Christine Keen

Bio: Christine Keen is an academic researcher from De Montfort University. The author has contributed to research in topics: Health care & Ambulatory care. The author has an hindex of 4, co-authored 4 publications receiving 74 citations.

Organisation of services for people with cardiovascular disorders in primary care: transfer to primary care or to specialist-generalist multidisciplinary teams?

Abstract: An ageing population and high levels of multimorbidity increase rates of GP and specialist consultations. Constraints on health care funding are leading to additional pressure for the adoption of safe and cost-effective alternatives to specialist care, in some cases by shifting services to primary care. In this paper we argue, having searched for evidence on approaches to shifting care for some people with cardiovascular problems from secondary to primary care, that a collaborative, multidisciplinary approach is required to achieve high quality outcomes from cardiovascular care in the primary care setting. Simply transferring patients from specialist care to management by primary care teams is likely to lead to worse outcomes than services that involve both specialists and primary care teams together, in planned and effectively managed systems of care. The care of patients with certain chronic conditions in the community, if appropriately organised, can achieve the same health outcomes as ambulatory care by hospital specialists. However, shared care by GPs and specialists for patients with chronic heart failure after discharge from hospital can deliver better patient survival. The existing models of shared care include specialists working in an ambulatory care setting (in Central and Eastern Europe) or in hospital based outreach clinics, and cardiology care organised by GPs in the UK and Australia, which have demonstrated reductions in referral rates. Current research supports the idea of the management of certain chronic health conditions in primary care based on the integration of GPs and specialists into multidisciplinary teams, based on availability of reliable evidence about cost-effectiveness, health care outcomes, patient preference and incentives for GPs. Evaluation of such schemes is mandatory, however, to ensure that the expected benefits do materialise.

The role of the information specialist in supporting knowledge transfer: a public health information case study.

Abstract: Objectives: To create research bulletins for public health professionals that support knowledge transfer and evidence-based practice. Methods: The methodology for the bulletins comprises five stages: scoping the topic, searching for relevant literature, selecting and obtaining relevant articles, assessing the quality of articles including evidence grading, producing a comment on quality and implications for practice and writing the research bulletin. An ABC—applicability, brevity and clarity—is considered at each stage to ensure that bulletins meet the needs of their intended audience. Results: Nine research bulletins have been produced on a range of health promotion topics. Bulletins are distributed to Welsh health professionals and are available online. The bulletins have developed since their inception to incorporate evaluation and feedback. Most significant among these developments has been introduction of an Implications for Practice section to promote uptake of research. Conclusions: Research bulletins support busy health professionals in evidence-based practice by assigning a level of evidence, highlighting implications for practice and providing a comment on quality. The bulletins further develop the extended role for information professionals in knowledge transfer and dissemination.

Supporting ‘Best Research for Best Health’ with best information

Abstract: Background: This article describes the potential role for National Health Service (NHS) libraries in supporting health research. The content is partly based on the proceedings of the ‘Best Information for Best Research for Best Health’ event at University of Leicester in November 2006. Objectives: With reference to the UK Department of Health's Research and Development (R&D) strategy, Best Research for Best Health and the Cooksey Review of public funding of health research, the article seeks to identify areas where NHS library and information staff can become involved in supporting the research process. Methods: The authors examined the challenges and opportunities that these reports offer and looked at two areas where library and information services (LIS) staff can potentially expand their services-supporting researchers at every stage of the research process and transferring research into practice. Results: Staff in NHS libraries need to create an environment in which their role in the research process is recognized and valued. LIS staff can develop roles within the research process and thereby improve the robustness and validity of research outputs. Training and development of LIS staff is a key priority and can be taken forward despite the limitations of budgets and staffing levels. Conclusions: A proactive and assertive approach is needed to achieve a cultural shift within NHS library practice from supporting research from the outside, to being fully integrated within the research process.

Primary Care: Concept, Evaluation, and Policy

Abstract: Section I: Primary Care: Concept and Goals. 1: What is primary care?. 2: A basis for evaluating primary care. Section II: Elements of Primary Care. 3: First contact care and gatekeepers. 4: Longitudinality and managed care. 5: Comprehensiveness and benefit packages. 6: Coordination and the processes of referral. Section III: Primary Care in the United States. 7: Characteristics of practice and practitioners. 8: Organization, financing, and access to services. Section IV: Issues in Primary Care. 9: What type of physicians should provide primary care. 10: Medical records and information systems in primary care. 11: Physician-patient interactionsin primary care. 12: Quality assessment and quality improvement. 13: Community oriented primary care. Section V: Primary Care Systems. 14: Evaluation of primary care programs. 15: Cross-national comparisons of primary care. 16: A research agenda. 17: A policy agenda and epilogue

Primary Care: Concept, Evaluation, and Policy

Abstract: Primary Care: Concept, Evaluation, and Policy is a comprehensive treatise that should be obligatory reading for all physicians and for legislators planning the future of health care in the United States. Dr Starfield, in this well-written and easily readable book, objectively reviews the concept of primary care in its entirety. She constructs the argument for primary care starting with a historical review. Within the book's first chapter, the need for restructuring from a primary medical to a primary health care model is introduced. Such a change requires new focus (eg, from illness to health), new content (eg, from treatment to health promotion), new organization (eg, from specialists to generalists), and new responsibility (eg, from professional dominance to community participation). To evaluate the rationale and the success of such a change, Dr Starfield reviews the 1978 Institute of Medicine approach to assessing the success of a health care system, noting accessibility,

Multimorbidity in chronic disease: impact on health care resources and costs.

Abstract: Effective and resource-efficient long-term management of multimorbidity is one of the greatest health-related challenges facing patients, health professionals, and society more broadly. The purpose of this review was to provide a synthesis of literature examining multimorbidity and resource utilization, including implications for cost-effectiveness estimates and resource allocation decision making. In summary, previous literature has reported substantially greater, near exponential, increases in health care costs and resource utilization when additional chronic comorbid conditions are present. Increased health care costs have been linked to elevated rates of primary care and specialist physician occasions of service, medication use, emergency department presentations, and hospital admissions (both frequency of admissions and bed days occupied). There is currently a paucity of cost-effectiveness information for chronic disease interventions originating from patient samples with multimorbidity. The scarcity of robust economic evaluations in the field represents a considerable challenge for resource allocation decision making intended to reduce the burden of multimorbidity in resource-constrained health care systems. Nonetheless, the few cost-effectiveness studies that are available provide valuable insight into the potential positive and cost-effective impact that interventions may have among patients with multiple comorbidities. These studies also highlight some of the pragmatic and methodological challenges underlying the conduct of economic evaluations among people who may have advanced age, frailty, and disadvantageous socioeconomic circumstances, and where long-term follow-up may be required to directly observe sustained and measurable health and quality of life benefits. Research in the field has indicated that the impact of multimorbidity on health care costs and resources will likely differ across health systems, regions, disease combinations, and person-specific factors (including social disadvantage and age), which represent important considerations for health service planning. Important priorities for research include economic evaluations of interventions, services, or health system approaches that can remediate the burden of multimorbidity in safe and cost-effective ways.

Moving knowledge into action for more effective practice, programmes and policy: protocol for a research programme on integrated knowledge translation

Abstract: Health research is conducted with the expectation that it advances knowledge and eventually translates into improved health systems and population health. However, research findings are often caught in the know-do gap: they are not acted upon in a timely way or not applied at all. Integrated knowledge translation (IKT) is advanced as a way to increase the relevance, applicability and impact of research. With IKT, knowledge users work with researchers throughout the research process, starting with identification of the research question. Knowledge users represent those who would be able to use research results to inform their decisions (e.g. clinicians, managers, policy makers, patients/families and others). Stakeholders are increasingly interested in the idea that IKT generates greater and faster societal impact. Stakeholders are all those who are interested in the use of research results but may not necessarily use them for their own decision-making (e.g. governments, funders, researchers, health system managers and policy makers, patients and clinicians). Although IKT is broadly accepted, the actual research supporting it is limited and there is uncertainty about how best to conduct and support IKT. This paper presents a protocol for a programme of research testing the assumption that engaging the users of research in phases of its production leads to (a) greater appreciation of and capacity to use research; (b) the production of more relevant, useful and applicable research that results in greater impact; and (c) conditions under which it is more likely that research results will influence policy, managerial and clinical decision-making. The research programme will adopt an interdisciplinary, international, cross-sector approach, using multiple and mixed methods to reflect the complex and social nature of research partnerships. We will use ongoing and future natural IKT experiments as multiple cases to study IKT in depth, and we will take advantage of the team’s existing relationships with provincial, national and international organizations. Case studies will be retrospective and prospective, and the 7-year grant period will enable longitudinal studies. The initiation of partnerships, funding processes, the research lifecycle and then outcomes/impacts post project will be studied in real time. These living laboratories will also allow testing of strategies to improve the efficiency and effectiveness of the IKT approach. This is the first interdisciplinary, systematic and programmatic research study on IKT. The research will provide scientific evidence on how to reliably and validly measure collaborative research partnerships and their impacts. The proposed research will build the science base for IKT, assess its relationship with research use and identify best practices and appropriate conditions for conducting IKT to achieve the greatest impact. It will also train and mentor the next generation of IKT researchers.

Multimorbidity in chronic disease: Impact on health care resources and costs

Abstract: Effective and resource-efficient long-term management of multimorbidity is one of the greatest health-related challenges facing patients, health professionals, and society more broadly. The purpose of this review was to provide a synthesis of literature examining multimorbidity and resource utilization, including implications for cost-effectiveness estimates and resource allocation decision making. In summary, previous literature has reported substantially greater, near exponential, increases in health care costs and resource utilization when additional chronic comorbid conditions are present. Increased health care costs have been linked to elevated rates of primary care and specialist physician occasions of service, medication use, emergency department presentations, and hospital admissions (both frequency of admissions and bed days occupied). There is currently a paucity of cost-effectiveness information for chronic disease interventions originating from patient samples with multimorbidity. The scarcity of robust economic evaluations in the field represents a considerable challenge for resource allocation decision making intended to reduce the burden of multimorbidity in resource-constrained health care systems. Nonetheless, the few cost-effectiveness studies that are available provide valuable insight into the potential positive and cost-effective impact that interventions may have among patients with multiple comorbidities. These studies also highlight some of the pragmatic and methodological challenges underlying the conduct of economic evaluations among people who may have advanced age, frailty, and disadvantageous socioeconomic circumstances, and where long-term follow-up may be required to directly observe sustained and measurable health and quality of life benefits. Research in the field has indicated that the impact of multimorbidity on health care costs and resources will likely differ across health systems, regions, disease combinations, and person-specific factors (including social disadvantage and age), which represent important considerations for health service planning. Important priorities for research include economic evaluations of interventions, services, or health system approaches that can remediate the burden of multimorbidity in safe and cost-effective ways. Keywords: chronic disease, comorbidity, economic, complexity, cost-effectiveness, burden