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Introduction Medication-related harm (MRH) events are increasing among older adults especially in the 8-weeks after hospital discharge. The Discharge Medical Service (DMS), a UK initiative, aims to reduce post-discharge MRH. In this study, we will compare the clinical, economic, and service outcomes of the DMS. Method Using a randomised control trial design, 682 older adults ≥ 65years due for hospital-discharge will be recruited. Participants will be randomized to either intervention arm (medicine management plan (MMP) and DMS), or control arm (DMS only) using a 1:1 stratification. The MMP includes patient and carer education about MRH, copy of discharge medications, and MRH risk score calculated using a validated prediction tool (1). Data collection includes patient clinical and social demographics, and admission and discharge medications. At 8-weeks post discharge, study pharmacist will verify MRH through patient telephone interview, and review of patients’ GP records. Data Analysis Univariate analysis will be done for baseline variables comparing the intervention and control arms. Variables known to be associated with MRH will be described by the randomisation groups. Further multivariate logistic regression will be done incorporating these variables. Economic evaluation will compare the cost-of-service use among the two arms and modelled to provide national estimates. Qualitative data from focus group interviews at participating hospital sites will explore practitioners’ understanding and acceptance of the DMS and MMP. Conclusion This study will inform the use of a validated MRH risk prediction tool, and provide a clinical, and economic evaluation of the DMS and MMP in the NHS. The study has ethics approval and is adopted in the national ageing research portfolio. We are seeking additional sites. Reference 1. Parekh N, Ali K, Davies JG et al. Medication-related harm in older adults following hospital discharge: development and validation of a prediction tool. BMJ Quality and Safety 2020; 29: 142–53.

Background and aim\ud In preparation for the Public Health England Impact Assessment of the 2014 AHP Public Health Strategy a follow up rapid literature review was commissioned. The aim was to identify primary studies in which Allied Health Professionals (AHP) contribute to public health outcomes, based on UK research evidence. This review was used to inform further UK policy and implementation for AHPs in the UK via Public Health England.\ud \ud Methods\ud A rapid mixed methods review was conducted, limiting the selection of studies to those published after December 2014 and recognising the same 12 Allied Health Professions that were used in the previous review. The rapid review included all age groups and patient populations but limited the searches to studies that reflected UK AHP practices and research outcomes. The literature search included title, abstract and full-text screening with data extraction of selected papers. A nominal group method invited expert AHPs to review and select the interventions for potential impact at population level.\ud \ud Results\ud 11 selected articles were grouped into two areas of interventions; health intervention/public health and secondary prevention/health improvement, based on the Public Health England Strategic Framework. AHP interventions were effective for Chronic Fatigue Syndrome and Osteoarthritis and specifically used to manage musculoskeletal conditions (e.g. frozen shoulder). AHPs leading vocational rehabilitation and falls management were also effective. These areas were additional to those previously identified and represented some additional specialist activity undertaken to affect health outcomes.\ud \ud Conclusions\ud This study also contributed to the UK AHP Public Health Strategic Framework 2019–2024 by appraising the UK evidence and impact of some AHP practices. Further improvement is required; for AHPs to measure the impact of their interventions which would demonstrate evidence of outcomes at population level.

Background The increasing demands on Emergency Departments has led to considerable rhetoric on the availability of general practitioner (GP) appointments of which one perceived solution is to offer more out of hours (OOH) care. In England, OOH healthcare provision is regarded as urgent care only and offered as a mixture of telephone triage, drop-in centres, emergency departments (ED), and triaged appointments. This evaluation describes the patients who used new OOH appointments offered through the UK Prime Minister’s Challenge Fund scheme which was intended to extend patient access to primary care. The aim of this paper is to report on the demographic profile of attendees and to offer some indication of the impact on ED. Methods The study used de-identifiable cohort data from 14 months of OOH appointments offered in 4 units in Sheffield and the responses to the standard NHS patient-opinion questionnaire modified for this programme. Descriptive analysis of the appointment data was conducted. Multivariate logistic regression analysis of the survey data examined the characteristics of the patients who would have gone to the Emergency Department (ED) had the OOH appointments not been available. Results There were 24,448 appointments for 19,701 different patients resulting in 29,629 service outcomes (i.e. clinical advice, prescription issued). Six percent of appointments were deemed urgent and two-thirds were non-urgent but needed follow-up. Less than 1% of appointments were judged inappropriate by the consulting GP. The non-attendance rate was 1.8%. Females accounted for 60% of all attendances and 70% in the under 35 age group. The patients from the poorest 5th of the population used nearly 40% of the appointments. The patient survey found OOH appointments were extremely popular - 93% selecting ‘extremely likely’ or ‘likely’ to recommend the service. Regression analysis of patient opinion survey data on whether ED would have been an alternative to the OOH service found that males, young children, people of Asian heritage and the most deprived were more likely to have gone to ED without this service. Conclusion Similar to the published literature, the users of the OOH service were substantially different from in-hours service users; consisting of young adults and children as opposed to the elderly. The findings of this analysis also support the idea that there may be unmet need in the poorest fifth of the population. Future analysis of access to primary care services needs to incorporate patient perceptions and not just statistical data.

This article describes the way in which the international Leadership in European Public Health Initiative (LEPHIE) course was developed, outlines its content, and describes how the earlier DELTAH project informed its development. The project, funded by the EC Leonardo da Vinci Lifelong Learning programme between 2004 and 2007 is now being operationalised in a number of European countries and continues to attract growing interest amongst those still striving to develop their public health systems.

Objectives: The objective was to identify a selection of the best examples of the public health contributions by Allied Health Professionals (AHPs) in order to encourage a wider awareness and participation from that workforce to public health practice.\ud \ud Study design: A mapping exercise was used to identify evidence-based interventions that could lead to health improvements across a population.\ud \ud Methods: A rapid review was undertaken to identify evidence, followed by a survey of Allied Health Profession (AHP) practitioners and an expert panel consensus method to select the examples of AHP public health interventions.\ud \ud Results: Nine evidence-based interventions are identified and selected as examples of current AHP good practice. These examples represent a contribution to public health and include screening interventions, secondary prevention and risk management.\ud \ud Conclusions: This study contributes to a strategy for AHPs in public health by appraising the effectiveness and impact of some exemplar AHP practices that contribute to health improvement. There is a need for AHPs to measure the impact of their interventions and to demonstrate evidence of outcomes at population level.\ud Keywords: allied health professions; Applied Health Professionals; evidence-based practice; health improvement; public health; rapid review