Commissioning for long-term conditions: hearing the voice of and engaging users – a qualitative multiple case study.

摘要: Some 15 million people in England have a long-term condition (LTC) but there is concern about whether or not the NHS meets their needs. To address this, consecutive governments developed policies aimed at improving service delivery and patient public engagement involvement (PPEI). There has been little research that examines impact benefit of PPEI commissioning. This project explored role commissioning for with LTCs. The was undertaken during period substantial change English NHS, which enabled us to observe how reforms impacted on approaches PPEI. aim examine commissioners enable voice LTCs identify what this process pattern services. Our specific objectives were (1) critically analyse relationship between public/patient process; (2) determine changes reshape local services; (3) explore any such services experience; (4) if LTCs; (5) groups/patient representatives get heard mechanisms processes patients use make heard. We used case study design examining experience three LTC groups - diabetes, rheumatoid arthritis neurological conditions through in-depth studies. approach involved reviewing practice across UK then focusing geographical areas practices health care LTCs, PPEI, patterns activities voluntary organisations had five phases participatory interactive methods data collection analysis. identified two key where improvements relation can be made. first relates framework infrastructure arrangements supported other organisations. combat short-termism fragility activities, sufficient resources need invested developing shared understandings sustaining relationships infrastructures. second area action it should undertaken. Action needs taken by both national levels. circular and, itself, extremely fragile. 'virtuous' successful leads improved outcomes. However, tokenistic ends, become disengaged less described as 'vicious circle'. In addition, we number methodological issues further considered funders researchers undertaking including young people. National Institute Health Research Services Delivery programme.