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For some children and young people (CYP) with long-term physical health conditions (LTPHCs) attending school can be difficult. There is a lack of evidence documenting their school attendance experiences, how schools manage absence for these children, and subsequent effects. This study utilised an existing dataset from eighty-nine 11–18-year-olds in mainstream secondary schools in the United Kingdom across 11 LTPHCs that provided first-hand accounts about the children’s experiences of school. Data pre-coded “attendance” were subject to thematic analysis to explore issues emerging. Findings showed attendance patterns varied, with some CYP missing little and others significant amounts of education. Children with LTPHCs wanted to attend school and did their best to navigate education alongside health. School systems for attendance were inconsistent and adversarial. Remedial and supportive action emerged as lacking, and children felt it was their personal responsibility to make up for lost time and missed work when absent. Decisions on whether they attended school, coupled with practices promoting high attendance had detrimental consequences for CYP with LTPHCs educationally, emotionally and socially. Overall, children with LTPHCs felt punished, stigmatised, unfairly treated, unequal and excluded. Results have implications for education, health, and policy practitioners to better plan and target attention so that the LTPHC cohort are treated sensitively and equitably and afforded their entitlement to education when they cannot go to school for health reasons often outside of their control.

Children and young people (CYP) with long-term physical health conditions (pLTCs) have increased risk of psychopathology compared to physically healthier peers. We explored risk factors for new onset and persistent psychiatric disorders in CYP with pLTCs compared to CYP without pLTCs. This 3-year follow-up study involved a UK representative sample of CYP from the British Child and Adolescent Mental Health Surveys (N = 7804). We examined potential baseline predictors of new onset and persistent psychiatric disorders at follow-up in four groups of children based on the presence of any physical and/or any psychiatric conditions at baseline. Psychiatric disorders were assessed using standardised multi-informant diagnostic assessment. Separate multivariable binary logistic regressions were conducted for each group. In CYP with pLTCs, rented housing (aOR = 1.42, 95% CI 1.01 to 1.99), non-traditional family structure (aOR = 2.08, 95% CI 1.42 to 3.05), increased parental distress (aOR = 1.09, 95% CI 1.04 to 1.14), and greater peer relationship difficulties (aOR = 1.29, 95% CI 1.19 to 1.39) predicted future psychiatric disorder. Only peer relationship difficulties predicted persistent disorder (aOR = 1.27, 95% CI 1.17 to 1.38) in this group. A greater number of factors predicted the onset of psychiatric disorder in CYP with pLTCs compared to physically healthier peers and similarly, a higher number of factors predicted persistent disorder in CYP without pLTCs. CYP with pLTCs might comprise a group with different vulnerabilities, some of which are potentially tractable and may be useful indicators of patients who require preventable or management interventions. [ABSTRACT FROM AUTHOR]

Introduction: Children with long-term physical health conditions (pLTCs) are at increased risk of mental health conditions but less is known about time trends in the mental health of this group of children. Methods: We used data from three comparable, population-based surveys of children conducted in 1999, 2004, and 2017. We examined whether the proportion of children aged 5–15 years old with comorbid mental health conditions (measured using the multi-informant Development and Well-being Assessment tool) and pLTCs (measured using parental report) in England increased from 1999 to 2017 using linear regression analysis. Results: Our analysis used data from 8662 (1999), 6401 (2004) and 6219 (2017) children, respectively. The proportion of children with comorbid pLTCs and psychiatric disorders was 0.050 (95% CI = 0.045, 0.055) in 1999, 0.054 (95% CI = 0.049, 0.060) in 2004, and 0.059 (95% CI = 0.053, 0.065) in 2017. The linear regression model revealed a non-significant effect of time on the proportion of children with comorbid pLTCs and psychiatric disorders from 1999 to 2017 (B = 0.0004785; SE = 0.0001256; p = 0.163). Conclusion: The estimated prevalence of school-aged children with comorbid pLTCs and mental health conditions in England remained stable since 1999, highlighting the need to prioritize mental health resources for children with physical health comorbidities. [ABSTRACT FROM AUTHOR]

Background Remote monitoring involves the measurement of an aspect of a patient’s health without that person being seen face to face. It could benefit the individual and aid the efficient provision of health services. However, remote monitoring can be used to monitor different aspects of health in different ways. This evidence map allows users to find evidence on different forms of remote monitoring for different conditions easily to support the commissioning and implementation of interventions. Objectives The aim of this map was to provide an overview of the volume, diversity and nature of recent systematic reviews on the effectiveness, acceptability and implementation of remote monitoring for adults with long-term physical health conditions. Data sources We searched MEDLINE, nine further databases and Epistemonikos for systematic reviews published between 2018 and March 2022, PROSPERO for continuing reviews, and completed citation chasing on included studies. Review methods (Study selection and Study appraisal): Included systematic reviews focused on adult populations with a long-term physical health condition and reported on the effectiveness, acceptability or implementation of remote monitoring. All forms of remote monitoring where data were passed to a healthcare professional as part of the intervention were included. Data were extracted on the characteristics of the remote monitoring intervention and outcomes assessed in the review. AMSTAR 2 was used to assess quality. Results were presented in an interactive evidence and gap map and summarised narratively. Stakeholder and public and patient involvement groups provided feedback throughout the project. Results We included 72 systematic reviews. Of these, 61 focus on the effectiveness of remote monitoring and 24 on its acceptability and/or implementation, with some reviews reporting on both. The majority contained studies from North America and Europe (38 included studies from the United Kingdom). Patients with cardiovascular disease, diabetes and respiratory conditions were the most studied populations. Data were collected predominantly using common devices such as blood pressure monitors and transmitted via applications, websites, e-mail or patient portals, feedback provided via telephone call and by nurses. In terms of outcomes, most reviews focused on physical health, mental health and well-being, health service use, acceptability or implementation. Few reviews reported on less common conditions or on the views of carers or healthcare professionals. Most reviews were of low or critically low quality. Limitations Many terms are used to describe remote monitoring; we searched as widely as possible but may have missed some relevant reviews. Poor reporting of remote monitoring interventions may mean some included reviews contain interventions that do not meet our definition, while relevant reviews might have been excluded. This also made the interpretation of results difficult. Conclusions and future work The map provides an interactive, visual representation of evidence on the effectiveness of remote monitoring and its acceptability and successful implementation. This evidence could support the commissioning and delivery of remote monitoring interventions, while the limitations and gaps could inform further research and technological development. Future reviews should follow the guidelines for conducting and reporting systematic reviews and investigate the application of remote monitoring in less common conditions. Review registration A protocol was registered on the OSF registry (https://doi.org/10.17605/OSF.IO/6Q7P4). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Services and Delivery Research programme (NIHR award ref: NIHR135450) as part of a series of evidence syntheses under award NIHR130538. For more information, visit https://fundingawards.nihr.ac.uk/award/NIHR135450 and https://fundingawards.nihr.ac.uk/award/NIHR130538. The report is published in full in Health and Social Care Delivery Research; Vol. 11, No. 22. See the NIHR Funding and Awards website for further project information. Plain language summary What is this map about? Remote monitoring is when an aspect of a patient’s health, such as blood pressure, is measured at home, and this information is passed to a healthcare professional. We created an evidence and gap map for remote monitoring in adults with long-term physical health conditions. The map is presented as an interactive online table, which can be used to find the number and quality of systematic reviews that address specific questions (e.g. remote monitoring in diabetes). The map does not summarise findings from the reviews (e.g. whether remote monitoring works or not). What studies are included? We found 72 reviews investigating whether remote monitoring works and/or how to implement it, including whether it is acceptable to patients, carers and healthcare professionals. What are the main findings? Thirty-seven reviews included studies from the United Kingdom. The most common health conditions were heart disease, diabetes and lung conditions. There was little or no evidence for some health conditions (e.g. epilepsy). Data from patients were collected mainly using common devices (e.g. heart rate monitors) and passed to healthcare providers using computer applications, websites and telephone calls. Most feedback received by patients was motivational/educational. There was evidence about the acceptability of remote monitoring for patients, but little for carers and healthcare professionals. Reviews focused on whether remote monitoring affected physical and mental health, health service use, acceptability or implementation. More than half the included reviews were judged to be low quality; however, they may still include high-quality studies. What do the findings mean? The map could help to design and deliver remote monitoring programmes and guide further research and technology development. Stakeholder and public and patient involvement Stakeholder and public and patient representatives provided feedback throughout the project. How up to date is this map? The map contains reviews published between 2018 and March 2022. Scientific summary Background Ageing populations and rising rates of non-communicable diseases are placing increasing pressure on health and social care services. New models of care are needed to meet these challenges. The use of technology offers opportunities for innovation, with the COVID-19 pandemic demonstrating its potential. Remote monitoring is one application of technology, involving the periodic or continuous measurement of an aspect of a patient’s health, such as their blood pressure, at home. This information is passed to a healthcare professional to enable the patient’s condition to be managed without the need for them to be seen face to face. Remote monitoring could benefit individuals, helping people to manage their own health and identifying exacerbations at an earlier stage. By improving communication with healthcare providers, it can also facilitate the delivery of personalised care. Potential benefits for the healthcare system more widely include efficiencies in service use and resulting reductions in cost. However, current reviews of the evidence indicate that remote monitoring may be more effective for some health conditions and in improving certain health outcomes. To commission and deliver effective remote monitoring interventions, policy-makers and practitioners need evidence on types of remote monitoring that improve health outcomes, as well as the acceptability of these interventions and how to implement them. The need for evidence synthesis on this topic was identified by a stakeholder group from NHS England’s NHS @home (an initiative that is using technology to enable people to manage their health at home), which was consulted throughout the production of the map. Objectives Our aim was to identify and map the volume, diversity and nature of recent systematic reviews on the use of remote monitoring interventions for adults living with long-term physical health conditions. Our specific research objectives were to: map recent systematic reviews of the effectiveness of remote monitoring interventions for adults living with long-term physical health conditions map recent systematic reviews of the acceptability and/or implementation of remote monitoring interventions for adults living with long-term physical health conditions. What is an evidence and gap map? Evidence and gap maps provide an overview of the evidence on a given topic. They are produced using the same principles as a systematic review. However, instead of summarising effectiveness data or findings from included studies and synthesising this information to answer a specific question, data are extracted on key characteristics of the included studies and presented visually (further description of evidence and gap maps can be found in White H, Albers B, Gaarder M, Kornør H, Littell J, Marshall Z, et al. Guidance for producing a Campbell evidence and gap map. Campbell Syst Rev 2020;16(4):e1125). Evidence and gap maps are typically presented as a table, with rows listing the types and characteristics of the intervention and columns displaying outcomes. This allows the identification of areas of evidence concentration as well as gaps in the evidence. They can be used both to inform evidence-based policy, commissioning and provision of healthcare interventions, and to identify areas for future research. Methods A protocol for the evidence and gap map was registered on the OSF (Center for Open Science, Charlottesville, VA, USA) registry (https://doi.org/10.17605/OSF.IO/6Q7P4). We searched MEDLINE, the Cochrane Database of Systematic Reviews, the Cumulative Index to Nursing and Allied Health Literature Complete, EMBASE, Web of Science, Scopus, PEDro physiotherapy database, OTseeker, ProQuest Dissertations & Theses Global, Epistemonikos and Google Scholar for systematic reviews published between 2018 and March 2022 on the effectiveness, acceptability and implementation of remote monitoring interventions for adults with long-term physical health conditions. We also conducted searches of PROSPERO for continuing reviews and completed citation chasing on included studies. Records identified by the searches were screened at title and abstract level by two independent reviewers, with disagreements resolved through discussion. Full texts were then screened using the same process. As prespecified in the protocol, our inclusion criteria were: systematic reviews which used a reproducible search strategy, prespecified inclusion/exclusion criteria and screening methods, conducted quality assessment and reported their method of data analysis at least 75% of participants were adults (≥ 18 years) with long-term physical condition(s) any type of remote monitoring (defined as the monitoring of a patient’s health status without face-to-face contact), with this information being passed to a healthcare professional to guide care (we included reviews in which at least 75% of the primary studies evaluated remote monitoring interventions that met this definition) systematic reviews of effectiveness, containing quantitative comparative outcome evaluations (at least 75% of the included primary studies), and systematic reviews synthesising evidence on acceptability and/or implementation, containing primary studies of any design systematic reviews published in English conducted in high-income countries (at least 75% of the included studies). Following the identification of a final sample of reviews for inclusion in the evidence and gap map, a standardised form was used to extract data from the reviews. Data were extracted by one reviewer and checked by a second, with disagreements resolved through discussion. Extracted data included study characteristics, patient population, characteristics of remote monitoring interventions and outcomes. Continuing reviews were classified according to their patient population of focus. AMSTAR 2 was used to assess the quality of included reviews. EPPI-Reviewer 4 (EPPI Centre, Social Science Research Unit, UCL Institute of Education, University of London, London, UK) was then used to create an interactive EGM. Concentrations of systematic reviews and gaps in the secondary research were identified from the map and are summarised below. We engaged with stakeholders and public and patient involvement (PPI) representatives throughout the production of the evidence and gap map. Our stakeholders were part of NHS England’s NHS @home initiative, while the PPI group had five members with experience of a range of health conditions and types of remote monitoring. Input from both groups informed the focus of the project and the presentation of the interactive map. Results We included 72 systematic reviews in the map. Of these, 61 focus on the effectiveness of remote monitoring and 24 on its acceptability or implementation, with some reviews including both types of outcome. We also identified 86 continuing reviews judged to be relevant to the review question. Most of the reviews included studies conducted in North America and Europe; of the latter, 38 reviews included studies based in the UK. Reviews tended to investigate the use of remote monitoring in patients with cardiovascular disease (CVD; 45 reviews), diabetes (25 reviews) and respiratory conditions (23 reviews). Similarly, among the continuing reviews, the majority focus on patients with CVD (36 reviews), although a greater proportion (8 reviews) are investigating remote monitoring for neurological conditions. There was a lack of consistent reporting on further patient characteristics such as age, gender and digital literacy. A wide range of health indicators were monitored, the most common being blood pressure (47 reviews), heart-related (35 reviews) and lung-related indicators (30 reviews), symptoms (27 reviews), treatment adherence (25 reviews) and blood glucose (22 reviews). The methods used to collect data included common devices, such as blood pressure and blood glucose monitors (48 reviews); symptom tracking [e.g. patients recording their symptoms in a computer application (app) or website, 29 reviews]; wearable devices (e.g. activity trackers, 20 reviews); and implantable devices (e.g. cardioverter defibrillators, 17 reviews). The most common ways of passing data to the healthcare provider were through apps, websites and e-mails (58 reviews); automatically (i.e. without the patient’s involvement, 46 reviews) and by telephone calls (33 reviews). Nurses were the healthcare professionals most often reported as involved in the remote monitoring intervention (41 reviews). In most studies, feedback was provided to the patient via telephone (42 reviews) and contained motivational/educational elements (33 reviews). In some interventions, if critical values were registered, the healthcare provider responded by making changes to treatment (28 reviews); fewer included studies where the patient was referred for further medical care (12 reviews). The outcomes assessed by the included reviews were categorised into six broad-outcome categories, with further subcategories. For physical health outcomes (55 reviews), mortality (23 reviews), blood glucose (16 reviews) and blood pressure (9 reviews) were the largest subcategories; for mental health and well-being outcomes, reviews reported on anxiety and depression (13 reviews) and quality of life (24 reviews); for health service use, hospitalisation (29 reviews) and emergency room visits (16 reviews). For health behaviours and self-regulation, there was most evidence for self-management (14 reviews) as a subcategory; for acceptability and implementation-related outcomes, most reviews reported on acceptability and satisfaction (24 reviews). Eleven reviews reported on both subcategories within the broad category of adherence and compliance. To obtain more precise estimates of specific outcomes, 48 reviews combined the results from individual studies using statistical methods (meta-analysis). Only 5 of the included reviews were judged to be of high quality and 22 of moderate quality; the rest of the reviews were of low or critically low quality, which means that they had one or more major methodological shortcomings that make their results less reliable. In addition, many of the reviews provided limited information about the evaluated interventions, making the judgement of their relevance and the interpretation of results difficult. Conclusions The map shows a number of reviews looking at the effectiveness of remote monitoring and, to a lesser degree, its acceptability and/or successful implementation. These could support the commissioning and delivery of remote monitoring interventions, while ‘gaps’ in the map could inform the further research and the development of monitoring technologies. Most of the reviews focused on CVD, diabetes and chronic respiratory conditions. While the evidence for less common conditions is limited, there are a number of continuing reviews for some populations, such as patients with neurological conditions. Reviews on acceptability and implementation focused almost entirely on the patients’ perspective, with only a small number on the perceptions and experiences of carers and healthcare professionals. The evidence and gap map and the evidence contained within in it have some limitations. More than half of the included reviews have serious methodological issues and many provided very scant descriptions of the included interventions. Additionally, a lack of consistent reporting on factors, such as age, gender and digital literacy, means that it is difficult to assess the impact of remote monitoring on equity of access to services. As the map includes systematic reviews, not primary research, we were only able to include evidence for remote monitoring interventions that have been subject to a systematic review. Remote monitoring and related terms are not used consistently in the literature, which created difficulties in identifying all relevant reviews. Finally, the volume of literature found meant that we had to apply strict inclusion and exclusion criteria, so some relevant evidence may have been excluded. For example, while we limited the map to reviews published from 2018, older reviews may contain relevant information, particularly regarding the implementation of interventions. The COVID-19 pandemic led to the rapid implementation of remote monitoring technology. While there has been a return to face-to-face provision for many services, the pandemic demonstrated the capabilities of technology. Demand for remote monitoring is likely to increase in the future, particularly given the role that it could play in meeting sustainability goals and reducing the environmental impact of health services. Evidence will be needed to support the design and delivery of further remote monitoring interventions. Future reviews should try to adhere more closely to the recommended systematic review methods; report their methods and findings as fully as possible; provide detailed description of the included interventions; report the effectiveness, acceptability and implementation of remote monitoring in all relevant patient groups; investigate the application of remote monitoring in further chronic conditions; and explore acceptability and implementation from a wider range of perspectives. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Services and Delivery Research programme (NIHR award ref: NIHR135450) as part of a series of evidence syntheses under award NIHR130538. For more information, visit https://fundingawards.nihr.ac.uk/award/NIHR135450 and https://fundingawards.nihr.ac.uk/award/NIHR130538. The report is published in full in Health and Social Care Delivery Research Vol. 11, No. 22. See the NIHR Funding and Awards website for further award information.

Children and young people (CYP) with long-term physical conditions (LTCs) are four times more likely to develop mental health disorders yet many cannot access Children and Young People's Mental Health Services (CYPMHS) or evidence-based interventions. This study aimed to understand the reasons for this; presence of an LTC neurodevelopmental disorder, or service requirements. 79 CYP mental health practitioners were randomly assigned to read vignettes depicting a hypothetical referral letter for a child with a mental health condition alone (n = 27), mental health condition and LTC (n = 25), or mental health condition and neurodevelopmental disorder (Autism Spectrum Disorder-ASD) (n = 27), answering questions about their likelihood of accepting the referral and proposed treatment plan. There were no significant differences between accessing CYPMHS or being offered first line evidence-based interventions in those with a LTC or ASD compared to those without. However, additional perceived complexity was frequently provided as a reason for rejecting referrals and not offering evidence-based intervention, with clinicians' predicted success of intervention significantly lower for these CYP. Clinicians were significantly more likely to suggest adapting the intervention in the LTC and the ASD groups to account for additional perceived complexity. The research suggests a need for additional services for CYP with LTCs and those with neurodevelopmental disorders, as well as training/awareness for clinicians. [ABSTRACT FROM AUTHOR]

For some children and young people (CYP) with long-term physical health conditions (LTPHCs) attending school can be difficult. There is a lack of evidence documenting their school attendance experiences, how schools manage absence for these children, and subsequent effects. This study utilised an existing dataset from eighty-nine 11-18-year-olds in mainstream secondary schools in the United Kingdom across 11 LTPHCs that provided first-hand accounts about the children's experiences of school. Data pre-coded "attendance" were subject to thematic analysis to explore issues emerging. Findings showed attendance patterns varied, with some CYP missing little and others significant amounts of education. Children with LTPHCs wanted to attend school and did their best to navigate education alongside health. School systems for attendance were inconsistent and adversarial. Remedial and supportive action emerged as lacking, and children felt it was their personal responsibility to make up for lost time and missed work when absent. Decisions on whether they attended school, coupled with practices promoting high attendance had detrimental consequences for CYP with LTPHCs educationally, emotionally and socially. Overall, children with LTPHCs felt punished, stigmatised, unfairly treated, unequal and excluded. Results have implications for education, health, and policy practitioners to better plan and target attention so that the LTPHC cohort are treated sensitively and equitably and afforded their entitlement to education when they cannot go to school for health reasons often outside of their control., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

Background: It is unclear as to the extent to which psychological interventions focusing specifically on depression and anxiety are helpful for people with physical health conditions, with respect to mood and condition management. Aims: To evaluate the effectiveness of a modified evidence-based psychological intervention focusing on depression and anxiety for people with type 2 diabetes mellitus (T2DM), compared with a control intervention. Method: Clients (n = 140) who experienced mild to moderate depression and/or anxiety and had a diagnosis of T2DM were allocated to either diabetes specific treatment condition (n = 52) or standard intervention (control condition, n = 63), which were run in parallel. Each condition received a group intervention offering evidence-based psychological interventions for people with depression and anxiety. Those running the diabetes specific treatment group received additional training and supervision on working with people with T2DM from a clinical health psychologist and a general practitioner. The diabetes specific treatment intervention helped patients to link mood with management of T2DM. Results: Both conditions demonstrated improvements in primary outcomes of mood and secondary outcome of adjustment [95% confidence interval (CI) between 0.25 and 5.06; p < 0.05 in all cases]. The diabetes specific treatment condition also demonstrated improvements in secondary outcomes of self-report management of T2DM for diet, checking blood and checking feet, compared with the control condition (95% CIs between 0.04 and 2.05; p < 0.05 in all cases) and in glycaemic control (95% CI: 0.67 to 8.22). The findings also suggested a non-significant reduction in NHS resources in the diabetes specific treatment condition. These changes appeared to be maintained in the diabetes specific treatment condition. Conclusions: It is concluded that a modified intervention, with input from specialist services, may offer additional benefits in terms of improved diabetic self-management and tighter glycaemic control. [ABSTRACT FROM AUTHOR]