Clinical Handover and Chronic Non-Communicable Diseases (NCDs)

Systematic Reviews

1. Handover communication in low and middle-income countries: a systematic review

This is a comprehensive scoping systematic review utilising a narrative synthesis approach to summarise the literature focussing on the quality of handover communication and associated interventions in low and middle-income countries across all dimensions of handover.

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Protocols:

Research Team and Project Partners:

2. Patient-held records in low and middle income countries; a systematic review

This is a systematic review investigating the evidence for patient-held records for clinical information handover and patient’s information to enable self-care in low and middle income countries. Patient-held records are primarily developed as a copy of the medical record for patients to keep, consult and to take with them during healthcare visits, to help manage communication and to improve the continuity and quality of care.

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Protocols:

Handover Europe 2008-2011 

Over the past two decades, awareness has grown that transitions of care are particularly vulnerable periods in the patient's journey. Evidence suggests that during these transitions vital information often is lost, distorted or misinterpreted. When transitions between the primary care setting and the inpatient hospital are less than optimal, the repercussions can be far-reaching—including hospital readmission, and avoidable morbidity and even mortality. 

HANDOVER Project, initiated in 2008, was the first multi-year, multi-million-euro effort to improve handovers at the interface between the hospital and the home in Europe. Six European nations (Italy, the Netherlands, Poland, UK, Spain, and Sweden) participated in the Project, along with researchers from the United States and Australia. The aims entailed optimising the continuum of clinical care between primary care and the hospital to reduce unnecessary treatment, medical errors, and avoidable harm. Specific objectives included identifying and studying best practices, creating standardised approaches to handover communication, and measuring their effectiveness in terms of impacts on patients and health care costs. The Project was initiated by a group of health services researchers and clinicians from the six participating nations, in the UK led by University of Birmingham, Prof Richard Lilford. Countries were specifically selected to represent different European systems for the organisation and funding of healthcare. The HANDOVER Project was funded by the European Union's (EU's) Seventh Framework Programme (FP7), which brought EU research initiatives under a common roof to foster growth in research and innovation through competitiveness, training programmes, and funding to support regional and cross-national collaborations. 

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Publications:

Research Team and Project Partners:

Clinical Handover and NCDs in India

Substantive development of our LMIC handover project began with research in India in 2014 with a MRC Health System Initiative grant which investigated the status of information exchange between primary and secondary care and between providers and patient with chronic non-communicable diseases (NCD). Ultimately we aim to provide research that works towards integration of primary and secondary care in India in order to improve continuity and quality of care for patients with NCDs. 

Since then, further work from our team has developed in India on NCD patient-held health records and maternal healthcare through University of Birmingham Global Challenges and student project funds.

Clinical Handover in India - MRC Development Project: Investigating Handover Communication Between Levels of Care in the Management of Non-communicable Diseases in India - 2014-2019

Project Objectives:

1. To describe the existing situation in two States of India for exchanging patient information (clinical handover) between providers and between providers and patients for patients with chronic NCDs in terms of:

  • Handover practices and activities (what happens at hospital outpatient, and stages of referral for inpatients or discharge)
  • Training for healthcare providers
  • Policies (documented policies and guidelines for healthcare providers from any level of healthcare system)
  • Opinion of patients and healthcare provides about information exchange between visits to healthcare providers and its importance

2. To identify factors that may be facilitators or barriers to good handover between healthcare providers and identify motivators and processes which may improve this communication.

3. To develop ideas and interventions that will improve the situation of information exchange between primary and secondary care (clinical handover) in India. These could in turn improve the continuity of care and integration of primary and secondary care health services for chronic non-communicable disease patients.

Project Setting: 

  • Himachal Pradesh

Himachal Pradesh, a northern Indian State in the Himalayas, is spread over 55673 km2 with a population of approximately 6.8 Million, with 90% living in rural areas and 10% in urban areas as per Census 2011. The capital city of the state is Shimla, and is a popular tourist destination as with many other parts of the state. The main language of the state is Hindi and literacy rate as per the census 2011 is 83% with male literacy rate of 90% and female literacy rate of 76%. The work participation rate of the state is 52% with the main industries being agriculture, tourism, textile, pharmaceuticals and hydropower.

There are 83 hospitals and 485 primary health centres in the state. Private healthcare providers are less prevalent in Himachal Pradesh compared to many other states and utilisation of public healthcare remains relatively high. The number of primary and community health centres across the state are in line with what is required by the government, however they are often significantly understaffed with a particular lack of specialty practitioners.

One primary health centre (PHC), one community health centre (CHC) and one tertiary-care hospital in Himachal Pradesh state were engaged in our project in Himachal Pradesh .

  • Kerala

Kerala, a southern Indian State situated on the south west corner of the country, is spread over 38,863 km2 with a population of 33.4 Million distributed equally between urban and rural living as per Census 2011. The capital city of the state is Thiruvananthapuram and the main language is Malayalam. The literacy rate of the state is highest in India at 94% with male literacy at 96% and female literacy at 92%. The work participation rate in Kerala is 34% with the service industry dominating the economy. Agriculture, fishing and tourism are also very important sectors.

There are 125 hospitals and 660 Primary health Centres in the state. The healthcare environment in Kerala has become increasingly complex in recent years due to low staffing at peripheral centres, public disenchantment with government facilities and a subsequent growth in popularity and presence of private healthcare providers. A 2008 government development report estimated that when taking both public and private facilities into account, there is (approximately) 1 medical institution per 2000 population and 1 hospital bed per 250 population.

One urban tertiary-care hospital in Cochin plus two PHCs and one secondary-care peri-urban hospital in a near-by district were engaged in our project in Kerala state.

Research Methods:

Consultation and the National Expert Meeting 2015

National Expert Meeting 2015

  • A successful and pivotal Experts meeting held in October 2015 in New Delhi, was attended by national, state level and international policy makers, academics, private and public hospital representatives and patient groups. The initial findings from the patients and healthcare providers were discussed and options were explored for potential evidence based interventions to improve clinical handover in India for a future implementation research study.

The meeting was chaired by the Deputy Commissioner for Non-Communicable Diseases from the Ministry of Health and Family Welfare and senior UN, NGO and hospital collaborators attended from the following Organisations: 

  • Non-communicable Diseases Directorate of the Ministry of Health and Family Welfare, India  (MHFW)
  • Directorate of Health Services,  State Government of Kerala 
  • World Health Organisation, India 
  • World Bank, India 
  • All India Institute of Medical Sciences 
  • Amrita Institute of Medical Sciences, Kerala  (NGO managed private teaching medical school and hospital)
  • Prince Aly Khan Hospital, Aga Khan Heath Services, India  (NGO managed private hospital)
  • ACCESS Health International  (Gates Foundation funded primary care strengthening implementation research project)
  • Centre of Chronic Disease Control CCDC 
  • Fortis Healthcare  Hospitals (private hospital)
  • National Centre for Disease Control, India  (an arm of the MOHFW)
  • National Health Mission, State Government of Kerala   
  • National Health System Resources Centre, India  (an arm of the MOHFW)
  • Patient for Patient Safety Group of World Health Organisation, India Representative
  • Public Health Foundation of India  (PHFI)
  • University of Birmingham, UK
  • University of Warwick, UK

We are utilising the findings from this situation analysis project with its mixed methods and expert consultation components to consult with experts and decision makers in India to prioritise evidence and theory based components for a multi-dimensional health systems intervention to improve handover. 

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Publications:


Conference presentations:

    1. Humphries C, Jaganathan S, Panniyammakal J, Singh SK, Goenka S, Dorairaj P, Gill P, Greenfield S, Lilford R, Manaseki-Holland S. (2017). An investigation into clinical handover practices for chronic disease patients at the point of hospital admission and discharge in two states of India. World NCD Congress, Chandigarh, India. November 2017
    2. Humphries C, Jaganathan S, Panniyammakal J, Singh SK, Goenka S, Dorairaj P, Gill P, Greenfield S, Lilford R, Manaseki-Holland S. Clinical handover communication for outpatients with chronic conditions in India: A mixed-methods exploratory study. Fourth Global Symposium on Health Systems Research. Vancouver, Canada. November 14-18 2018.
    3. Humphries C, Jaganathan S, Panniyammakal J, Singh SK, Goenka S, Dorairaj P, Gill P, Greenfield S, Lilford R, Manaseki-Holland S. (2018). Investigating the relationship between quality of discharge and health outcomes for chronic disease patients in three hospitals in India. Fifth Global Symposium on Health Systems Research. Liverpool, UK. October 8-12 2018. 

Research Team and Project Partners

Funders: 

  • MRC HSRI Joint funding – jointly funded by the Department of International Development (DFID), the Economic and Social Research Council (ESRC), the MRC and Wellcome.
  • NIHR CLAHRC for Richard Lilford and Sheila Greenfield
  • University of Birmingham Global Challenges 

Investigating Handover Communication Interventions for Improving Clinical Handover Between Levels of Care in the Management of Non-communicable Diseases in India

This project is managed by Linju Joseph based in Karela at the Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, and affiliated to Centre for Chronic Disease Control (CCDC), New Delhi. 

Linju Joseph is a Global Challenges PhD Scholar at University of Birmingham, College of Medical and Dental Sciences. Her project involves a mixed-methods study which includes qualitative research and the development of approaches and components of a patient-held health intervention tools for non-communicable disease in India.

Kerala

Methods

Ethics:

This project has been approved by the Ethics Committee at the University of Birmingham and in India by CCDC (Centre for chronic disease control).

Outputs:

Protocols

PhD studentships: 

  • Mrs Linju Joseph is a Global Challenges Scholar and is conducting her PhD research on developing interventions based around paper and digital based patient-held records that can facilitate clinical handover and patient-centred care in India for chronic NCD patients.

The Research Team and Project Partners:

  • Dr Semira Manaseki-Holland, Reader in Public Health, University of Birmingham, UK and Lead Investigator on 'Clinical Handover in India'
  • Assistant Professor Jeemon Panniyammakal, Assistant Professor, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum
  • Dr Pratap Kumar , Senior Lecturer, Strathmore University Business School, Founder and CEO-Health-E-Net, Kenya 
  • Professor Sheila Greenfield, Professor of Medical Sociology, University of Birmingham,  UK and qualitative expert providing data collection and analysis advice
  • Dr Anna Lavis, Lecturer in Medical Sociology and Qualitative Methods, University of Birmingham, UK

Cochin team

Photo of field research team in Cochin and project manager Ms Suganthi and PI, Dr Semira Manaseki-Holland, 2014.

Funders: 

  • University of Birmingham Global Challenges (L Joseph)
  • University of Birmingham MDS Studentship (C Humphries)

 

Clinical Handover in the care of Atrial Fibrillation patients in Brazil, China and Sri Lanka

Global AF Reach LogoA nested study within the NIHR Global Health Research Group on Atrial Fibrillation management (Global AF Reach) 2018-22

As a part of the Global AF Reach, two studies have been included across the three countries to investigate the current clinical pathways and handover practices for AF patients (incident and prevalent cases) in Brazil, China, and Sri Lanka. The first study is a pilot study investigating AF patient care seeking pathways and loss to follow-up after diagnosis during an admission, or a visit to primary care or A&E (incident cases)

The second study is investigating AF patient management, clinical pathways, care-seeking behaviours, and loss to follow-up once seen at tertiary centres (prevalent cases)

Outputs:

Protocols:

Publications:

Gregory Y H Lip, Yutao Guo, Paulo Lotufo, Rajendra Surenthirakumaran, Lindsey Humphreys, G Neil Thomas, NIHR Global Reach AF Investigators. 2019. The National Institute for Health Research (NIHR) Global Health Research Group on Atrial Fibrillation management. European Heart Journal, Volume 40, Issue 36, 21 September 2019, Pages 3005–3007. 

The Research Team and Project Partners 

 Photo of Annual Global AF Reach meeting

August 2019 Paris at the annual Global AF Reach meeting

  • Dr Semira Manaseki-Holland, Reader in Public Health, University of Birmingham, UK
  • Professor Neil Thomas, Professor in Epidemiology and Research Methods, Institute Director of Research Knowledge and Transfer, University of Birmingham, UK
  • Professor Sheila Greenfield, Professor of Medical Sociology, University of Birmingham, UK
  • Professor Kate Jolly, Professor of Public Health and Primary Care, Deputy Director of the Institute of Applied Health Research, University of Birmingham, UK
  • Dr Krishnarajah Nirantharakumar, UKRI Innovation Clinical Fellow, Honorary Consultant in Public Health Medicine, University of Birmingham, UK
  • Professor Greg Lip, Price-Evans Chair of Cardiovascular Medicine, University of Liverpool, UK Distinguished Professor, Aalborg University, Denmark
  • Dr Deirdre Lane, Reader in Cardiovascular Health, University of Liverpool, UK; Adjunct Professor, Aalborg University, Denmark
  • Professor Yutao Guo, Job title, affiliation, China
  • Professor Feng Mei, Job title, affiliation, China
  • Professor. Li Xuewen, Job title, affiliation, China
  • Professor Paulo A. Lotufo, Professor & Director, University of São Paulo, Brazil
  • Dr Isabela M. Benseñor, Associate Professor, Faculdade de Medicina da Universidade de São Paulo, Brazil
  • Dr Rodrigo Olmos, Assistant Professor, University of São Paulo, Brazil
  • Dr Gustavo Gusso, Assistant Professor, University of São Paulo, Brazil
  • Dr Alessandra Goulart, Associate Professor, Faculdade de Medicina da Universidade de São Paulo, Brazil
  • Dr Rajendra Surenthirakumaran, Senior Lecturer & Consultant Community Physician, University of Jaffna, Sri Lanka
  • Dr Ajini Arasalingam, Senior Lecturer in Medicine & Honorary Consultant Neurologist, University of Jaffna, Sri Lanka
  • Dr Subaschandren Kumaran, Senior Lecturer & Consultant Family Physician, University of Jaffna, Sri Lanka
  • Dr Balachandran Kumarendran, Senior Lecturer & Consultant Community Physician, University of Jaffna, Sri Lanka
  • Dr Mahesan Guruparan, Consultant Cardiologist, Teaching Hospital Jaffna, Sri Lanka

Funders: 

Mongolia: Investigating Hospital Outpatients Handover 

In 2016 based on the experience and tools developed during the Clinical Handover in India project, we began a programme of work looking at clinical handover between primary and secondary care for NCD chronic diseases.

Outputs

Protocols:

Publications:

Research Team and Project Partners

  • Dr Semira Manaseki-Holland, Reader in Public Health, University of Birmingham, UK
  • Professor Richard Lilford, Director of National Institute for Health Research (NIHR) Applied Research Centre West Midlands (ARC WM), University of Birmingham, UK
  • Dr Claire Humphries, PhD student, University of Birmingham, UK at the time of the project
  • Dr Hussein Ibrahim, BMedSci 3rd year medical student, University of Birmingham, UK at the time of the project
  • A Toivgoo 
  • I Narula 
  • Professor C Ochir, Mongolian National University of Medical Sciences 
  • U Munkhbayar , Mongolian National University of Medical Sciences