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      Implementation and delivery of group consultations for young people with diabetes in socioeconomically deprived, ethnically diverse settings

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          Abstract

          Background

          Young people with diabetes experience poor clinical and psychosocial outcomes, and consider the health service ill-equipped in meeting their needs. Improvements, including alternative consulting approaches, are required to improve care quality and patient engagement. We examined how group-based, outpatient diabetes consultations might be delivered to support young people (16–25 years old) in socio-economically deprived, ethnically diverse settings.

          Methods

          This multi-method, comparative study recruited a total of 135 young people with diabetes across two implementation and two comparison sites (2017–2019). Informed by a ‘researcher-in-residence’ approach and complexity theory, we used a combination of methods: (a) 31 qualitative interviews with young people and staff and ethnographic observation in group and individual clinics, (b) quantitative analysis of sociodemographic, clinical, service use, and patient enablement data, and (c) micro-costing analysis.

          Results

          Implementation sites delivered 29 group consultations in total. Overall mean attendance per session was low, but a core group of young people attended repeatedly. They reported feeling better understood and supported, gaining new learning from peers and clinicians, and being better prepared to normalise diabetes self-care. Yet, there were also instances where peer comparison proved difficult to manage. Group consultations challenged deeply embedded ways of thinking about care provision and required staff to work flexibly to achieve local tailoring, sustain continuity, and safely manage complex interdependencies with other care processes. Set-up and delivery were time-consuming and required in-depth clinical and relational knowledge of patients. Facilitation by an experienced youth worker was instrumental. There was indication that economic value could derive from preventing at least one unscheduled consultation annually.

          Conclusions

          Group consulting can provide added value when tailored to meet local needs rather than following standardised approaches. This study illustrates the importance of adaptive capability and self-organisation when integrating new models of care, with young people as active partners in shaping service provision.

          Trial registration

          ISRCTN reference 27989430.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12916-022-02654-0.

          Related collections

          Most cited references36

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          State of Type 1 Diabetes Management and Outcomes from the T1D Exchange in 2016–2018

          To provide a snapshot of the profile of adults and youth with type 1 diabetes (T1D) in the United States and assessment of longitudinal changes in T1D management and clinical outcomes in the T1D Exchange registry.
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            Making sense of qualitative data analysis: an introduction with illustrations from DIPEx (personal experiences of health and illness).

            This paper outlines an approach to analysing qualitative textual data from interviews and discusses how to ensure analytic procedures are appropriately rigorous. Qualitative data analysis should begin at an early stage in data collection and be highly systematic. It is important to identify issues that emerge during the data collection and analysis as well as those that the researcher may have anticipated (from reading or experience). Analysis is very time-consuming, but careful sampling, the collection of rich material and analytic depth mean that a relatively small number of cases can generate insights that apply well beyond the confines of the study. One particular approach to thematic analysis is introduced with examples from the DIPEx (personal experiences of health and illness) project, which collects video- and audio-taped interviews that are freely accessible through http://www.dipex.org. Qualitative analysis of patients' perspectives of illness can illuminate numerous issues that are important for medical education, some of which are unlikely to arise in the clinical encounter. Qualitative studies can also cover a much broader range of experiences - of both common and rare disease - than clinicians will see in practice. The DIPEx website is based on qualitative analysis of collections of interviews, illustrated with hundreds of video and audio clips, and is an innovative resource for medical education.
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              Studying complexity in health services research: desperately seeking an overdue paradigm shift

              Complexity is much talked about but sub-optimally studied in health services research. Although the significance of the complex system as an analytic lens is increasingly recognised, many researchers are still using methods that assume a closed system in which predictive studies in general, and controlled experiments in particular, are possible and preferred. We argue that in open systems characterised by dynamically changing inter-relationships and tensions, conventional research designs predicated on linearity and predictability must be augmented by the study of how we can best deal with uncertainty, unpredictability and emergent causality. Accordingly, the study of complexity in health services and systems requires new standards of research quality, namely (for example) rich theorising, generative learning, and pragmatic adaptation to changing contexts. This framing of complexity-informed health services research provides a backdrop for a new collection of empirical studies. Each of the initial five papers in this collection illustrates, in different ways, the value of theoretically grounded, methodologically pluralistic, flexible and adaptive study designs. We propose an agenda for future research and invite researchers to contribute to this on-going series.
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                Author and article information

                Contributors
                chrysanthi.papoutsi@phc.ox.ac.uk
                Journal
                BMC Med
                BMC Med
                BMC Medicine
                BioMed Central (London )
                1741-7015
                25 November 2022
                25 November 2022
                2022
                : 20
                : 459
                Affiliations
                [1 ]GRID grid.4991.5, ISNI 0000 0004 1936 8948, Nuffield Department of Primary Care Health Sciences, , University of Oxford, Radcliffe Observatory Quarter, ; Woodstock Road, Oxford, OX2 6GG UK
                [2 ]GRID grid.7445.2, ISNI 0000 0001 2113 8111, School of Public Health, , Imperial College London, ; London, UK
                [3 ]GRID grid.499599.1, ISNI 0000 0004 7590 3079, Association for Young People’s Health, ; London, UK
                [4 ]GRID grid.414601.6, ISNI 0000 0000 8853 076X, Brighton and Sussex Medical School, ; Brighton, UK
                [5 ]GRID grid.451052.7, ISNI 0000 0004 0581 2008, London Northwest University Healthcare NHS Trust, ; London, UK
                [6 ]GRID grid.4868.2, ISNI 0000 0001 2171 1133, Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, , Queen Mary University of London, ; London, UK
                [7 ]GRID grid.139534.9, ISNI 0000 0001 0372 5777, Barts Health NHS Trust, ; London, UK
                Article
                2654
                10.1186/s12916-022-02654-0
                9701006
                36434593
                3a6e7a98-31e2-41dc-8ea4-377c44321aef
                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 29 July 2022
                : 7 November 2022
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100002001, Health Services and Delivery Research Programme;
                Award ID: 15/25/20
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2022

                Medicine
                group consultations,shared medical appointments,diabetes,young people,complexity
                Medicine
                group consultations, shared medical appointments, diabetes, young people, complexity

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