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Understanding the impact of delegated home visiting services accessed via general practice by community-dwelling patients: a realist review protocol
  1. Ruth Abrams1,
  2. Geoffrey Wong2,
  3. Kamal Ram Mahtani2,
  4. Stephanie Tierney2,
  5. Anne-Marie Boylan2,
  6. Nia Roberts3,
  7. Sophie Park1
  1. 1 Department of Primary Care and Population Health, Institute of Epidemiology and Public Health UCL Medical School, London, UK
  2. 2 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  3. 3 Bodleian Health Care Libraries, University of Oxford, Oxford, UK
  1. Correspondence to Mrs Ruth Abrams; r.abrams{at}ucl.ac.uk

Abstract

Introduction In western countries, early visiting services (EVS) have been proposed as a recent intervention to reduce both general practitioner workload and hospital admissions among housebound individuals experiencing a healthcare need within the community. EVS involves the delegation of the patient home visits to other staff groups such as paramedics or nursing staff. However, the principles of organising this care are unknown and it remains unclear how different contexts, such as patient conditions and the processes of organising EVS influence care outcomes. A review has been designed to understand how EVS are enacted and, specifically, who benefits, why, how and when in order to provide further insight into the design and delivery of EVS.

Methods and analysis The purpose of this review is to produce findings that provide explanations of how and why EVS contexts influence their associated outcomes. Evidence on EVS will be consolidated through realist review—a theory-driven approach to evidence synthesis. A realist approach is needed as EVS is a complex intervention. What EVS achieve is likely to vary for different individuals and contexts. We expect to synthesise a range of relevant data such as qualitative, quantitative and mixed-method research in the following stages: devising an initial programme theory, searching evidence, selecting appropriate documents, extracting data, synthesising and refining the programme theory.

Ethics and dissemination A formal ethics review is not required as this study is secondary research. Findings will be disseminated in a peer-reviewed journal, at national and international conferences and to relevant professional associations.

PROSPERO registration number CRD42018096518.

  • general practice
  • home visits
  • delegation
  • primary care
  • housebound
  • realist review

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Footnotes

  • Contributors RA, GW, KRM and SP conceptualised the study. RA designed and wrote the protocol manuscript. GW, KRM, SP, ST, A-MB and NR contributed to protocol development. GW provided methodological advice. GW and SP critically reviewed and edited the manuscript. All authors read and approved the final manuscript.

  • Funding The Evidence Synthesis Working Group is funded by the National Institute for Health Research School for Primary Care Research (NIHR SPCR) [Project Number 390].

  • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NIHR, the NHS or the Department of Health.

  • Competing interests KRM is Chair, and GW is a Deputy Chair of the United Kingdom’s National Institute of Health Research Health Technology Assessment Primary Care Panel.

  • Patient consent Not required.

  • Ethics approval Formal ethical approval is not required for this review as it is secondary research.

  • Provenance and peer review Not commissioned; externally peer reviewed.