practice based on the Scottish Government’s ASP legislation is still being shaped. In England and Wales, the principles of identification and multi-agency working underpinning the safeguarding of vulnerable individuals are broadly similar to Scotland. These audits add to the literature by challenging the assumption that patients who would benefit from local authority investigation and possible support are not being identified within EDs.

Physical comorbidities of alcohol misuse are common and result in frequent attendance to hospitals with estimated £3.5bn annual cost to the NHS in England. The purpose of this paper is to evaluate the effect of the hospital in-reach team of the Leeds Addiction Unit (LAU) in reducing hospital service utilization in people with alcohol dependence.

This is a retrospective cohort study, with a mirror-image design. The authors included all patients who had wholly alcohol attributable admission(s) to Leeds Teaching NHS Hospitals Trust (LTHT) during a four-month period between January and April 2013 and received treatment from LAU. The primary outcome measures were changes in A and E attendance (A&E) attendances, number of hospital admissions and days spent in hospital between the three months before and after the LAU intervention.

During the four-month period, there were 1,711 wholly alcohol attributable admissions related to 1,145 patients. LAU saw 265 patients out of them 49 who had wholly alcohol attributable admissions engaged in treatment with LAU. Of those who engaged 33 (67.3 per cent) had fewer A&E attendances, 34 (69.4 per cent) had fewer admissions and 39 (80 per cent) spent fewer days in hospital in the three months after compared to three months before. There was a significant reduction in total number of hospital admissions (78 vs 41, mean=1.56 vs 0.82, p<0.001) and days spent in hospital (490 vs 146, mean=9.8 vs 2.92, p<0.001).

This mirror-image study suggests that an alcohol hospital in-reach team could be effective in reducing acute hospital service utilization by engaging with the frequent attenders with alcohol misuse complications.

The purpose of this paper is to describe how frequent attenders (FAs), divided into different profiles, use of primary care, emergency care and specialised medical care and which social services have been granted to them.

The present study utilises previous research of FAs and their identification of four profiles. The data were acquired from three data registries in Finland. Analysis of the FAs (n = 56) data was undertaken using descriptive statistics methods and qualitative analysis.

Patients with multiple problems used primary care, emergency care and specialized medical care frequently, and they had the highest number of appointments with doctors and nurses. Social services were required mostly social work. Visits made by patients with an impaired capacity caused by substance abuse were mainly targeted at appointments and mental health care services to a nurse in primary care. The required types of social services were often rehabilitative work experience. For mothers requiring support, the most frequently used services in primary were the child health and maternity clinic. The social services granted were mostly social work. Children and adolescents who are burdened by everyday concerns visits were mainly focused on primary to the child health and maternity clinic. Use of social services often entailed the supervision of contact sessions between parents and children’s.

The study confirmed that there is a need for increase knowledge of FAs. The service needs of FAs should be understood multi-dimensionally and the research results justify the individualised integration of social and health services for FAs.

The research results justify the individualised integration of social and health services for FAs.

English Football Club Plymouth Argyle had been in the Third Division, with an unpopular management team and a bleak future. Incoming managers made major changes on and off the pitch and success soon followed. The club also completely overhauled its business plan. Central to this was a major research initiative that included both quantitative and qualitative elements. The research results gave the club the information it needed to implement a new marketing strategy that has seen season ticket sales increase by more than 500 percent and merchandise sales rise by more than 200 percent. The club has been in profit since 2001, a rarity in English football.

The purpose of this paper is to demonstrate the usefulness of the “audience exchange” approach for audience development and research, and to highlight the insights offered by peer-to-peer dialogue in understanding experiences of unfamiliar arts.

Using a case study with contemporary arts audiences, and setting this in the wider context of studies with other first-time attenders at a range of arts events, the paper explores the use of the “audience exchange” method, in which facilitated conversations after performance events allow newcomers to reflect upon and deepen their first-time encounters with live arts.

The study demonstrates the way in which conversations about arts events can enrich audience experience, and shows how participants use exploratory and emotional language to articulate their understanding of unfamiliar arts events. Peer-to-peer learning occurs through these conversations, in ways that could be further supported by arts organisations as a valuable tool for audience development. The audience exchange discussions also reveal the varieties of participation from “drifting” to full attention that are all part of audience engagement.

This is a small-scale, qualitative study, and the method has potential to be tested in future studies with a greater variety of participants (e.g. younger or more ethnically diverse groups).

Use of the audience exchange for enriching experiences of first-time attendance could be adopted by arts organisations as a regular part of their audience engagement. Greater understanding of how new audience members draw on prior cultural experiences in finding the language to articulate their first impressions of an unfamiliar arts event could be valuable for targeted marketing and increasing accessibility.

The originality of this study lies in its elaboration of the audience exchange method, and its focus on the language and peer-to-peer learning evident in the facilitated post-performance discussions.

Homeless people experience extreme health inequalities and high rates of morbidity and mortality (Aldridge et al., 2017). Use of primary care services are low, while emergency healthcare use is high (Mathie, 2012; Homeless Link, 2014). Duration of admission has been estimated to be three times longer for homeless patients who often experience poor hospital discharge arrangements (Mathie, 2012; Homeless Link, 2014). This reflects ongoing and unaddressed care and housing needs (Blackburn et al., 2017). The paper aims to discuss these issues.

This paper reveals how GPs employed in secondary care, as part of Pathway teams, support improved health and housing outcomes and safe transfer of care into community services. It draws on published literature on role of GPs in working with excluded groups, personal experience of working as a GP in secondary care, structured interviews with Pathway GPs and routine data collected by the team to highlight key outcomes.

The expertise of GPs is highlighted and includes holistic assessment, management of multimorbidity or “tri-morbidity” – the combination of addictions problems, mental illness and physical health (Homeless Link, 2014; Stringfellow et al., 2015) and research and teaching.

The role of the GP in the care of patients with complex needs is more visible in primary care. This paper demonstrates some of the ways in which in-reach GPs play an important role in the care of multiply excluded groups attending and admitted to secondary care settings.