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As well as journal publications NIHR ARC Wessex produces - Evidence Brief - Evidence summaries regarding Workforce and Health Systems

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Research papers published by our team


Listed in date order

A randomised controlled feasibility trial of E-health application supported care vs usual care after exacerbation of COPD: the RESCUE trial

Mal North, Simon Bourne, Ben Green, Anoop J. Chauhan, Tom Brown, Jonathan Winter, Tom Jones, Dan Neville, Alison Blythin, Alastair Watson, Matthew Johnson, David Culliford, Jack Elkes, Victoria Cornelius & Professor Tom M. A. Wilkinson


Exacerbations of COPD are one of the commonest causes of admission and readmission to hospital. The role of digital interventions to support self-management in improving outcomes is uncertain. We conducted an open, randomised controlled trial of a digital health platform application (app) in 41 COPD patients recruited following hospital admission with an acute exacerbation. Subjects were randomised to either receive usual care, including a written self-management plan (n = 21), or the myCOPD app (n = 20) for 90 days. (follow link to read full article)

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Implementing a social network intervention: can the context for its workability be created? A quasiethnographic study

October 27, 2020

J. Ellis , I. Vassilev, E. James and A. Rogers

Background: Policy makers and researchers recognise the challenges of implementing evidence-based interventions into routine practice. The process of implementation is particularly complex in local community environments. In such settings, the dynamic nature of the wider contextual factors needs to be considered in addition to capturing interactions between the type of intervention and the site of implementation throughout the process. This study sought to examine how networks and network formation influence the implementation of a self-management support intervention in a community setting.

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Planning and optimising CHAT&PLAN: A conversation-based intervention to promote person-centred care for older people living with multimorbidity

Corbett, T., Cummings, A., Lee, K., Calman, L., Fenerty, V., Farrington, N., Lewis, L., Young, A., Boddington, H., Wiseman, T., Richardson, A., Foster, C., Bridges, J. (2020)

Published: October 16, 2020


Older people are more likely to be living with cancer and multiple long-term conditions, but their needs, preferences for treatments, health priorities and lifestyle are often not identified or well-understood. There is a need to move towards a more comprehensive person-centred approach to care that focuses on the cumulative impact of a number of conditions on daily activities and quality of life. This paper describes the intervention planning process for CHAT& PLANTM, a structured conversation intervention to promote personalised care and support self-management in older adults with complex conditions.

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Supporting patient access to medicines in community palliative care: on-line survey of health professionals’ practice, perceived effectiveness and influencing factors

Sue Latter, Natasha Campling, Jacqueline Birtwistle, Alison Richardson, Michael I. Bennett, Sean Ewings, David Meads & Miriam Santer



Patient access to medicines at home during the last year of life is critical for symptom control, but is thought to be problematic. Little is known about healthcare professionals’ practices in supporting timely medicines access and what influences their effectiveness. The purpose of the study was to evaluate health professionals’ medicines access practices, perceived effectiveness and influencing factors.

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The association between ward staffing levels, mortality and hospital readmission in older hospitalised adults, according to presence of cognitive impairment: a retrospective cohort study

Carole Fogg, Jackie Bridges, Paul Meredith, Claire Spice, Linda Field, David Culliford, Peter Griffiths


Lower nurse staffing levels are associated with increased hospital mortality. Older patients with cognitive impairments (CI) have higher mortality rates than similar patients without CI and may be additionally vulnerable to low staffing.


To explore associations between registered nurse (RN) and nursing assistant (NA) staffing levels, mortality and readmission in older patients admitted to general medical/surgical wards.

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The influence of personal communities in understanding avoidable emergency department attendance: qualitative study

Gemma McKenna, Anne Rogers, Sandra Walker & Catherine Pope


Use of emergency department (ED) care globally seems to be increasing at a faster rate than population growth (Baker, House of Commons Library. Accident and Emergency Statistics, Demand, Performance, 2017). In the UK there has been a reported 16% rise in emergency admissions over the past 5 years. Estimates that between 11 and 40% of ED attendances are non-urgent, with 11% of patients being discharged from the ED without treatment (NHS Digital 2017), and a further 44% require no follow-up treatment (NHS Digital, Hospital Accident and Emergency Activity 2016-17, 2019) is cited as evidence that these patients did not require this level of care. The solution to not using the most appropriate point in the system has traditionally been seen as a knowledge problem, requiring, improved sign-posting and information to enable people to self-manage or use health care management for minor ailments. However research about help-seeking behaviour suggests that the problem may not be an informational one. A considerable literature points to help seeking as a social process influenced by a range of contingencies and contextual factors including the way in which lay people influence health care utilisation (Giebel et al. BMJ Open 9:1, 2019). Personal communities comprise a variety of active and significant social ties which have potential to influence individual capacity to seek help. Here we extend and unpack further influencing decisions about seeking formal health care with reference to how they are shaped and informed by and within personal social networks.

Corresponding author

Correspondence to Gemma McKenna.

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Creating pre-conditions for change in clinical practice: the influence of interactions between multiple contexts and human agency

Michelle Myall, School of Health Sciences, University of Southampton, Southampton, UK

Carl May, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK

Alison Richardson, School of Health Sciences, University of Southampton, Southampton, UK and Clinical Academic Facility, Southampton General Hospital,
University Hospital Southampton NHS Foundation Trust, Southampton, UK, and 
Sarah Bogle, Natasha Campling, Sally Dace and Susi Lund, School of Health Sciences, University of Southampton, Southampton, UK


Purpose The purpose of this paper is to explore what happens when changes to clinical practice are proposed and introduced in healthcare organisations. The authors use the implementation of Treatment Escalation Plans to explore the dynamics shaping the translational journey of a complex intervention from research into the everyday context of real-world healthcare settings.

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Self-management in older people living with cancer and multi-morbidity: A systematic review and synthesis of qualitativestudies

Teresa Corbett 1,2 | Amanda Cummings 3 | Lynn Calman 3 | Naomi Farrington 1,4 | Vicky Fenerty 5 | Claire Foster 3 | Alison Richardson 1,2,4 | Theresa Wiseman 1,6 | 
Jackie Bridges 1,2 - June 2020
School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
NIHR ARC Wessex, University of Southampton, UK
Macmillan Survivorship Research Group, University of Southampton, Southampton, UK
University Hospital Southampton NHS Foundation Trusts, Southampton, UK
University of Southampton Library, University of Southampton, Southampton, UK
The Royal Marsden NHS Foundation Trust, London, UK
Funding information: National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Wessex.
Objective: Many older people with cancer live with multimorbidity. Little is understood about the cumulative impact of old age, cancer and multi-morbidity on self-management. This qualitative systematic review and synthesis aimed to identify what influences self-management from the perspective of older adults living with cancer and multi-morbidity.
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Mediating engagement in a social network intervention for people living with a long-term condition: A qualitative study of the role of facilitation.

James E, Kennedy A, Vassilev I, Ellis J, Rogers A - March 2020

Successful facilitation of patient-centred interventions for self-management support has traditionally focussed on individual behaviour change. A social network approach to self-management support implicates the need for facilitation that includes an orientation to connecting to and mobilizing support and resources from other people and the local environment.
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Primary care risk stratification in COPD using routinely collected data: a secondary data analysis

Primary care risk stratification in COPD using routinely collected data: a secondary data analysis

Matt Johnson, Lucy Rigge, David Culliford, Lynn Josephs, Mike Thomas, Tom Wilkinson


Most clinical contacts with chronic obstructive pulmonary disease (COPD) patients take place in primary care, presenting opportunity for proactive clinical management. Electronic health records could be used to risk stratify diagnosed patients in this setting, but may be limited by poor data quality or completeness. We developed a risk stratification database algorithm using the DOSE index (Dyspnoea, Obstruction, Smoking and Exacerbation) with routinely collected primary care data, aiming to calculate up to three repeated risk scores per patient over five years, each separated by at least one year. Among 10,393 patients with diagnosed COPD, sufficient primary care data were present to calculate at least one risk score for 77.4%, and the maximum of three risk scores for 50.6%. Linked secondary care data revealed primary care under-recording of hospital exacerbations, which translated to a slight, non-significant cohort average risk score reduction, and an understated risk group allocation for less than 1% of patients. Algorithmic calculation of the DOSE index is possible using primary care data, and appears robust to the absence of linked secondary care data, if unavailable. The DOSE index appears a simple and practical means of incorporating risk stratification into the routine primary care of COPD patients, but further research is needed to evaluate its clinical utility in this setting. Although secondary analysis of routinely collected primary care data could benefit clinicians, patients and the health system, standardised data collection and improved data quality and completeness are also needed.


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The impact of delayed transfers of care on emergency departments: common sense arguments, evidence and confounding.

The impact of delayed transfers of care on emergency departments: common sense arguments, evidence and confounding.
Dr Brad Keogh & Dr Thomas Monks
There have been claims that Delayed Transfers of Care (DTOCs) of inpatients to home or a less acute setting are related to Emergency Department (ED) crowding. In particular DTOCs were associated with breaches of the UK 4-hour waiting time target in a previously published analysis. However, the analysis has major limitations by not adjusting for the longitudinal trend of the data. The aim of this work is to investigate whether the proposition that DTOCs impact the 4-hour target requires further research
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Older people's experiences in acute care settings: systematic review and synthesis of qualitative studies

Older people's care experiences in hospital may be negative in the absence of relational work by nurses to maintain people's identity, establish caring connections and ensure that individual patient needs, preferences and values are honoured in the care that is delivered. Relational care by nurses can mediate powerful institutional drivers that may otherwise result in negative experiences and poor care.

Jackie Bridges, Joanna Hope - November 8 2019

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Patient involvement in pressure ulcer prevention and adherence to prevention strategies: An integrative review

There is limited research that focuses on the patient view of factors affecting adherence to prevention measures, particularly in community settings. Individual and daily lifestyle considerations and involvement in decision-making around pressure ulcer care are important aspects from the patient perspective. Further research is necessary to explore which factors affect patient adherence in order to improve clinical practice and support patient involvement in preventative strategies.

Jo Hope, Lisette Schoonhoven - October 23 2019

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A novel exploration of the support needs of people initiating insulin pump therapy using a social network approach: a longitudinal mixed‐methods study

A social network approach determined what resources and support people with diabetes require when incorporating a new health technology. Visualisation of support networks using concentric circles enabled people to consider and mobilise support and engage in new activities as their needs changed. The novelty of pump therapy creates new illness‐related work, but mobilisation of personally valued flexible, tailored support can improve the process of adaptation.

C. Reidy, C. Foster, A. Rogers - October 16 2019
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Cognitive impairment is independently associated with mortality, extended hospital stays and early readmission of older people with emergency hospital admissions: A retrospective cohort study

Cognitive impairment is associated with an increased risk of adverse outcomes in hospitalised older people with an unscheduled admission, by increasing hospital mortality, extending hospital stays and increasing frequency of readmissions.

Carole FoggPaul Meredith, David Culliford, Jackie Bridges, Peter Griffiths - August 2019

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