Workshop C - Prioritising our ‘long list’ of person and community centred approaches Hear an update from Newcastle’s Health Economics team on interim findings from their evidence review of person and community centred care before participating in discussions to help develop criteria for prioritising which approaches the rest of the programme will ‘deep dive’ into. Criteria will be be evidence driven but also take into account ensuring a good mix of approaches and practice / grey evidence submitted to the consortium.

1. Workshop C
Health Economics Evidence
Review & MCDA Process:
Newcastle University
Professor Luke Vale
Jo Dinning
Jenni Hislop

2. Summary of evidence
• Systematic reviews/meta analysis
• UK based single studies ( recently published)
• 4 families of PSC interventions:
Engaging people in keeping healthy
Share Decision Making (SDM)
Supported self management
Involving families and carers

3. Engaging people in keeping
healthy/supported self management
Intervention Area ( number of studies)
Community led interventions CVD (1), Housing (1), Maternal/Neonatal care
(1), Physical Activity (1), Public Health (1),
Smoking Cessation (2)
Community health workers TB (1)
Education Arthritis (8), Cancer (1), CHD (1), Chronic
Conditions (1), Diabetes (12), Kidney Disease
(2), Low Back Pain (4), Mental Health (2),
Orthopaedics (2), Screening (2), Smoking
Cessation (2), NHS staff (1), Stroke (1)
Education and IT based peer support Chronic conditions (1)
Education, self management,
behavioural interventions
Public Health (2), Sexual Health (2), Smoking
Cessation (3)
School/workbased interventions Alcohol Misuse (1), chronic conditions (1),
CVD (1), Mental Health (1), obesity/weight
management (9), Physical Activity (2), Public
Health (9), Smoking Cessation (1)

4. Engaging people in keeping healthy
Intervention Area ( no of studies)
Behavioural interventions/behaviour
change (including IT-based
interventions)
CVD (3), General (1), Housing (1), Pain/Disability
(1), Physical Activity (9), Public Health (6), Sexual
Health (3)
Community engagement in schools Obesity/Weight Management (2)
Educational & Behavioural
Interventions
Asthma (4), Diabetes (5), Epilepsy/Neurological
Disorders (1),
Environmental interventions/policies Public Health (2), Smoking Cessation (2)
Mass media interventions Cancer (1), General (2), Housing (1), Physical
Activity (1), Screening (1), Smoking Cessation (1)
Self-management behavioural
interventions
Housing (6), Hypertension (1), Kidney Disease (1),
Learning Disabilities (2), Low Back Pain (3),
Maternal/Neonatal Care (1), Mental Health (1),
obesity/weight management (9), Physical Activity
(8), Public Health (3), Smoking Cessation (1)
Smoking Cessation Interventions Mental Health (1), Smoking Cessation (4)
Suicide Prevention Programmes Mental Health (1)
Volunteering Diabetes (1), General (1)

5. Shared Decision Making and
Involving Families and Carers
Intervention Area ( no of studies)
Care Management Smoking Cessation (3)
Communication Advanced/Serious Illness (1), Cancer (5),
Childhood Vaccinations (1), General (4),
Geriatrics/Paediatrics (1), Screening (1),
Stroke (7)
Decision aids/support tools Cancer (1), General (3), Genetics (2),
Maternal/Neonatal Care (1), Musculoskeletal
Health (1), Surgery (1), Screening (3)
Shared Decision Making (General) Advanced/Serious Illness (1), Breastfeeding
(1), Emergency Medicine (1), Gynaecology
(1), HIV (1), NHS Staff (1)
Involving Families and Carers Advanced/Serious Illness (1), Alcohol Misuse
(1), Dementia (1), Diabetes (1),
Geriatrics/Paediatrics (2), Obesity/Weight
Management (3), Physical Activity (1),

6. Supporting Self-Management #1
Intervention Area ( no of studies)
Rehabilitation/Early Discharge support
interventions
CHD (1), Low back pain (1), Pain/Disability
(1), Stroke (1)
Care management Advanced/Serious Illness (1), Breastfeeding
(2), Cardiac Rehabilitation (1), CVD (1),
Dementia (1), Diabetes (3), Epilepsy/Neuro
(1), General (4), Geriatrics/Paediatrics (1),
Hypertension (1), Mental Health (1), Palliative
Care (1), Physical Activity (1), Public Health
(2), Screening (2), Sexual Health (4)
Community-based interventions COPD (1), General (2), Geriatrics/Paediatrics
(2)
Education/Coaching interventions Asthma (8), CHD (1), COPD (4),
Epilepsy/Neuro (4), General (2), MSK (2),
Obesity/Weight Management (4),
Fall Prevention Programmes Geriatrics/Paediatrics (3)
Group Therapy Dementia (1)
Health Literacy COPD (4), General (4), Geriatrics/Paediatrics
(3), MSK (1)

7. Supporting Self-Management #2
Intervention Area ( no of studies)
Information Arthritis (1), Asthma (3), Cancer (4), General (2),
Maternal/Neonatal Care (1), Mental Health (1),
Rehabilitation (1), Physical Activity (2), Smoking
Cessation (1), NHS Staff (1), Stroke (1)
IT-based interventions Asthma (1), Anxiety/Depression (2), Cancer (1),
Chronic Conditions (5), COPD (1), Diabetes (7),
General (13), Geriatrics/Paediatrics (2), Mental
Health (1), Obesity/Weight Management (4), Public
Health (3), Sexual Health (1), Smoking Cessation
(1), NHS Staff (1)
Lay workers Maternal/Neonatal Care (2)
Mobile phone interventions General (1), Chronic Conditions (2), Diabetes (1)
Occupational Therapy Dementia (1), Occupational Therapy (1), Stroke (2)
Patient adherence/prompts Blood Donation (1), Childhood vaccinations (1),
Chronic Conditions (2), COPD (1), CVD (1),
Diabetes (2), Kidney Disease (1), Mental Health
(5), Public Health (1)Screening (7), Sexual Health
(1)
Patient-centred approaches Chronic Conditions (1)

8. Supporting Self-Management #3
Intervention Area ( no of studies)
Self-
management/monitoring/efficacy
Anticoagulation (6), Anxiety/Depression (5), ENT (1),
Cancer (3), Cardiac Rehab (1), Chronic Conditions (4),
COPD (1), CVD (4), Diabetes (15), General (3), Heart
Failure (2), Hypertension (2), IBS (1), Mental Health
(6), obesity/weight management (3), Pain/Disability (1),
Physical disability (1), Smoking Cessation (3), Stroke
(2)
Peer support Breastfeeding (2), Cancer (2), Cardiac Rehab (1), CHD
(1), COPD (2), Maternal/Neonatal Care (1), Mental
Health (8), Pain/Disability (1), Public Health (2)
Psychological interventions Asthma (3), Cancer (3), Diabetes (2), Epilepsy/Neuro
(2), Gynaecology (1), IBS (1), Low Back Pain (1), MSK
(3), Obesity/Weight Management (2), Oral Health (1),
Smoking Cessation (3)
Telemedicine Asthma (2), CHD (1), Chronic Conditions (3), COPD
(1), CVD (1), Diabetes (2), General (3),
Geriatrics/Paediatrics (1), Heart Failure (2),
Telephone based interventions Maternal/Neonatal Care (1), Obesity/Weight
Management (1), Public Health (1), Smoking Cessation
(2)

9. Typically used outcome measures
Types of outcomes
· Disease specific scales
· Self reported generic physical health, mental health, well
being, quality of life, activation scales scales
· Health indicators /health events
· Behaviour change measures- e.g. time in physical activity,
smoking rates, attendance, adherence
· Use of formal care resources
· Patient satisfaction
· Self efficacy scales
· Cost effectiveness

10. UK Based Single Studies
Heart Failure Expressive writing
1
Heart Failure Self management 1
Heart Failure Education and rehabilitation 1
HIV Singing 1
Housing/Built
Environment/Neighbour
hood regeneration
Behaviour change
1
Low back pain
Education, self management-
behavioural interventions 2
Low back pain Self management 1
Mental health Family interventions 1
Mental health Work based social support 3
Mental health
Social capital defined by generalised
trust 1
Mental health Arts based projects 1
Mental health CBT 1
MS Self management 1
Oral Health
Social Capital: Social participation and
Volunteering 1
Orthopaedics lifestyle interventions 1
Pain/Disability Telephone CBT 1
Pain/Disability Self management 1
Public Health Community development activities 2
Public Health Social capital 3
Public Health Community engagement 1
Public Health Community centre activities 1
Public Health Social prescribing 1
Smoking cessation
social capital measured by trust and
community participation 1
Smoking cessation Education and self management 1
Urology Self management 2
Anxiety/Depression Third sector self help clinic 1
Anxiety/Depression Self management 1
Arthritis Self management 2
Arthritis Self management and education 1
Asthma Self management 2
Asthma Targeted care/ telephone triage 1
Cancer Community lay health champions 1
CHD Community led pharmacists 2
CHD Education and Self management 2
CHD Lay health mentors 1
Chronic conditions Social networks 1
Chronic conditions Group self management 1
Chronic conditions Lay led self management 1
COPD Rehabilitation 2
CVD Lay trainers 1
Diabetes Education and self management 3
Diabetes
Trained GP practices in self
management support 1
Diabetes Community champions 1
Diabetes Adherence and behaviour change 1
Diabetes (adolescents) Self management 2
Diabetes (adolescents) Education and self management 1
General
Lay and clinician led self management
training for clinicians to improve self
management in patients 1
General Telehealth 1
Heart Failure Lay led mentoring groups 1

11. Supported Self Management
Study Type of
person
centred care
Area Outcome Outcome Outcome
Dale JR, Williams SM,
Bowyer V. What is the
effect of peer support
on diabetes outcomes
in adults? A systematic
review. Diabet Med
2012;29(11):1361-
1377.
peer support Diabetes Depression Perceived
social
support
Self efficacy
Dennis CL,.Kingston
D. A systematic
review of telephone
support for women
during pregnancy
and the early
postpartum period. J
Obstet Gynecol
Neonatal Nurs
2008;37(3):301-314.
Telephone
based support
from
professional
Maternal
and
neonatal
morbidity
and
mortality
Smoking
rates
Birth weight Duration of
breast
feeding

12. Engaging People in Keeping Healthy
Study Type of
person
centred care
Area Outcome Outcome Outcome
Bravata DM, Smith-
Spangler C, Sundaram V,
Gienger AL, Lin N, Lewis
R, Stave CD, Olkin I,
Sirard JR. Using
pedometers to increase
physical activity and
improve health: a
systematic review. JAMA
2007;298(19):2296-
2304.
Pedometer
Use
Physical
Activity
BMI Steps per
day
Systolic
blood
pressure
Cahill K, Lancaster T.
Workplace interventions
for smoking cessation.
Cochrane Database Sys
Rev 2014(26;2):
CD003440
Group
Therapy
Smoking
cessation
in the
workplace
Smoking
cessation
rates

13. Shared Decision Making
Study Type of
person
centred care
Area Outcome Outcome Outcome
Forster A, Brown L, Smith
J, House A, Knapp P,
Wright JJ, Young J et al
(2012). ‘Information
provision for stroke
patients and their
caregivers (Cochrane
review).’ The Cochrane
Library
Information
provision
strategies
Stroke Patient &
carer
knowledge
depression satisfaction
Evans R, Edwards A, Brett
J et al. Reduction in
uptake of PSA tests
following decision aids:
systematic review of
current aids and their
evaluations. Patient Educ
Couns 2005;58(1):13-26.
Decison Aids Screening Probability
of PSA
testing
Knowledge

14. Involving Families and Carers
Study Type of
person
centred care
Area Outcome Outcome Outcome
Cooper C, Mukadam N,
Katona C, Lyketsos CG,
Ames D, Rabins P, et al.
Systematic review of the
effectiveness of non-
pharmacological
interventions to improve
quality of life of people
with dementia. Int
Psychogeriatr
2012;24:856–70
Family based
interventions:
e.g. patient
and carer
coping
strategies
Dementia Patient
HRQoL
Boyd M, Lasserson TJ,
McKean MC, Gibson PG,
Ducharme FM, Haby M.
Interventions for
educating children who
are at risk of asthma-
related emergency
department attendance.
Cochrane Database Syst
Rev 2009;2:CD001290
Education for
children and
their carers
Asthma A&E visits
GP visits
Hospital
admissions
Medication
use
FEV1
PEF
Patient
quality of
life

15. MCDA process to help inform
intervention types
• Assessing options against multiple criteria
• Can be conflicting objectives
• Weighting and scoring criteria
• Uses different data sources
• Combines hard data & value judgements
• East to use – scorecard/tabular format
• Today….

16. Potential criteria for intervention
selection
• Quality of evidence ( SRs/Meta analysis)
• Quantity of evidence
• Setting? Non NHS?
• Extent of community/lay interventions
• Practice coverage
• Breadth of interventions ( spread)