ABSTRACT
BACKGROUND: There may be differential impact of the COVID-19 pandemic on mental health and burnout rates of healthcare professionals (HCPs) performing different roles. AIMS: To examine mental health and burnout rates, and possible drivers for any disparities between professional roles. METHODS: In this cohort study, online surveys were distributed to HCPs in July-September 2020 (baseline) and re-sent 4 months later (follow-up; December 2020) assessing for probable major depressive disorder (MDD), generalized anxiety disorder (GAD), insomnia, mental well-being and burnout (emotional exhaustion and depersonalization). Separate logistic regression models (at both phases) compared the risk of outcomes between roles: healthcare assistants (HCAs), nurses and midwives (nurses), allied health professionals (AHPs) and doctors (reference group). Separate linear regression models were also developed relating the change in scores to professional role. RESULTS: At baseline (n = 1537), nurses had a 1.9-fold and 2.5-fold increased risk of MDD and insomnia, respectively. AHPs had a 1.7-fold and 1.4-fold increased risk of MDD and emotional exhaustion, respectively. At follow-up (n = 736), the disproportionate risk between doctors and others worsened: nurses and HCAs were at 3.7-fold and 3.6-fold increased risk of insomnia, respectively. Nurses also had a significantly increased risk of MDD, GAD, poor mental well-being and burnout. Nurses also had significantly worsened anxiety, mental well-being and burnout scores over time, relative to doctors. CONCLUSIONS: Nurses and AHPs had excess risk of adverse mental health and burnout during the pandemic, and this difference worsened over time (in nurses especially). Our findings support adoption of targeted strategies accounting for different HCP roles.
ABSTRACT
(PUCOP) has offered an 8-week international advanced pharmacy practice experience (APPE) in London, England at St. Bartholomew's Hospital since 2007. To date, 130 student pharmacists have participated within three focus areas: nuclear medicine, cardiology, and oncology. During this APPE, students participate in direct patient care and clinical research. Another key focus of this APPE is intercultural learning. Due to the COVID-19 pandemic and travel restrictions, this experience was hosted using a virtual platform during 2020. Justification/Documentation: COVID-19 impacted many hospitals, including St. Bartholomew's, causing limited time for dedicated research and education/training. Virtual APPE students and preceptors partnered to move research projects forward and develop educational materials. PUCOP students also focused on enhancing their intercultural skills as evidenced by growth in both the Intercultural Development InventoryTM and Cultural Intelligence AssessmentTM. Adaptability: This APPE demonstrated the feasibility of using virtual interactions for international APPEs and could be adapted to other settings. Given the demonstrated intercultural growth and research productivity virtual interactions could be considered when international student travel is not feasible (pandemic, cost, schedule availability). This APPE was successful due to the continued engagement with preceptors through video conferencing platforms (Microsoft Teams™) and messaging applications (WhatsApp™). Significance: Differences between in-person and virtual international APPEs assessments provided insight into how experiential education can be adapted and still meet the needs of the practice site and students. In the event international travel or APPEs are not feasible, virtual interactions can be an option. As demonstrated with this example, virtual experiences still allowed student pharmacists to experience healthcare in another country and broaden their knowledge, skills and attitudes. Student research projects still contributed to hospital quality improvement initiatives and clinical practice protocols. This virtual international research APPE can be a model for healthcare-related international training programs with or without a global pandemic.
ABSTRACT
Introduction COVID-19 has disrupted pathways of care for over 12 months. Primary care has transformed dramatically with much care being provided remotely. The COVID surges and vaccination programme have reduced capacity further. People with conditions such as hypertension, cardiovascular disease and diabetes depend on regular review and treatment optimisation to keep them well. There is a high risk that continued disruption to proactive care will drive an increase in exacerbations and complications. It is likely this will drive further waves of demand for urgent care over the coming months in primary care, in emergency departments and in hospital admissions. Methods The team of GPs & pharmacists at UCLPartners, with patient and public support, developed proactive care frameworks for six conditions including atrial fibrillation, hypertension, high cholesterol and type 2 diabetes mellitus. The frameworks focus on the 'how to' of delivering care in the new world of primary care post COVID-19. They are built on 4 principles: virtual where appropriate, use of the wider workforce, step change in self-management, and use of digital resources. For each condition, the frameworks include: risk stratification tools;pathways that support remote care and deploy staff such as healthcare assistants and social prescribers to systematically support education, self-management and lifestyle change;scripts, protocols and training to guide these staff in consultations;digital tools;and resources to support treatment optimisation. The frameworks include clinical and project management support for local pathway adaptation and implementation. Results The frameworks have gained wide traction in primary care across England. There have been over 2,700 downloads of the search/stratification tools with evidence of implementation in several regions. In the UCLP geography, North East London and North Central London have adopted the frameworks for roll out across 475 GP practices and 2.8 million people. NHSEngland has now adopted the Frameworks as a key part of the NHS@Home programme with plans to support at scale national roll out. Evaluation is being commissioned. Conclusions The UCLPartners Proactive Care Frameworks provide systematic, evidence-based support to restore services post COVID: stratifying so that higher risk patients can be prioritised and workload managed;maximising remote care;optimising personalisation and support for self-care. By using a population health management approach together with comprehensive resources to support clinical management in real world primary care, the frameworks provide a platform not just to restore services but to optimise treatment and outcomes in the high-risk conditions for CVD. The widespread national traction the frameworks are gaining suggests that despite the pandemic, this brings an opportunity to deliver the NHS Long Term Plan ambitions for CVD prevention and prevent 150,000 heart attacks, strokes and cases of dementia.