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Andrew F Long

Publications and source records attributed to Andrew F Long.

16 recordsLinked to original sources
PubMed2006

Exploring patient perceptions of movement through the stages of change model within a diabetes tele-care intervention.

Achieving strict control of diabetes is challenging for many patients and most need regularly to depend on ongoing support from health care professionals. One approach that might successfully provide this in a cost-effective and acceptable way is the delivery of advice and support over the telephone (tele-care). To date the process and effects of tele-care have however rarely been studied. This article explores the potential of one behavioural model, the trans-theoretical stages of change model (TTM), to understand and theorize about behaviour change for this chronic disease. Case study data are drawn from a wider randomized controlled trial (RCT) set up to assess the effectiveness of a pro-active call centre-based stepped treatment support to people with type 2 diabetes. The case study demonstrates the relevance and importance of the TTM model in this area. Different experiential and behavioural processes were of particular significance and held different meanings for the various change groups.

Aged↗
PubMed2005

The use of patient reported outcome measures in routine clinical practice: lack of impact or lack of theory?

This paper applies a theory-driven approach to explore why the use of patient-reported outcome (PRO) measures in clinical practice, in particular, health-related quality of life (HRQoL) instruments, has little or no apparent influence on clinical decision making. A theory-driven approach involves combining knowledge of whether and how an intervention works. It is argued that such an approach is currently lacking within the literature evaluating the effectiveness of feeding back HRQoL information to clinicians. The paper identifies a number of mechanisms that might give rise to the expected outcomes that are currently implicit within the design of the intervention and hypotheses specified within the trials evaluating the use of HRQoL measures in clinical practice. It then examines how far current clinical practice matches these mechanisms and in doing so, a number of possible explanations for the lack of impact of HRQoL on clinical decision making are reviewed. The influence of HRQoL information on clinical decision making depends on a large number of factors related to the design of the intervention, patients' and clinicians' desire to discuss HRQoL issues within the consultation and the legitimacy that clinicians give to HRQoL instruments. To date, knowledge of how the feedback of HRQoL information to clinicians might improve doctor-patient communication or clinical decision making has yet to sufficiently inform an assessment of whether these aspects of patient care are improved. The paper concludes by specifying how the feedback of HRQoL information to clinicians might be modified to maximise its impact on clinical decision making.

Decision Making↗
PubMed2005

Square pegs and round holes? A review of economic evaluation in complementary and alternative medicine.

INTRODUCTION: Economic evaluation, linking the costs and consequences of an intervention to indicate the potential benefits of alternative interventions, is becoming established as one of the core tools for decision making in health care. As knowledge of the safety and effectiveness of complementary and alternative medicine (CAM) interventions increases, economic evaluation within CAM has a heightened significance. OBJECTIVE: To explore whether the present framework for economic evaluation fits CAM and what modifications if any are needed for its application. DESIGN: Systematic review. METHODS: A comprehensive search of four databases was undertaken (NHS Economic Evaluation Database, AMED, MEDLINE, CINAHL). Studies were included if they took the form of a comparative analysis of costs and consequences of a CAM treatment and were written in English. Each study was reviewed using a set of methodological questions to judge their quality as economic evaluations. RESULTS: A total of 19 studies were identified, of which 9 were cost-effectiveness studies, 7 cost-consequence studies, 2 cost-minimization studies, and 1 cost-benefit analysis. Seventeen (17) of the studies involved CAM treatments being used alongside mainstream or conventional treatments. The majority of the treatments aimed to alleviate pain, including chronic pain, back pain, neck pain, and migraine. Only a small minority of studies addressed wider outcomes of particular relevance to CAM disciplines. Nine (9) adopted a service provider perspective only, 7 included wider sickness absence costs and 3 patient costs. Only 1 study included costs to relatives. The quality of the cost and benefit dimensions of the studies was mixed. CONCLUSIONS: A CAM sensitive approach to economic evaluation is required. This needs to include a focus on outcomes that explore the range of effects of CAM treatment, an exploration of the client's perspective and not just that of the service provider and study designs that facilitate the individualized practitioner approach so central to CAM treatment.

Complementary Therapies↗
PubMed2005

Pro-active call center treatment support (PACCTS) to improve glucose control in type 2 diabetes: a randomized controlled trial.

OBJECTIVE: To determine whether Pro-Active Call Center Treatment Support (PACCTS), using trained nonmedical telephonists supported by specially designed software and a diabetes nurse, can effectively improve glycemic control in type 2 diabetes. RESEARCH DESIGN AND METHODS: A randomized controlled implementation trial of 1-year duration was conducted in Salford, U.K. The trial comprised 591 randomly selected individuals with type 2 diabetes. By random allocation, 197 individuals were assigned to the usual care (control) group and 394 to the PACCTS (intervention) group. Lifestyle advice and drug treatment in both groups followed local guidelines. PACCTS patients were telephoned according to a protocol with the frequency of calls proportional to the last HbA(1c) level. The primary outcome was absolute reduction in HbA(1c), and the secondary outcome was the proportion of patients reducing HbA(1c) by at least 1%. RESULTS: A total of 332 patients (84%) in the PACCTS group and 176 patients (89%) in the control group completed the study. Final HbA(1c) values were available in 374 patients (95%) in the PACCTS group and 180 patients (92%) in the usual care group. Compared with usual care, HbA(1c) improved by 0.31% (95% CI 0.11-0.52, P = 0.003) overall in the PACCTS patients. For patients with baseline HbA(1c) >7%, the improvement increased to 0.49% (0.21-0.77, P < 0.001), whereas in patients with baseline HbA(1c) <7% there was no change. The difference in the proportions of patients achieving a >/=1% reduction in HbA(1c) significantly favored the PACCTS intervention: 10% (4-16, P < 0.001) overall and 15% (7-24, P < 0.001) for patients with baseline HbA(1c) >7%. CONCLUSIONS: In an urban Caucasian trial population with blood glucose HbA(1c) >7%, PACCTS facilitated significant improvement in glycemic control. Further research should extend the validity of findings to rural communities and other ethnic groups, as well as to smoking and lipid and blood pressure control.

Adult↗
PubMed2005

Acceptability and satisfaction with a telecarer approach to the management of type 2 diabetes.

OBJECTIVE: To examine patients' views of the acceptability of and satisfaction with telephone care center support provided to improve blood glucose control in type 2 diabetes. RESEARCH DESIGN AND METHODS: The Pro-Active Call-Center Treatment Support (PACCTS) Trial randomized patients from 47 general practices in a deprived urban area in northwest England to usual care or to proactive call center support in addition to usual care. Satisfaction with care was assessed in all 591 patients at baseline and the end of the study using the Diabetes Satisfaction and Treatment Questionnaire (DTSQ). Acceptability was assessed in 394 intervention patients after at least three proactive calls from the call center and at the end of the trial. A purposive sample of 25 patients took part in in-depth semistructured interviews. RESULTS: The response rates to the questionnaires were 79% (DTSQ) and 65% (acceptability). Persons receiving the intervention continued to report high levels of satisfaction with their treatment (95% CI 32.3-33.2 at 1 year), and >90% strongly agreed or agreed that the telecarer approach was acceptable. Qualitative comments pointed to the importance of a personalized service; increased feelings of well-being, including confidence and self-control; help with problem-solving; and patients developing rapport and a strong bond with the telecarers. CONCLUSIONS: A personalized PACCTS approach is acceptable to patients. A service giving priority to the interpersonal dimension leads to increased commitment from patients to improve long-term glycemic control.

Aged↗
PubMed2005

Qualitative data analysis using data displays.

The amount of data generated in qualitative research can be difficult to manage. In this paper Tracey Williamson and Andrew Long discuss how the use of data displays can improve data management and also how the process can help to make the routes from raw data to research findings in qualitative research more transparent. Data displays can take several forms but share the benefit of helping to condense large amounts of data into more manageable forms. They can also help to convey information in a visually stimulating format where presentation time or column space may be limited.

Data Display↗
PubMed2003

Rehabilitation practice: challenges to effective team working.

Effective rehabilitation depends on multiple inputs from a variety of skilled multi-professional team members. This paper explores perceptions of the nurse's role within the multi-professional rehabilitation team and challenges for effective team working. It draws on findings from a 2-year qualitative study exploring the role of the nurse within rehabilitation. Substantial differences in the nurse's role were evident, depending on their and others' perceptions, especially in relation to the nurse's carry-on role. Many nurses felt their contributions were not valued and others desired greater reciprocity within the team. Blurring of role boundaries could bring benefits to clients but also led to professional tensions and rivalry.

Arthritis, Rheumatoid↗
PubMed2003

An exploration of the contribution of the community nurse to rehabilitation.

Effective hospital and community rehabilitation services are increasingly recognised as a means of meeting the changing pattern of health and social care need. While the district or community nurse has the potential to play a central part in community rehabilitation provision, this role has received relatively scant attention in the literature. This paper describes research findings on community nurses' perceptions of their role and potential contribution to rehabilitation. As part of a wider, 2-year, qualitative investigation of the role of the nurse in rehabilitation, fieldwork was undertaken with both district and community staff nurses. This comprised focus group discussions and interviews with staff recruited as a consequence of the follow-up of patients' experiencing rehabilitation. The findings indicate that community-based nurses contributed to patient rehabilitation by making assessments, referring on to other members of the multi-professional team, advocating for and liaising with other services, helping people to adapt, teaching and motivating patients and carers, supporting and involving families, and providing technical care. A number of challenges to community-based nursing roles were apparent, including feelings of exclusion, lack of recognition, a lack of time for rehabilitation and paucity of referrals for rehabilitation. Greater clarity and recognition is needed of the community-based nursing contribution to rehabilitation, and there is a need to ensure that community nursing assessments contribute to patients' rehabilitation goals and the promotion of independent living.

Community Health Nursing↗
PubMed2003

The effects of shiatsu: findings from a two-country exploratory study.

OBJECTIVES: To provide insight into client and practitioner perceptions of the effects of shiatsu, in the short and longer term, and positive and negative in nature. DESIGN: A two-country, exploratory study was undertaken in the United Kingdom and Germany. In-depth interviews were undertaken with a purposive sample of 14 shiatsu practitioners and 15 clients. Client interviews focused on the experience of shiatsu and perceptions of its effects, both positive and negative. Practitioners were also asked about factors that enhanced or inhibited successful treatment. The taped and transcribed data were analyzed using grounded theory, assisted by NVivo (QSR, Markham, Ontario, Canada) software. To enhance generalizability, the findings from the alternative country data set were presented to a further set of practitioners in each country and as a whole to an international meeting of practitioners from seven European countries. RESULTS: There was similarity in the perspectives of the clients and practitioners and participants from the United Kingdom and Germany. Both described a wide range of common, immediate and longer term effects. These included effects on initial symptoms, relaxation, sleeping, posture, and experiences of the body. A category of transitional effect arose, describing an effect that was not particularly positive and did not last long. Practitioners characterized this as being part of the healing response. Only a few negative effects were described by clients. One mentioned a negative physical reaction and two indicated difficulties coping with emotional reactions. While most practitioners conceived negative effects to be possible, these were more likely to be described as negative reactions. CONCLUSION: This exploratory study has shed greater light on the effects of shiatsu. The sample findings provide a user and practitioner grounded base for the design of appropriate questions for exploration in a larger and more generalizable study of the effects of shiatsu.

Acupressure↗
PubMed2003

The problem with measuring patient perceptions of outcome with existing outcome measures in foot and ankle surgery.

Quality outcome measures are the cornerstone of clinical research. A review of outcome measures used in foot and ankle surgery research reveals that the issues of validity, reliability and responsiveness of outcome measures have not been addressed. Most reports in the literature have attempted to evaluate patient perceptions of outcome following foot surgery. Underlying the many difficulties with these outcome measures is a lack of understanding of what patients perceive to be important in terms of outcome. Consequently none of the existing outcome measures can claim to be valid measures of patient perceptions of outcome, as there has been no research uncovering these perceptions. In addition, measures of general health status and quality of life in relation to outcome of foot and ankle surgery have been largely ignored to date.

Ankle↗
PubMed2002

The role of the nurse within the multi-professional rehabilitation team.

UNLABELLED: AIM OF THE STUDY/PAPER: To identify the contribution of the nurse within the multi-professional rehabilitation team. BACKGROUND: The requirement for nurses to work effectively within the multi-professional rehabilitation team is increasingly important with the higher incidence of chronic disease, growing numbers of older people and enhanced survival from major trauma. METHODS: A 2-year qualitative investigation was undertaken centred on three contrasting condition case studies (fractured neck of femur, rheumatoid arthritis and stroke). Clients were theoretically sampled, with their 'rehabilitation pathway' through different services providing the window through which the nurse's contribution was explored. Multiple methods and points of data collection were used, including observation, face to face interviews (clients, carers and staff) and record review. To enhance generalisability, a series of national expert workshops were undertaken with four groups: users, carers and carers' organizations; nurses; members of the multi-professional team; and educationalists. FINDINGS: Six interlinked roles for the nurse were identified: assessment, co-ordination and communication, technical and physical care, therapy integration and therapy carry-on, emotional support, and involving the family. Of particular significance is the creation of a supportive environment for rehabilitation to occur. Some nurses undertook aspects of all of these roles at any one time while others were only involved in one or two areas. While nurses expressed a desire to integrate therapy into their care delivery, the actual achievement of this goal was variable. CONCLUSIONS: Key elements of the nurse's contribution within rehabilitation should aim to maximize client choice to enhance independent living in the client's future environment. At a nursing educational policy level the nurse needs to have a full understanding of the principles and models of rehabilitation. At a practice level, the nurse's role must be valued and recognized, by nurses themselves and other team members.

Arthritis, Rheumatoid↗
PubMed2002

Exploring qualified nurses' perceptions of the relevance of education in preparation for their role in rehabilitation.

The increasing importance of rehabilitation in the health sector and the nurses' critical role therein make it essential that nurses have the right skills and knowledge to work effectively in rehabilitation settings. Drawing from a wider qualitative investigation of the role of the nurse within the multi-professional rehabilitation team, gaps in the skills and knowledge of qualified nurses working in rehabilitation settings are presented and ways to address them are proposed. Both pre- and post-registration education were found wanting. Only one third of nurses thought, in retrospect, that their pre-registration education had provided them with adequate skills and knowledge for their role in rehabilitation. A need for greater focus on rehabilitation per se and associated clinical skills was identified. Whilst post-registration education was highly valued, substantial difficulties accessing relevant courses were noted. In-service training and ad hoc learning 'from experience' and colleagues formed additional ways to develop hands-on skills. Benefits of better education included enhancing confidence, promoting inter-professional equality and improving client care. Potential ways to address some of these concerns included: adoption of a 'thread and module' approach and dedicated rehabilitation student placements, a nationally recognized multi-professional post-registration course, and an integration of work based learning with formal educational provision.

Attitude of Health Personnel↗
PubMed2002

Outcome measurement in complementary and alternative medicine: unpicking the effects.

The issues of what outcomes to measure and how this is central to the development of a sound knowledge base for evidence-based practice are examined. Within complementary and alternative medicine (CAM) there is a crucial debate over what is meant by an "effect" of a set of CAM treatment sessions. The goal of this paper is promote debate and reflection on why outcome measurement is important, the range of specific effects that need to be measured, and ways to take forward their measurement. It is argued that monitoring the achievement of desired outcomes needs to be recognized as an essential step in evidence-based practice, with effectiveness, achieved effects/outcomes--both positive and negative--and quality assurance inextricably linked together in an evidence spiral. The choice of outcome measures must also match the desired outcomes of the key participants, specifically those of the user. Three types of effects of a CAM intervention are conceptualized: (1) those arising from the philosophy and practice of health and healing; (2) factors arising from the relationship between user and practitioner: and (3) those factors brought about by the set of techniques used to enhance the healing process. Their conceptual separation clarifies what should be measured and raises questions about the adequacy of available measuring instruments. This delineation of effects has relevance beyond CAM to conventional medicine and discussions over the nature of the placebo effect. Measurement of all three types of effect is essential, in research and in practice, if the full effect of a CAM discipline is to be recognized. Further work is needed to develop and validate measures that address the multiple effects of CAM and to explore the nature and form of the three types of effect within different CAM disciplines.

Complementary Therapies↗
PubMedDate not supplied

The role of the senior health care worker in critical care.

This article identifies that the introduction of the support worker role in the critical care team facilitates flexibility when organizing and managing patient care. Qualified nurses' time can be used more effectively, enhancing the quality of the patient care delivered. Aspects of the qualified nurses' workload in critical care can be shared and delegated successfully to unqualified staff. It is our view that staffing levels in critical care environments need to be reviewed with more flexible working practices to meet the current and future demands of critical care. There is a need for national consensus amongst qualified nurses to clarify and define the role of the support worker and develop a critical care competency framework to standardize training. To ensure proficiency, adequate training and appropriate accountability, support workers require regulation by a nationally recognized body.

Critical Care↗