Developing a complex intervention to reduce subsequent healthcare use for patients presenting to UK emergency departments with acute headache

Roberts, Thomas

Abstract

Understanding the factors that drive subsequent healthcare resource use in patients who have presented to UK Emergency Departments (EDs) with acute headache, has potential patient and health system benefits. It is important that clinicians provide the best available care to acute headache patients without unnecessarily increasing pressures elsewhere in the health and care system. This thesis therefore aimed to define subsequent healthcare resource use in acute headache patients discharged from UK EDs and develop an intervention to decrease subsequent healthcare resource use.

Methods
1. Overview of systematic reviews.
This aimed to identify any ED intervention that decreased subsequent healthcare resource use after discharge from the ED and report current definitions of subsequent resource use.

2. A cross-cultural adaptation of the Patient Reported Outcome Measured – ED (PROM-ED).
As a validated instrument that specifically measures outcomes after discharge from the ED, the PROM-ED was identified as a key tool to understand resource use. It was cross-culturally adapted to ensure equivalence in the UK population.

3. A multicentre sequential mixed-methods feasibility study of acute headache patients discharged from emergency care.
The feasibility study was designed to assess the ability to recruit, consent and follow-up at 30 days acute headache patients discharged from emergency care. Hypothesis generating analyses were conducted.

Results
The overview identified 38 eligible reviews. Of the interventions reported, shared decision-making showed the most promise to reduce subsequent healthcare resource use. There was no unifying definition for subsequent healthcare resource use.
The cross-cultural adaptation committee approved six adaptations, four semantic and two grammatical, to the PROM-ED.
The feasibility study identified that recruitment of acute headache patients across emergency care was hospital dependent. Completed follow-up across all three surveys was 43.6% (17/39) of the analysis cohort.
Hypothesis generating analysis found that at 30 days, 52.9% (n=9/17) of participants had used subsequent healthcare resource. General Practice was the most commonly used resource. Domains within the PROM-ED, illness-perception questionnaire and EQ-5D-5L all showed promise as targets for future acute headache interventions.

Conclusions
This thesis provides the foundations for further research in this area. In the future a shared decision-making model could provide the basis on which acute headache consultation are based. Outcomes could be credibly measured using the UK version of the PROM-ED and a mixed methods research design could be feasibly used as a method through which to better understand subsequent healthcare resource use.

• Thesis Type: Thesis
• Deposit Date: Jun 26, 2023
• Publicly Available Date: Oct 24, 2023
• Public URL: https://uwe-repository.worktribe.com/output/10888287
• Award Date: Oct 24, 2023