Background
Healthcare in Prison (HiP) aims to provide a quality, safe and effective service to all people in custody at least equivalent to that of the community. Our patients are often from the most marginalised parts of Northern Ireland and often have a high level of need, both from a mental and physical health perspective. Many of our patients are prescribed high doses of analgesics for chronic pain– this prescribing is inherited into the prison system due to the responsibility placed upon us to ensure continuity of medicines from community prescribers.
There has been a move away from the use of medication, including opioids, to treat chronic pain due to limited benefit. If medication is required, this should be in line with NICE Guidance and include non-pharmacological alternatives e.g self-management programmes. Until now access to programmes such as the Better days pain management programme was not available in our setting. SPPG Pharmacy funded a pilot programme led by a joint Healthcare in prisons (HIP) working group and Resurgam Trust was piloted in HMP Magilligan.

Approach
A multidisciplinary group including Hip pharmacists, nurses , physiotherapists and colleagues from Resurgam Trust agreed on recruitment of candidates, structure of course (to allow for local implementation given IT restrictions) and types of practical support deliverable. The programme was delivered over 6 sessions:
Week 1: Understanding pain + connecting with others living with pain
Week 2: Understanding Medicines for pain management
Week 3: What we eat and how it impacts pain
Week 4: Mental Health and Sleep
Week 5: Physiotherapy, movement and pain
Week 6: Holistic Therapies and managing flares
13 participants attended the programme. It helped them to understand their pain more fully using a holistic approach to pain management. It explored the role of medicines, current evidence based guidelines, prescribing rationale and the limited benefits and side effects of medicines in pain management. It included sessions on physiotherapy, mental health, sleep, eating well and 10 steps to living well with pain. These sessions were tailored specifically to the prison environment and helped to empower and support the men to help to manage their pain.
Results
Feedback from the participants was overwhelmingly positive with 64% of participants citing that they found the programme very helpful and 45% have indicated that they have reduced or cut down on their medication. There was a 16% reduction in the level of pain and discomfort and 17% reduction in anxiety and depression (as a result of chronic pain) participants experienced after programme completion. The programme demonstrated the positive impact of making pain management programmes available to people who live in prisons and the improvements that can be made over a relatively short period of time. By collaborative working with Norther Ireland Prison Service the programme achieved meaningful outcomes that (positively)impacted on our patients journey and empowered them in the management of their pain. These demonstrable outcomes evidence that support programmes allow those living with chronic pain to self-manage beyond medication.

With limited advancement in the development of treatments to prevent or halt the progression of dementia, welcome attention is now being directed to the sphere of “care” for people already living with dementia, specifically the integration of social and health care and possible benefits of integration for people with dementia, their families, and caregivers.
Ethics approval has been granted for an exploratory qualitative study focusing on dementia within the developing integrated care system (ICS). Integrated Care (IC) will be explored from the perspectives of social care and health care practitioners, managers and commissioners working in statutory and voluntary and community sector organisations in the north Midlands area of England.
The study is part of a programme of work being developed for a National Institute for Health and Care Research Applied Research Collaboration (NIHR ARC) Dementia Fellowship in the field of social care. A range of stakeholders have been involved and engaged with this study and have stated their support for it. These are: the Social Care Research EngagemEnt (SCREEN) Group – a collective of academics and practitioners who lead on the social care research strategy for a local NHS Foundation Trust; academics from the researcher’s own institution; and an externally facilitated Public Contributors Group. Public Contributors included people with lived experience of caring for a friend or family member with dementia.
Comments from Public Contributors highlighted the importance of carers and the need for research/services to build a better understanding of how to support staff/relatives to understand and navigate existing systems; issues of lack of effective communication between services that lead to pitfalls in care; and the value of research to explore the inter-relatedness of health and social care. Several Contributors expressed an interest in staying connected with the programme of research through membership of a PPIE (Patient and Public Involvement and Engagement) group.
This study will use semi-structured interviews and focus groups with practitioners to explore aspects such as what meaning is given by practitioners to the term IC; what will IC offer people living with dementia in respect of what care will now look like, whether people will have greater control over care provided, the effect of changes on meeting people’s needs and resulting outcomes; and perspectives on the impact of IC at team level including how practitioners work together.
Provisional findings will be presented and discussed, and future directions for research will be indicated. It is hoped that findings will make a contribution to knowledge about the place of dementia in ICSs in England.
Findings will be disseminated through local academic and practice networks to support understanding of practitioner perspectives and inform development of IC practices in dementia; through a stakeholder event; through PPIE networks; and through publication outputs.
This work will inform other work strands being developed by the NIHR ARC dementia research fellowship programme in the West Midlands and will be a basis for developing grant applications to further explore the impact of IC approaches from the perspectives of people with lived experience of dementia.

Mental health difficulties are by now considered the norm in diabetes, not the exception and there is a call for more integrated interventions and care pathways for this group (Amrit et al 2023). As a diabetes psychologist at the Diabetes Integrated Care Ealing (DICE) service in Southall, London, I have noticed the need for psychological support in this service echoes the gap identified nationally (Askew et al. 2019). In a recent audit by one of my colleagues, it was found that 80% of people referred to our service also had a mental health condition (Gomwe, 2022) and we are working on developing and integrating care pathways to better meet this need. The "Adapted 5-Level Pyramid of Psychological Needs in People with Diabetes" (Sachar et al. 2020) illustrates five levels of psychological needs (outlined below) among people with diabetes. I have used this as a framework to illustrate how provision is currently met in this service and thoughts on how pathways could be further integrated and developed: Level 1) General difficulties with coping with diabetes. Common to most people receiving a diagnosis of diabetes. Likely to increase at each significant life stage and each significant change in diabetes progression/ /No specific psychological support is offered on this level. Level 2) Psychological problems related to diabetes like anxiety, depression, diabetes distress, phobias, and some disordered eating// Provision here met by Increased Access to Psychological Therapies (IAPT) Level 3) Psychological problems related to diabetes like anxiety, depression, diabetes distress, phobias, some disordered eating// Provision met by diabetes psychology service (individual or group intervention*) Level 4) Significant difficulties coping and self-caring in the context of multiple complexities like substance misuse, complex trauma, and social difficulties. +/- depression, anxiety, diabetes distress/ Provision met by diabetes psychology service (individual or group intervention *). Some referred to secondary mental health services at this level**. Level 5) Severe Mental illness, dementia, or eating disorder, +/- in acute mental health crisis // Provision** here needs further integration. Not only due to complexity but also to manage risk. Presently managed on a case-by-case basis and involves screening by diabetes psychologist. The common thread across levels is diabetes distress (here defined “as the unique, often hidden emotional burdens and worries specific to people with diabetes”) across all levels of severity. I believe integrated interventions addressing both the psychology and physiology of diabetes could halt the intensity likely to exacerbate any other conditions and issues on all levels. With this in mind, and as a service development initiative I am presently offering a structured education group* adapted for people with diabetes who also have a psychological condition of varying severity. Outcome measures used in both individual - as well as group- interventions involve both general psychological screening tools, more specific diabetes distress measures as well as physical measures of diabetes. Preliminary evaluations of such looks promising. I hope to develop diabetes psychology interventions further through more formal research using a co-production design involving the views of people with diabetes and healthcare professionals.

Introduction:
In Japan, since the Long-Term Care Insurance launched in 2000, elderly care has been supported with both medical and long-term care insurance, based on the community-based integrated care system aiming at living in the community to the end of lives. Medical expenses per person aged 75 and older show a decrease from US $8,192 in 1999 to US $7,197 in 2002, however, they gradually increased to US $9,352 in 2019. The long-term care costs also increased from US $4,248 in 2006 to US $5,182 in 2021. Meanwhile, the proportion of deaths in hospitals decreased from 82.4% in 2005 to 67.4% in 2021, showing a shift towards non-hospital settings. (US $1.00 = 102 Japanese yen)

Aims, Objectives, Methods:
This study focused on the last 5 years of life for 96 individuals aged 75 and older. They received their initial long-term care certification after 2016 and died during the fiscal year 2021. These individuals lived in a small rural municipality with a population of less than 20,000, an aging rate of 37.9%, and a long-term care certification rate of 19% in Japan. Individually, we linked medical fees and records of the long-term care insurance. Ultimately, we identified the location of end-of-life care. Subsequently, we categorized individuals with hospitalization expenses in the last month as ‘hospital-deaths’, while those without hospitalization expenses as ‘community-deaths’.

Highlights, Results, or Key Findings:
The average total care costs over the last five years amounted to US $116,241, including hospitalization expenses of US $55,250, outpatient expenses of US $25,997, and long-term care costs of US $34,995. The 80-84 age group had the highest total care costs. Places of death comprised 62.5% in hospital-deaths and 37.5% in community-deaths. The final severity of care required (range 0-5) for community-deaths was significantly higher at 3.5, compared to 2.9 for hospital-deaths. The residency at care facilities was significantly longer for community-deaths (8.4 months) than hospital-deaths (3.8 months) . Total care costs were markedly elevated for hospital-deaths, reaching US $129,830, in contrast to US $93,594 for community-deaths. Especially in the last month, total care costs were significantly higher, reaching US $7,616 for hospital-deaths and US $2,796 for community-deaths.

Conclusion:
This study examined the total care costs for elderly people with long-term care certification in a small municipality over the five years before death and analyzed the places of end-of-life care. The final severity of care required in community-deaths was significantly higher than that in hospital-deaths and the duration of residency in care facilities was significantly longer. This suggests that elderly people with substantial care and medical needs lived in the community to the end of lives. Meanwhile, the total care costs during the last five years were higher in hospital-deaths, particularly in the last month before death. In Japan, the community-based integrated care system since 2006 has facilitated end-of-life care in long-term care services and changed the situation where hospital deaths accounted for over 80% in 2005. This system appears to have gradually improved.

Integrated care is most effective when the system is built around the patient, rather than requiring the patient to navigate the system. This was the guiding principle behind the Calgary Foothills Primary Care Network's case collaborative program, initiated over five years ago. Roughly 20% of Canadians experience mental illness or addiction issues annually, with 57% of those seeking professional mental health care consulting a family doctor first. Modern healthcare complexity demands provider collaboration yet lacks a structured framework for support.

Feedback from patients and families highlighted challenges in navigating numerous resources and coordinating care across multiple agencies. In response, the case collaborative initiative was established, bringing together doctors, healthcare professionals, schools, communities, and government services. This collaborative approach addresses the complex health, psychological, and social needs of patients. The model, co-designed by the Primary Care Network and community partners with input from patient advisors, aligns with best practices such as patient-centered care, team-based care, population-focused care, evidence-based and quality improvement.

The successful implementation of four case collaboratives has addressed 223 cases, focusing on concerns such as a lack of family resources, coordination of care, housing, financial issues, and social isolation. Evaluation results indicate that 85% of providers believe the model facilitated timely connection to resources, 91% believe it enhanced patients' quality of care, and 100% felt empowered to provide care. Patients reported feeling better supported, emphasizing the collaborative team's significant impact.

The strengthened relationships among providers have not only benefited patients directly involved but have created a ripple effect, improving overall service delivery in the community. Our presentation will emphasize the integration of primary health care with patients and families as active partners. We'll outline the transition from traditional primary health practices to an integrated community care model, focusing on the co-design of the case collaborative model, key principles, challenges, learnings, and enablers supporting its success. Our goal is to contribute to a primary care collaborative that leads to better health, care, and value.

Our future steps include enhancing patient engagement, transitioning to an inclusive model where families serve as primary referrers, and scaling the model provincially, nationally, and internationally.

1,2Alison McAlister, 1,2Cherry Wynne, 1,2Abi Mani, 1,2,3 Stanley Miller
1Respiratory Integrated Care, Dublin North Central, Dublin
2 Mater Misericordiae University Hospital, Dublin, ³ University College Dublin
Introduction: In Ireland an estimated 380,000 people are living with Chronic Obstructive Pulmonary Disease (COPD) but only 110,000 are diagnosed[1]. Extensive under-diagnosis and misdiagnosis leads to patients receiving no treatment or incorrect treatment. Spirometry is vital to establish a diagnosis of COPD [2]. Appropriate and earlier diagnosis of COPD can have a very significant public health impact.
Aim: The aim of the study is to demonstrate that Respiratory Integrated Care Nurse Led Clinics enable earlier access to spirometry and earlier diagnosis via RIC consultant led multidisciplinary meetings (MDM). Data was collected on all patients reviewed in nurse led clinics.
Method: A retrospective review was carried out of patients referred from GP practices between May 2021 and May 2023, with a diagnosis of Chronic Obstructive Pulmonary Disease (COPD) or ‘query’ COPD, and no previous spirometry performed. Spirometry was requested and carried out in the Pulmonary Function Laboratory of the Mater Misericordiae University Hospital (MMUH) and all cases were discussed at our weekly integrated respiratory MDM.
Results: 99 patients were referred to RIC with a clinical diagnosis of COPD or ‘query’ COPD but no previous spirometry performed. Of these 99 patients, 64 (64.6%) were subsequently confirmed with a diagnosis of COPD. Global Initiative for Chronic Obstructive Lung Disease (GOLD) Grade 1: 22 (34.4%); Grade 2: 32 (50%); Grade 3: 9 (14%). 35 patients were not given a COPD diagnosis. Of these 35, 5 had no respiratory illness, 5 were diagnosed with asthma , 5 had probable asthma, 4 had obstructive sleep apnoea (OSA), 2 had asthma and OSA, 2 had rhinitis. One patient died of unknown cause and 11 did not attend, declined or were still awaiting spirometry at the time of abstract writing.
Key Learning: RIC nurse led clinics enables improved access to diagnostics and specialist input, which provides correct diagnosis and treatment. This provides an opportunity for secondary prevention and early intervention to minimise the impact of the disease process.
RIC centres nationwide will have access to spirometry within Integrated Care Hubs. Spirometry will then be more easily accessible to GP practices. In the near future Patient Satisfaction questionnaires will be utilised to gather further evidence of the effectiveness of the Respiratory Integrated Care Service.
References
1. National Clinical Programme for Respiratory End To End COPD Model of Care (December 2019). Available from: https://www.hse.ie/eng/about/who/cspd/ncps/ncpr/copd/moc/end-to-end-copd-model-of-care-december-2019.pdf
2. Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary. Eur Respir J. 2023 Apr 1;61(4):2300239. doi: 10.1183/13993003.00239-2023.

Introduction: For myocardial infarction (MI), in-hospital lethality is still significantly higher in women than in men. Medical guidelines and nursing expert standards include recommendations for gender-sensitive care, but it is unknown how these are implemented in health care practice. It is hypothesized that there is a discrepancy between evidence-based GSC+ guidelines and expert standards and their implementation in practice. The HeartGap project, which is funded by the German Innovation Fund, investigates influencing factors and whether a gap exists between evidence and the reality of care. Who is it for? All genders can benefit from an increase of GSC+.

Methods: The current state of GSC+ in cardiology is examined through a mixed-methods research design, including a scoping review and qualitative and quantitative surveys from the perspectives of nurses, clinicians, and patients. We included the patient's and stakeholder's perspective into the study to ensure public involvement in addition to the healthcare professionals' perspective. From the analysis and triangulation of research results, recommendations are derived to implement GSC+ sustainably in everyday healthcare. The focus of this poster will be on the results of the scoping review and qualitative survey. The scoping review investigated measures for the sustainable implementation of GSC+ and identified existing barriers and challenges. Additionally, results from 12 qualitative focus group interviews conducted between February 2023 and October 2023 in six hospitals of varying sizes and levels of care in Lower Saxony and North Rhine-Westphalia, Germany, involving nurses and doctors, will be presented.

Results: During the review, identified measures to promote the implementation of GSC+ were clustered into 14 dimensions. Besides hospital-specific factors, external factors such as universities and training institutions influence the success of the implementation of GSC+. The dimensions of "Education" and "Research and Science" captured the majority of measures. As the review included international studies in English and German, the measures identified relate to the global level therefore benefit an international audience.
In qualitative interviews, it was observed that barriers to implementing more GSC+ primarily exist in temporal and financial aspects. Furthermore, the importance and urgency of GSC+ are not universally recognized among healthcare providers. Supporting factors include an increase in scientific evidence, educational offerings, more awareness of the topic, policy directives, and practical implementation recommendations.

Summary: In the HeartGap project, disparities between expectations regarding gender-sensitive medical guidelines/expert standards in hospitals and their actual implementation are investigated. Despite existing guidelines for gender-sensitive care (GSC+), obstacles impede the implementation. The implementation should occur at an interdisciplinary level and in a holistic approach, as all genders benefit from GSC+. The next steps are to conduct the quantitative study in 2024. After the evaluation, all data will be triangulated and recommendations for action for the implementation of more GSC+ at German and international levels will be derived.

Our research team is currently working on the use of AI-enhanced algorithms to predict oxygen needs in patients on ambulatory oxygen therapy. The training of the algorithms, for which rich data sets are required, was a challenge for engineers. The solution proposed was to build an automated version of the 6MWT (named A-6MWT). This serendipitous development is currently promoting the revision of current practices, including a more integrated care perspective.
The 6MWT is a simple test that measures the distance that a patient can quickly walk on a flat, hard surface in a period of 6 minutes. This test helps to evaluate the global and integrated responses of all the systems involved during exercise, notably the pulmonary and cardiovascular systems. For most of the patients, the results accurately reflect the functional exercise level for activities of daily living. At present, the 6MWT is done by health professionals working at hospital departments (nurses, technicians, physiotherapists, doctors) and, in most locations, the test is still run on paper.
A few digital solutions are available but the A-6MWT is the only one that fully automates the process of data collection and recording with the goal to obtain richer data sets (acquisition frequency for oxygen saturation and heart rate is 1Hz). It is composed of:
1) Two light beacon devices that fit in the type of cones used to mark the walking course and detect that the patient passes by in the right direction.
2) A mobile app that is used to perform the 6MWT. This app connects the beacons and a pulse-oximetry device to gather and process test data. It also manages the test logic for time tracking and sends it to a database. The professional’s front-end can then access this database to display the required reports.
3) A desktop web-based interface that integrates all the information and computes the metrics that the professionals require to assess the results of the 6MWT.
In a cross-sectional study that included 45 patients with COPD or Pulmonary Hypertension, the A-6MWT demonstrated reliability and excellent agreement with the manual registration of oxygen saturation and heart rate.(1)
Other important advantages are a reinforcement of the standardisation and quality of the 6-MWT test, and the easiness of its use. These characteristics facilitate the extension to other clinical domains (rehabilitation, geriatrics, oncology…), as well as to the pharma (6-MWT is used in clinical trials to study exertion and gait).
Additionally, we are considering its transferring to primary care through a dedicated programme of coordination and support by hospital-based professionals. Potential benefits of such a programme could be a closer patient’s follow-up, increased facilities for rehab activities in primary care, and overall system-level efficiency.
There is a real element of serendipity in integrated care and its inclination to combine components in new, previously unthought, ways. Thus, leftovers from other research fields might be interesting and, eventually, become game changers. Keeping an eye on them seems advisable.

(1) doi:10.1016/j.pulmoe.2023.08.011

Background of this project
While the oncology day ward remains vital for administering Systemic Anticancer Treatment (SACT), the rationale for a community- based clinic for pre-chemotherapy care is underscored by its potential to provide accessible, patient-centered and efficient care. Tallaght University Hospital's oncology day ward provides SACT for hundreds of patients per year. Moving certain elements of cancer care to the community setting will address the growing challenges posed by the increasing prevalence of cancer. Such challenges include and increase in the diagnosis of cancer which impacts capacity for treatment in our oncology day ward and longer waiting times. This new initiative fosters collaborative partnerships between oncology day ward and the South Dublin Community Intervention Team, fundamentally transforming the way we approach cancer care.
The Innovation:
We are strategically integrating certain elements of pre-chemotherapy care into the community, starting with prechemotherapy phlebotomy services. We have opened up a community based clinic ran by the CIT whereby patients are referred to by the oncology day ward for pre-chemo care. Through the extension of these components, we are not only reshaping the patient's journey, but also establishing a revolutionary framework with the capacity to enhance accessibility to cancer services and increase efficiency in care delivery.

Aims: The central aim of this project is to improve primary and secondary cancer prevention among people experiencing homelessness (PEH) through promoting cancer awareness and self-management, and to effectively guide PEH through healthcare systems, facilitate their access to care, and enhance their general and cancer-specific health outcomes.
Methods: A Health Navigator Model (HNM) is currently being piloted through the implementation of a longitudinal cohort of PEH across four European countries (Austria, Greece, Spain, and the UK) as part of the Horizon 2020 CANCERLESS project. The HNM is being delivered by Health Navigators (HN) who are professionals with a background in health or social care and an understanding of the local population. Data are collected through pre-vs post questionnaires and interviews with PEH. Interviews are audio-recorded and transcribed verbatim and then thematically analysed. Questionnaires are collected manually and face-to-face by using paper forms - this data is then transferred to an online database. Key findings of the qualitative and quantitative data will be available after December 2023 and included in this presentation for the UK Site.
Results: The HNM is being implemented across the four European countries until December 2023. To date, 155 PEH agreed to participate in the HN intervention in the UK. Of those, 25 registered with GP services, 40 took part in educational workshops on cancer symptoms/signs and general cancer prevention, 22 participated in physical activity (gym, swimming or football) and 59 underwent screening services (phone consultations, general health checks, blood tests, Hepatitis C tests).
Conclusion: The HNM appears to be an effective approach in facilitating access to healthcare services and cancer screening, promoting cancer awareness and self-management, overcoming health inequalities and providing practical assistance to PEH.

Introduction
Community-governed comprehensive primary health care organizations came together, with their provincial association, to develop a Health Equity Charter that centres social justice, anti-Black racism, anti-Indigenous racism, anti-racism and anti-oppression into the practices of the organization thereby improving access for communities and people in Ontario Canada

Target Audience
Primary Health Care Organizations or providers that want to improve access and care for people that are marginalized or face oppression.

Implementation of Health Equity Charter
At the 2011 Alliance for Healthier Communities Annual General Meeting, a resolution was put forward that called for the development of a Health Equity Charter to serve as “a guide and an inspiration” in delivering better care. This initiative reflected a desire to articulate a unifying vision for organizations that would “describe our aspirations for access, participation, equity, inclusiveness and social justice.” In 2012, Alliance membership made their commitment to Health equity official by adopting the Health Equity Charter.

Since its adoption, Health Equity Charter has become one of the foundational documents and has been acting as a guide and inspiration for the sector. It allows us to speak together about the barriers that certain groups in Ontario face and what we can do to address these barriers and ensure everyone can have access to the services and supports they need and be as healthy as they can be.

In 2017, endorsement of the Charter became one of Alliance membership criteria and in 2019 and then again in 2021 the Charter was refreshed with additional acknowledgements and commitments. As part of the refresh process, we formed a working group that included representatives from the Alliance Board and Alliance’s priority population groups (Indigenous, Black, Francophone and 2SLGBTQ+). In addition to the consultation, an environmental scan of relevant documents, reports and tools was undertaken.

The call for refresh came from within the Alliance membership, especially those organizations that serve Indigenous and Black and racialized populations who felt that there were some gaps in the previous charter. As our understanding of health equity kept evolving, the Charter needed to evolve with it. The goal was to create a more relevant, living document with clear accountability mechanisms that could better support our work.

Learnings will be shared that include:
- Rational for primary care providers to consider adopting a HE charter
- The process for developing a culturally relevant HE charter
- How to implement the charter at a micro and macro level
Next Steps
Alliance members have committed to endorse the Charter and review their progress in putting this in action. To support this work, the Alliance has developed a self-assessment tool to help measure their progress of advancing health equity in their organizations and communities.