Blerina Kellezi

Seeking support after hospitalisation for injury: a nested qualitative study of the role of primary care

BACKGROUND In the UK, studies suggest that the transition from hospital to home after an injury can be a difficult time and many patients report feeling inadequately prepared. Patients often use primary care services after hospital discharge. These consultations provide opportunities to consider problems that patients experience and to facilitate recovery. Little is known, however, about how patients and service providers view care after hospital discharge and the role played by primary care services, specifically GPs. AIM To identify good practice and unmet needs in respect of post-discharge support for injured patients. DESIGN AND SETTING Qualitative study using semi-structured interviews at four sites (Bristol, Leicester/Loughborough, Nottingham, and Surrey). METHOD Qualitative interviews with 40 service providers and 45 hospitalised injured patients. RESULTS Although there were examples of well-managed hospital discharges, many patients felt they were not provided with the information they needed about their injury, what to expect in terms of recovery, pain control, return to work, psychological problems, and services to help meet their needs. They also described difficulty accessing services such as physiotherapy or counselling. Service providers identified problems with communication between secondary and primary care, lack of access to physiotherapy, poor communication about other services that may help patients, GP service and resource constraints, and difficulties in providing information to patients concerning likely prognosis. CONCLUSION Discharge from hospital after an injury can be problematic for patients. Changes in both secondary and primary care are required to resolve this problem.

Doing research in immigration removal centres: Ethics, emotions and impact

Immigration Removal Centres (IRCs) are deeply contested institutions that rarely open their doors to independent research. In this article we discuss some of the complications we faced in conducting the first national British study of everyday life in them. As we will set out, research relationships were difficult to forge due to low levels of trust and unfamiliarity with academic research. At the same time, many participants had unrealistic expectations about our capacity to assist while most exhibited high levels of distress. We were not immune from the emotional burden of the field sites. Such matters were compounded by the limited amount of published information about life in IRCs and a lack of ethical guidelines addressing such places. Drawing on related literature from prison sociology, we use our experiences in IRCs to set out a methodological account of understanding, ethics, and impact within these complex sites.

Providing effective trauma care: the potential for service provider views to enhance the quality of care (qualitative study nested within a multicentre longitudinal quantitative study)

Objective To explore views of service providers caring for injured people on: the extent to which services meet patients’ needs and their perspectives on factors contributing to any identified gaps in service provision. Design Qualitative study nested within a quantitative multicentre longitudinal study assessing longer term impact of unintentional injuries in working age adults. Sampling frame for service providers was based on patient-reported service use in the quantitative study, patient interviews and advice of previously injured lay research advisers. Service providers’ views were elicited through semistructured interviews. Data were analysed using thematic analysis. Setting Participants were recruited from a range of settings and services in acute hospital trusts in four study centres (Bristol, Leicester, Nottingham and Surrey) and surrounding areas. Participants 40 service providers from a range of disciplines. Results Service providers described two distinct models of trauma care: an ‘ideal’ model, informed by professional knowledge of the impact of injury and awareness of best models of care, and a ‘real’ model based on the realities of National Health Service (NHS) practice. Participants’ ‘ideal’ model was consistent with standards of high-quality effective trauma care and while there were examples of services meeting the ideal model, ‘real’ care could also be fragmented and inequitable with major gaps in provision. Service provider accounts provide evidence of comprehensive understanding of patients’ needs, awareness of best practice, compassion and research but reveal significant organisational and resource barriers limiting implementation of knowledge in practice. Conclusions Service providers envisage an ‘ideal’ model of trauma care which is timely, equitable, effective and holistic, but this can differ from the care currently provided. Their experiences provide many suggestions for service improvements to bridge the gap between ‘real’ and ‘ideal’ care. Using service provider views to inform service design and delivery could enhance the quality, patient experience and outcomes of care.

Psychological morbidity and return to work after injury: multicentre cohort study

BACKGROUND The benefits of work for physical, psychological, and financial wellbeing are well documented. Return to work (RTW) after unintentional injury is often delayed, and psychological morbidity may contribute to this delay. The impact of psychological morbidity on RTW after a wide range of unintentional injuries in the UK has not been adequately quantified. AIM To quantify the role of psychological factors, including anxiety, depression, and post-traumatic distress, on RTW following unintentional injuries. DESIGN AND SETTING A longitudinal multicentre prospective study was undertaken in Nottingham, Bristol, Leicester, and Guildford, UK. METHOD Participants (n = 273) were 16-69-year-olds admitted to hospital following unintentional injury, who were in paid employment prior to injury. They were surveyed at baseline, then at 1, 2, 4, and 12 months following injury; demographic data were collected along with injury characteristics, psychological morbidity, and RTW status. Associations between demographic, injury and psychological factors, and RTW between 2 and 12 months after injury were quantified using random effects logistic regression. RESULTS The odds of RTW between 2 and 12 months after injury reduced as depression scores early in the recovery period (1 month after injury) increased (odds ratio [OR] 0.87, 95% confidence interval [CI] = 0.79 to 0.95) and as length of hospital stay increased (OR 0.91, 95% CI] = 0.86 to 0.96). For those experiencing threatening life events following injury (OR 0.27, 95% CI = 0.10 to 0.72) and with higher scores on the Crisis Support Scale (OR 0.93, 95% CI] = 0.88 to 0.99), the odds of RTW between 2 and 12 months after injury were lower. Multiple imputation analysis found similar results, but those relating to crisis support did not remain statistically significant. CONCLUSION Primary care professionals can identify patients at risk of delayed RTW who may benefit from management of psychological morbidity and support to RTW.

The impact of injuries on health service resource use and costs in primary and secondary care in the English NHS

© The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. Background: Injuries in working age adults are common, but few studies examine NHS resource use or costs. Methods: Costing study based on a cohort of 16- to 70-year olds admitted to hospital following unintentional injury in NHS Trusts in four UK centres. Participants completed resource-use questionnaires up to 12 months post-injury. Primary and secondary care, aids, adaptations, appliances and prescribed medications were costed. Mean costs by injury type and age group and costs per clinical commissioning group (CCG) were estimated. Results: A total of 668 adults participated. Follow-up rates ranged from 77% at 1 month to 65% at 12 months. The mean cost of injuries over 12 months was £4691 per participant. Costs were highest for hip fractures (£5159), lower limb fractures (£4969) and multiple injuries (£4969). Secondary care accounted for 87% of mean costs across all injuries and primary care for 10%. The mean cost per CCG was £7.3 million (range £1.8 million-£25.6 million). The total cost across all English CCGs was £1.53 billion. Conclusions: Unintentional injuries in working age adults result in high levels of NHS resource use and costs in the year following injury. Commissioning effective injury prevention interventions may reduce these costs.

Early risk factors for depression, anxiety and post-traumatic distress after hospital admission for unintentional injury: multicentre cohort study

OBJECTIVE To quantify psychological morbidity and identify baseline factors associated with depression, anxiety and post-traumatic distress symptoms up to 12 months post-injury. METHODS Multicentre cohort study of 668 adults, aged 16 to 70, admitted to 4 UK NHS hospital trusts. Data on injury, socio-demographic characteristics and health status was collected at recruitment. Depression, anxiety and post-traumatic distress were measured at 1, 2, 4 and 12 months post-injury. Multilevel linear regression assessed associations between patient and injury characteristics and psychological outcomes over 12 months follow-up. RESULTS Depression, anxiety and post-traumatic distress scores were highest 1 month post-injury, and remained above baseline at 2, 4 and 12 months post-injury. Moderate or severe injuries, previous psychiatric diagnoses, higher pre-injury depression and anxiety scores, middle age (45-64 years), greater deprivation and lower pre-injury quality of life (QoL) were associated with higher depression scores post-injury. Previous psychiatric diagnoses, higher pre-injury depression and anxiety scores, middle age, greater deprivation and lower pre-injury QoL were associated with higher anxiety scores post-injury. Traffic injuries or injuries from being struck by objects, multiple injures (≥3), being female, previous psychiatric diagnoses, higher pre-injury anxiety scores and greater deprivation were associated with higher post-traumatic distress scores post-injury. CONCLUSION A range of risk factors, identifiable shortly after injury, are associated with psychological morbidity occurring up to 12 months post-injury in a general trauma population. Further research is required to explore the utility of these, and other risk factors in predicting psychological morbidity on an individual patient basis.

Getting In, Getting Out and Getting Back: Conducting Long-Term Research in Immigration Detention Centres

In this chapter, we document challenges we face in conducting ongoing research on everyday life in immigration removal centres (IRCs) many of which relate to the highly contested nature of these sites. Immigration detention is frequently in the news, yet rarely the topic of independent academic scrutiny. The Home Office and the private companies who manage these sites of confinement hardly ever allow researchers into them, leaving most of those who write about such places dependent on NGOs, former detainees or evidence gleaned from conversations in the visits halls. We are the exception to the rule, having obtained and retained permission to enter IRCs to conduct independent academic research in 2009. In this chapter, drawing on interviews and field notes with and about staff, we explore some of the tensions inherent in maintaining a working relationship over a long period of time and in these complex research sites. Though aspects of our experience are specific to IRCs, some will apply to other, long-term research projects in custody.