UK health osteopathic surveys

Transcription

1 UK health osteopathic surveys Describing osteopathic healthcare: Issues and examples from the UK Steven Vogel Vice Principal (Research and Quality) The British School of Osteopathy

2 Aims Motivations what for, who for? Methods Examples of recent survey work OPAQ Clinical Risk Osteopathy and Management

3 Motivations what for? Little published research available about what osteopaths do in practice, what their patients experience and how well they respond to treatment Professional curiosity and development Response to external pressures and critics

4 Who for? Purchaser Patient, Insurer, Employer, State, Practitioner Professional development Revalidation Quality assurance and enhancement Promotion of practice Employability Professional contribution and esteem

5 Who for? Media Research community Profession Next generation Regulator Patient Advancing Academic Osteopathy

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8 Methods Cross sectional surveys Prospective observational surveys Practitioner and patient completion Describe experiences of practice: associations and relationships between variables, modelling predictors of a variable Not strong evidence of effectiveness: no comparator, natural history, no randomisation

9 How do we respond practically? People, Conditions and Research Osteopaths see a range of people with problems Specific measures for conditions not appropriate for whole population Selection and recruitment are resource intensive Global measures are generally less able to discriminate and respond to change

10 Osteopathic practice assessment questionnaire (OPAQ) Adapted from the General Practice Assessment Questionnaire used nationally in primary care Quality of health care service and satisfaction Used at BSO and some NHS practices for osteopathy

11 6 Thinking about your last consultation with your osteopath, how do you rate the following: Very Poor Fair Good Very Excel- Does poor good lent not apply a) How thoroughly the osteopath asked about your symptoms and how you are feeling? b) How well the osteopath listened to what you had to say? c) How well the osteopath put you at ease during your physical examination? d) How much the osteopath involved you in decisions about your care? e) How well the osteopath explained your problems or any treatment that you need? f) The amount of time your osteopath spent with you? g) The osteopath s patience with your questions or worries? h) The osteopath s caring and concern for you? OPAC has been adapted from the GPAQ.GPAQ is copyright of the National Primary Care Research and Development Centre, University of Manchester and Safran/NEMCH

12 Score Patient Satisfaction opening hours availability waiting reception GPAQ satisfaction scores 4 lambeth NHS practices (n=227) continuity questioning listens patient at ease involves patient explanations time spends caring and concern osteopath's patience Evaluation questions cope with problem after understand problem after Mean score GPAQ benchmark keep healthy after

13 BSO team Steven Vogel (Principal Investigator) Tom Mars (Research Fellow) Sam Keeping (Research Administrator) Professor Martin Underwood, Warwick Medical School Professor Sandra Eldridge, Barts and The London School of Medicine and Dentistry Professor Tamar Pincus, Royal Holloway, University of London Dr Rob Froud, Barts and The London School of Medicine and Dentistry

14 Questions What types of adverse events and treatment reactions do osteopaths and patients experience? How do osteopaths assess and manage risk? What patient characteristics and treatment interventions predict adverse events?

15 Overview of design Practitioner survey Patient survey Risk assessment and management Experience of treatment and outcomes -Treatment reactions -6 week follow up outcomes Interview study Practitioners and Patients Interpret and explore treatment reactions

16 NCOR conference - Evidence in practice 26th February, 2011

17 38 versions of the practitioner questionnaire Optical Mark Recognition Making it happen NCOR conference - Evidence in practice 26th February, 2011

18 Results

19 Summary Several larger scale projects initiated funding from the regulator Good capacity building for research Picture of osteopathic practice in the UK emerging Possible to identify interventions and practice from which to build effectiveness studies

20 Thank you for your attention Acknowledgements: Research team and colleagues at the BSO Majority funding GOsC, BSO contribution E: mail

21 Practitioner postal survey Stage 1 Practitioner Survey Postcard contact two weeks Six week follow up to non responders Expression of interest for further stages No response Decline to take part Stage 2 Patient survey Info pack Stage 3 Interview study Info pack

22 Stage 2 Patient Survey Stage 2 patient survey Info pack PIS Patient questionnaires No response Opt out Patient packs sent Proportion of reported volumes Pre-treatment Day one Day two Pens No response Expression of interest stage 3 Interview study Six week follow up questionnaire 2 week follow up to non responders

23 Stage 3 Interviews Expression of interest stage 3 Patient and practitioner interview study Purposive sampling Practitioner invitation PIS Consent Opt in Availability Telephone or face to face Patient invitation PIS Consent Opt in Availability Telephone or face to face Opt out Interviews scheduled by phone Opt out No response Interview completed No response

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25 Types of measures of outcome Physical and physiological ROM, performance, inflammatory markers Questionnaires Pain, disability, satisfaction, beliefs, etc Health care utilization, consultations, meds etc Cost, direct and indirect

26 Common measures Global outcome health transition NRS, Semantic Rating Scale Satisfaction Gobal and specific GPAQ Global Pain VAS, NRS General well being - SF12, 36, EQ5D Disability Oswestry DI, RMDQ, Neck DI Distress BDI, HADS Coping strategies Q (Catastrophising sub scale, FAB (Tampa S Kinesiaphobia)

27 Standardised Data Collection project (SDC) Funded by the GOsC and carried out by NCOR team at the university of Brighton: C Fawkes, J Leach, S Mathias, A Moore Developed through a series of consultations with research hubs across the country Themes developed for instrument

28 Standardised data collection project Patient profiles demographics Symptom profiles Therapeutic history Osteopathic management Outcomes of treatment Financial information costs Pilot and amendments practitioner and patient completion

29 Standardised data collection project 342 practitioners in sample,1630 patients Further refinements and further data collection ongoing, interest from other countries to use the instrument Baseline description of practice for a range of stakeholders dardised_data_collection_finalreport_ pdf