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Multiple sclerosis (MS) is a chronic condition with variable physical, cognitive, and quality of life impacts. Little research has investigated how MS outcomes vary by social identity (race, gender, disability, age, sexual orientation, and nationality) and social location (place within systems of power and privilege). However, emerging evidence points to racial and ethnic group disparities in MS outcomes. This chapter integrates core concepts from the life course perspective and an intersectional feminist disability framework to interrogate the role of diagnosis pathways in determining differential MS outcomes. MS diagnosis pathways (the time from symptom onset to the point of diagnosis) are a logical place to begin this work given the varying nature of symptom onset and the importance of a quick diagnosis for optimal MS outcomes. Whereas the life course perspective provides a framework for understanding disability transitions and pathways across the life span, an intersectional feminist disability framework centers disability within an axis of overlapping social identities and locations. The combination of both frameworks provides an approach capable of examining how MS disparities and inequities emerge in different contexts over time. The chapter begins with an overview of MS and current knowledge on disparities (mainly racial) in MS prevalence, diagnosis, and outcomes. The chapter proceeds to describe the utility of key concepts of both the life course perspective and intersectional frameworks when researching health disparities. Finally, the chapter ends with a theoretical application of an intersectional feminist disability life course perspective to investigate disparities in MS diagnosis pathways.

The purpose of this paper is to describe current care pathways for children with autism including enablers and barriers, as experienced by health professionals, education professionals and families in South Wales, UK.

This study is based on a mixed-methods approach using focus group discussions, creative writing workshops and visualisation using rich pictures.

The experiences of the care pathways differed significantly across the three groups. Health professionals described the most rigidly structured pathways, with clear entry points and outcomes. Education professionals and parents described more complex and confusing pathways, with parents assuming the responsibility of coordinating the health and education activity in a bid to link the two independent pathways. All three groups identified enablers, although these differed across the groups. The barriers were more consistent across the groups (e.g. poor communication, missing information, lack of transparency, limited post-diagnosis services and access to services based on diagnosis rather than need).

This research could inform the design of new services which are premised on multi-agency and multi-disciplinary working to ensure children with Autism spectrum disorders (ASD) receive joined up services and support.

Although this study did not represent all professional groups or all experiences of autism, the authors examined three different perspectives of the ASD pathway. In addition, the authors triangulated high-level process maps with rich pictures and creative writing exercises, which allowed the authors to identify specific recommendations to improve integration and reduce duplication and gaps in provision.

The study aims to summarise the literature on cancer care pathways at the diagnostic and treatment phases. The objectives are to find factors influencing the delivery of cancer care pathways; to highlight any interrelating factors; to find gaps in the literature concerning areas of research; to summarise the strategies and recommendations implemented in the studies.

The study used a qualitative approach and developed a causal loop diagram to summarise the current literature on cancer care pathways, from screening and diagnosis to treatment. A total of 46 papers was finally included in the analysis, which highlights the recurring themes in the literature.

The study highlights the myriad areas of research applied to cancer care pathways. Factors influencing the delivery of cancer care pathways were classified into different albeit interrelated themes. These include access barriers to care, hospital emergency admissions, fast track diagnostics, delay in diagnosis, waiting time to treatment and strategies to increase system efficiency.

As far as the authors know, this is the first study to present a visual representation of the complex relationship between factors influencing the delivery of cancer care pathways.

The assessment of patterns in risky drinking and its association with dual diagnosis in community services for older people remains under-explored. The paper aims to discuss this issue.

Drinking risk using the Alcohol Use Disorders Identification Test (AUDIT) and the presence of co-existing mental disorders was examined in 190 people aged 65 and over.

In total, 24 per cent of drinkers drank above lower risk levels and 22 per cent reported binge drinking over the past 12 months. Those scoring 1 or more on the AUDIT were more likely to be male and to have greater cognitive impairment than non-drinkers and those reporting no past problems with alcohol.

Given the limitations of the Mini Mental State Examination in the detection of alcohol related cognitive impairment (ARCI), the use of other cognitive screening instruments in larger study populations is also warranted.

Greater attention needs to be paid to the assessment of risky drinking in older male drinkers and those with cognitive impairment.

There is considerable scope for the routine detection of cognitive impairment and dementia in older people with alcohol use within mainstream mental health services, particularly in those with binge drinking. As ARCI is associated with loss of function and independence, early detection and intervention can improve health and social outcomes.

The Dual Diagnosis National Programme at the Department of Health (England) commissioned an awareness‐raising e‐learning resource. The resource was developed by consultant nurses and other experts in PROGRESS and the Centre for Enhancement in Learning Innovation at Coventry University. This brief paper outlines the process of development and the initial feedback by users.

The authors examined the cardiac care pathway with the aim of identifying factors that impact on diagnosis and treatment of coronary heart disease in British Pakistani women.

This is an exploratory qualitative study. In depth interviews and focus groups with an opportunistic sample of Pakistani women and a purposive sample of clinicians working at different points along the care pathway were conducted. The authors used a pathways to care approach to illustrate how their individual and cumulative effect may contribute to differential receipt of treatment, including revascularisation, and health inequalities.

Four major issues were identified: complex life circumstances; “atypical” presentation and symptomatology; problems related to investigative testing; and poor communication. Mapping these barriers onto the Pathways to Care Model provided valuable insight into their impact on patients' progression through the different stages of the care pathway.

Adopting a care pathway approach demonstrated how individual factors have an impact at several points along the care pathway. It indicated where further, more detailed enquiry is merited and where intervention studies might usefully be directed to improve care.

Examining the whole care pathway identified areas of service improvement that merit a co‐ordinated response.

The framework provided by the Pathways to Care Model offered insight into the causes of the previously observed attenuation in women's progress along the cardiac diagnosis and treatment pathway and is an important first step to addressing this health inequality in a holistic way.

In the OECD countries, hospitals face increased financial restrictions and competition. Process orientation is an essential means of remaining competitive. A wide range of theories and concepts relating to clinical process management already exists. When it comes to practical implementation, however, a comprehensive approach for the target‐oriented and consistent introduction of clinical process management throughout an entire hospital is missing. The purpose of this paper is to document the case of a German hospital that has realised a project of this kind and demonstrate the impacts on cooperation and on operational efficiency, which is understood as the degree to which a hospital is capable of steadily realising short lengths of stay.

The case shows the approach to implementing theories and concepts for managing clinical processes in practice as a consistent management system in the day‐to‐day use of process management and its impacts.

The effect of using clinical processes shown in the case is an additional net profit of several million euros a year – without a reduction in quality.

While the impacts of clinical pathways on hospitals are not country‐specific, the reasons are nonetheless subject to the political and economic conditions. Therefore, some findings are only valid for hospitals in German‐speaking countries. However, major effects (e.g. reduction in the length of stay) may exist everywhere.

The paper shows how process orientation in a medium‐sized hospital can be systematically implemented.

The purpose of this paper is to identify actual (as-is) patient pathway variation among breast cancer patients and to investigate the relationship between pathways and the cost incurred by patients.

Both quantitative and qualitative methods were employed to analyze data from four Swedish hospital groups. Quantitative methods include event-log data mining and statistical analyses on the related patient cost from the Swedish breast cancer quality registry and case-costing system. Qualitative methods included collaboration with and interviewing domain experts.

Unique pathways, followed by only one patient, were generally costlier than the most and less frequent pathways. Earlier study findings are confirmed for mastectomy patients, with more frequent pathways having a lower cost, whereas contradicting and inconclusive results emerged for the partial mastectomy patient groups. Highest variation in pathways was identified for patients receiving chemotherapy.

The common belief – if one follows a standardized patient pathway, then the cost will be lower – should be re-examined based on the actual pathways that occur in reality.

The relationships between patient pathways and patient cost allow more complex insights, beyond the general causal relationship between successfully implementing a “to-be” care pathway and lower cost. This highlights data-driven research’s importance, where actual pathways (as-is) provide more useful information than to-be care pathways.

This paper aims to examine effective diagnostic and treatment pathways for attention deficit hyperactivity disorder (ADHD) in prison settings given the high prevalence of ADHD and comorbidities in the prison population.

Two studies were carried out in two separate prisons in London. Firstly, data were collected to understand the prevalence of ADHD and the comorbidities. The second study used quality improvement (QI) methodology to assess the impact of a diagnostic and treatment pathway for prisoners with ADHD.

Of the prisoners, 22.5% met the diagnostic criteria for ADHD. Nearly half of them were screened positive for autistic traits, with a higher prevalence of mental disorders among prisoners with ADHD compared to those without. The QI project led to a significant increase in the number of prisoners identified as requiring ADHD assessment but a modest increase in the number of prisoners diagnosed or treated for ADHD.

Despite various challenges, an ADHD diagnostic and treatment pathway was set up in a prison using adapted QI methodology. Further research is needed to explore the feasibility of routine screening for ADHD in prison and examine at a national level the effectiveness of current ADHD prison pathways.