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Right Decision Service newsletter: April 2024

Welcome to the Right Decision Service (RDS) newsletter for April 2024. 

Issues with RDS and Umbraco access

Tactuum has been working hard to address the issues experienced during the last week. They have identified a series of three mitigation measures and put the first of these in place on Friday 3rd May.  If this does not resolve the problems, the second mitigation will be actioned, and then the third if necessary.

Please keep a lookout for any slowing down of the system or getting locked out. Please email myself, mbuchner@tactuum.com and onivarova@tactuum.com if you experience any problems, and also please raise an urgent support ticket via the Support Portal.

Thank you for your patience and understanding while we achieve a full resolution.

Promotion and communication resources

A rotating carousel presenting some of the key RDS tools and capabilities, and an editable slideset, are now available in the Resources for RDS providers section of the Learning and Support toolkit.

Redesign and improvements to RDS

The redesign of RDS Search and Browse is still on-track for delivery by mid-June 2024. We then plan to have a 3-week user acceptance testing phase before release to live. All editors and toolkit owners on this mailing list will be invited to participate in the UAT.

The archiving and version control functionality is also progressing well and we will advise on timescales for user acceptance testing shortly.

Tactuum is also progressing with the deep linking to individual toolkits within the mobile RDS app. There are several unknowns around the time and effort required for this work, which will only become clear as the work progresses. So we need to be careful to protect budget for this purpose.

New feature requests

These have all been compiled and effort estimated. Once the redesign work is complete, these will be prioritised in line with the remaining budget. We expect this to take place around late June.

Evaluation

Many thanks to those of you completed the value and impact survey we distributed in February. Here are some key findings from the 65 responses we received.

Figure 1: Impact of RDS on direct delivery of care

Key figures

  • 93% say that RDS has improved evidence-informed practice (high impact 62%; some impact 31%)
  • 91% report that RDS has improved consistency in practice (high impact 65%, some impact 26%)
  • 85% say that RDS has improved patient safety (high impact 59%, some impact 26%)
  • Although shared decision-making tools are only a recent addition to RDS, and only represent a small proportion of the current toolset, 85% of respondents still said that RDS had delivered impact in this area (53% high impact, 32% some impact.) 92% anticipate that RDS will deliver impact on shared decision-making in future and 85% believe it will improve delivery of personalised care in future.

Figure 2 shows RDS impact to date on delivery of health and care services

 

Key figures

These data show how RDS is already contributing to NHS reform priorities and supporting delivery of more sustainable care.

Saving time and money

  • RDS clearly has a strong impact on saving practitioner time, with 90% of respondents reporting that this is the case. 65% say it has a high impact; 25% say it has some impact on time-saving.
  • It supports devolved decision-making across the multi-professional team (85% of respondents)
  • 76% of respondents confirm that it saves money compared, for example, to investing in commercial apps (54% high impact; 22% some impact.)
  • 72% believe it has impacted already on saving money and reducing waste in the way services are delivered – e.g. reducing costs of referral management, prescribing, admissions.

Quality assurance and governance

  • RDS leads are clear that RDS has improved local governance of guidelines, with 87% confirming that this is the case. (62% high impact; 25% some impact.)

Service innovation and workforce development

  • RDS is a major driver for service innovation and improvement (83% of respondents) and has impacted significantly on workforce knowledge and skills (92% of respondents – 66% high impact; 26% some impact).

New toolkits

A few examples of toolkits published to live in the last month:

Toolkits in development

Some of the toolkits the RDS team is currently working on:

  • SARCS (Sexual Assault Response Coordination Service)
  • Staffing method framework – Care Inspectorate.
  • SIGN 171 - Diabetes in pregnancy
  • SIGN 158 – British Guideline on Management of Asthma. Selected sections will be incorporated into the RDS, and complemented by a new chronic asthma pathway being developed by SIGN, British Thoracic Society and NICE.
  • Clinical pathways from NHS Fife and NHS Lanarkshire

Please contact his.decisionsupport@nhs.scot if you would like to learn more about a toolkit. The RDS team will put you in touch with the relevant toolkit lead.

Quality audit of RDS toolkits

Thanks to all of you who have responded to the retrospective quality audit survey and to the follow up questions.  We still have some following up to do, and to work with owners of a further 23 toolkits to complete responses. An interim report is being presented to the HIS Quality and Performance Committee.

Implementation projects

Eight clinical services and two public library services are undertaking tests of change to implement the Being a partner in my care app. This app aims to support patients and the public to become active participants in Realistic Medicine. It has a strong focus on personalised, person-centred care and a library of shared decision aids, as well as simple explanations and videoclips to help the public to understand the aims of Realistic Medicine.  The tests of change will inform guidance and an implementation model around wider adoption and spread of the app.

With kind regards

Right Decision Service team

Healthcare Improvement Scotland

Headache is one of the commonest problems seen in both primary and secondary care:

  • General Practice: 4.44 consultations/100 registered patients
  • Neurology: 20-25% of referrals

Global Burden of Disease study ranks headache disorders as the second leading cause of years lived with disability worldwide

One-year prevalence of headache disorders is 50%:

  • Episodic Tension Type Headache: 41% female, 40% male
  • Episodic Migraine: female 18%, male 6%
  • Chronic Daily Headache: female 5%, male 3% 

Migraine alone is the leading cause of disability among people aged 15 to 49 years

  • In UK, an estimated 10 million people aged 16-65 experience migraine
  • 190,000 migraine attacks are experienced everyday, 100,000 are absent from work or school everyday, contributing to 43 million lost work or school days every year
  • 94% of primary care consultations for headache are due to migraine
    • Yet migraine is often not recognised and < 20% of patients with migraine attain a diagnosis
  • Costs of migraine to UK: £8.8 billion

 

Pathway Recommendations

This pathway is has been developed to aid the assessment, diagnosis and management of common primary headache disorders and give guidance on when to consider secondary headache disorders.

Patients with headache disorders access care across the NHS and this pathway is intended to be relevant to those working across primary care including community pharmacy and general practice and those working across secondary care including emergency care, acute/general medicine and neurology.

It is split into 9 sections to allow easy access:

1. Overview: National referral pathway; red, amber and green flag; diagnosis of common primary headaches; life style advice and useful guidelines

2. Acute Treatment of Migraine: relevant to primary and secondary care

3. Preventative Treatment of Migraine: migraine prophylaxis accessed in primary care and specialist options available in secondary care

4. Open access CT from primary care, including information on incidental findings

5. Management of migraine in pregnancy and lactation: including pre-conception advise

6. Management of menstrual and peri-menopausal migraine

7. Management of Medication Overuse Headache

8. Cluster Headache (Currently in development)

9. Indomethacin Sensitive Headaches (Currently in development)The Cluster Headache and Indomethacin Sensitive Headache sections are currently in development.

References and Further Resources

Vos T, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016 Lancet. 2017;390:1211–1259.

Steiner T. All Party Parliamentary Group on Primary Headache Disorders, 2008

Tepper S, et al. Prevalence and diagnosis of migraine in patients consulting their physician with a complaint of headache: data from the Landmark Study. Headache. 2004 Oct;44(9):856-64.

Kernick D. GPs' classification of headache: is primary headache underdiagnosed? Br J Gen Pract 2008; 58: 102–104.

Latinovic R, et al. Headache and migraine in primary care: consultation, prescription, and referral rates in a large population. JNNP. 2006;77(3):385-7 https://www.lancaster.ac.uk/media/lancaster-university/content-assets/documents/lums/work-foundation/SocietysHeadacheTheSocioeconomicimpactofmigraine.pdf 

Editorial Information

Last reviewed: 11/10/2023

Next review date: 01/04/2025