eb290c7e-cd77-4244-9d45-322994af9f69 ADOPTED PROJECT: Comparing pharmacological and non-pharmacological interventions for adults with Attention-Deficit/Hyperactivity Disorder (ADHD): systematic review and network meta-analysis Chief Investigator: Professor Samuele Cortese – University of Southampton Project Team Members: Professor Andrea Cipriani – University of Oxford, Associate Professor Corentin Gosling – University of Paris Nanterre, France, Dr Luis Faraht – University of São Paulo, Brazil / Yale University Child Study Center, USA, Dr Cinzia Del Giovane – University of Modena and Reggio, Italy Project partners: Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK; Oxford Precision Psychiatry Lab, National Institute for Health and Care Research Oxford Health Biomedical Research Centre, Oxford, UK; Oxford Health National Health Service (NHS) Foundation Trust, Warneford Hospital, Oxford, UK. Electronic address: edoardo.ostinelli@psych.ox.ac.uk . Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany. Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK; Oxford Precision Psychiatry Lab, National Institute for Health and Care Research Oxford Health Biomedical Research Centre, Oxford, UK; Oxford Health National Health Service (NHS) Foundation Trust, Warneford Hospital, Oxford, UK. Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil. Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK; Oxford Precision Psychiatry Lab, National Institute for Health and Care Research Oxford Health Biomedical Research Centre, Oxford, UK. Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy; Institute of Primary Health Care, University of Bern, Bern, Switzerland. Hampshire and Isle of Wight NHS Foundation Trust, Southampton, UK; Department of Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK. Psychology Services, London, UK; Department of Psychology, Reykjavik University, Reykjavik, Iceland. Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK; Oxford Health National Health Service (NHS) Foundation Trust, Warneford Hospital, Oxford, UK. The National Attention Deficit Disorder Information and Support Services, Edgware, UK. Hampshire and Isle of Wight NHS Foundation Trust, Southampton, UK Full team listing including PPI :O stinelli EG, Schulze M, Zangani C, Farhat LC, Tomlinson A, Del Giovane C, Chamberlain SR, Philipsen A, Young S, Cowen PJ, Bilbow A (PPI), Cipriani A, Cortese S Ended: 28th February 2024 Background: It is currently unclear how different treatment options for preschool children with ADHD compare with each other in terms of efficacy and safety. We will use data from available randomised controlled trials (RCTs) and apply an advanced and innovative statistical approach (network meta-analysis) to answer this question. What did we find out? We found that Stimulant medications and atomoxetine are the only treatments that clearly help reduce the main symptoms of ADHD in the short term, based on both what patients say and what doctors observe. However, people were less likely to stick with atomoxetine than with a placebo (a dummy pill). There was no evidence available other important things like improving quality of life, and we don’t know much about how well they work in the long run. Non-medication treatments had mixed results depending on who was doing the rating. This study gives the most complete picture so far of how different treatments for adult ADHD compare to each other. It can help guide treatment choices, but those choices should always be based on a careful look at both the benefits and risks — and on what matters most to the individual. The study is already informing clinical guidelines, e.g., the ongoing guidelines from APOSARD (USA). The study has informed a freely available platform ( https://ebiadhd-database.org/ ) that has been utilised by 15,000 colleagues around the world and improved through feedback from 1,000 stakeholders worldwide See medication and treatment ratings Next Steps To test the impact of the platform on knowledge and clinical practice To contact guideline bodies in the UK (eg NICE) and abroad to bring the network meta-analysis and the related platform to their attention. Publications Comparative efficacy and acceptability of pharmacological, psychological, and neurostimulatory interventions for ADHD in adults: a systematic review and component network meta-analysis - ScienceDirect

d9f3030e-3acc-4dc2-87bc-c01e65471d56 FLEXI: Falls management exercise programme led by NIHR ARC East Midlands working with NIHR ARC Greater Manchester and NIHR ARC South West Peninsula The FLEXI Study (FaLls EXercise Implementation) Lay Summary Falling can cause injury, pain, loss of confidence and independence. This is undesirable for the individual and their families, and places significant demands on health and social care services. Falls are not inevitable. By improving an individual’s strength and balance, alongside skills to help getting up from a fall (should this happen), the likelihood of a fall occurring or having damaging consequences, such as a long lie on the floor, can be minimised. The Falls Management Exercise (FaME) programme is a group-based, face-to-face, six-month exercise programme specifically aimed at improving the strength and balance of people aged 65 and over. Research has shown that FaME results in fewer falls, improved confidence, and reduced fear-of-falling. Despite this, FaME is still not available everywhere across England. More needs to be understood about how best to increase its availability and ensure high quality delivery. To improve our understanding of this, we previously studied FaME’s set-up, delivery and quality in the East Midlands. We learnt a lot about how to get FaME running and showed that the programmes worked outside of a research setting. Using learning from the East Midlands, we developed a guide for implementing FaME called the implementation toolkit . This evidence-based toolkit contains all the information needed to set up and run a FaME programme, from making the initial business case to promoting it to participants. “FaME gives value. We know it's great value for money. We know it works in terms of it reduces falls, it increases physical activity, improves function, improves confidence. So many different benefits” What have we discovered? What works to foster (encourage) the adoption (initial decision to choose or take up something) and spread (roll out over a large area) of The Falls Management Exercise (FaME) programme ? Using implementation frameworks, we successfully identified key barriers and enablers of adoption, implementation and spread of the Falls Management Exercise (FaME) programme across the three localities. We found that the adoption, implementation and spread of FaME into community settings is complex and faces multiple health system challenges. In order for the FaME programme to be chosen as a community fall prevention intervention by commissioners, the programme must be able to demonstrate how successful it is in reducing falls for older adults (this is often determined by internal service evaluation). The programme was also required to fit the needs of those receiving the intervention, for example, FaME was primarily provided where there was a growing, aging population in need of fall prevention interventions. The spread of the FaME programme within organisations and into new regional areas was dependant on the input of commissioners passionate about fall prevention. Commissioners were required to support this roll out and provide funding, whilst also ensuring that there was a sufficient expert instructor workforce available to deliver FaME. The programmes were further required to be monitored regularly to evidence how successfully each programme was in reducing rate and risk of falls for older adults receiving the intervention. This was often the role of the postural stability instructor. Future funding is required to build in paid time for this to ensure that programme outcomes can support future funding cycles as often instructors are funded on an hourly basis. Does FaME work in the real world, how is it adapted (altered or changed), and does it reach the intended audience (older adults at risk of falling)? The collection of routine class data across three regions in England demonstrated that FaME was associated with benefits for participants at 12 and 24 weeks of the programme. Those benefits included improved balance and mobility and reduced falls. Programmes that provided higher ‘dose’ (i.e. ran over 24 weeks rather than 12 weeks) found that older adults experienced greater improvements in balance and mobility and were less likely to be concerned about falling again. What works to maintain the quality (the standard) and fidelity (how well something is reproduced) of the FaME programme over time? One of the key findings of the FLEXI study was that sites demonstrated a lack of clarity of essential components or key ingredients of the FaME intervention. This influenced both implementation and the providers' ability to assess adherence. The need for an understanding of central components was also clear in understanding delivery adherence and, therefore, the ability to evaluate programmes for their effectiveness. At the point of implementation, it became apparent that commissioners and managers are prioritising aspects of the intervention, with these decisions mediated by knowledge (or lack ) of the intervention, economic culture and organisational priorities. Adaptation of Evidence Based Interventions is key to improving their fit in a new context, however, essential components should not be adapted as intervention effectiveness cannot be guaranteed. We have proposed a new framework of implementation fidelity, that shows that mediators were key both in the implementation and delivery of complex interventions, as well as the mediating more of global mediators. Understanding of essential components is paramount at the point of implementation in order to ensure fidelity is implemented, maintained, and assessed. We suggest that complex interventions have a standard of evaluation (based on core components) and insights on fidelity/value negotiations within toolkits. We highlight that local fidelity evaluation is key to standardisation across programmes and delivery. What difference does this knowledge make? We have worked collaboratively with the Health Innovation Networks (HINs), local Integrated Care Systems and Combined Authorities to study ‘spread in action’. As a result, in one of our areas (Devon), where we have applied HINs spread methodology, we have seen a near trebling of available programmes from 13 to 41 (without intervention costs from the study). The study has highlighted the need for an increased frequency of local Quality Assurance to monitor delivery (instructors given the opportunity to observe each other deliver and provide constructive feedback). This has improved the quality of delivery. We have also hosted Greater Manchester-wide collaborative events, which resulted in quality improvement initiatives relating to FaME provision across GM and have established the National FaME Implementation Team (N-FIT) which is now primed and ready to work in new areas to support spread, using the methodologies we have tested. We are refining our implementation toolkit, which is ready to be tested in new areas and we want to refine and improve our quality assurance framework and costing tool using data collected from the study to support future FaME provision. What next? Our future planned work aims to address: Gaps in our understanding about what works to reach underserved communities in relation to FaME participation. We are currently working to explore the provision of FaME in ‘neighbourhood’ areas where there are good examples of reach into underserved groups (e.g. minority ethnic groups, male participants and socioeconomically deprived areas). We are conducting case-study research methodologies to further investigate this aim. The original FLEXI project highlighted that the monitoring and evaluation of programme outcomes are not captured well by local areas delivering programmes. We are, therefore, now developing a more structured evaluation framework for sites to use a legacy of the project. New data on the costs of implementing FaME have been determined and we would love to use these figures to update the national return on investment tool for FaME, developed by Public Health England and York University, to see if this improves the economic case for FaME roll-out. Lastly, we have also tested quality assurance tools for FaME and can see that improvements can be made to increase the tools’ internal and external validity. Moving forward, we would like to refine our preferred tool using academic methods to test this in new areas. FLEXI output links digital .pdf Download PDF • 616KB We would like to thank: Principle Investigator: Dr Elizabeth Orton Team members: Professor Denise Kendrick , Professor Stephen Timmons , Professor Carol Coupland , Professor Pip Logan , Professor Tahir Masud , Professor Vicki Goodwin , Professor Claire Hulme , Professor Chris Todd , Dr Helen Hawley-Hague , Dr Paul Wilson, Professor Dawn Skelton , Mrs Margaret Beetham Study researchers and study staff: Dr Fay Manning Dr Jodi Ventre Dr Aseel Mahmoud Dr Basharat Hussain Dr Michael Taylor Dr Grace Brough Dr Amar Shukla Dr Robert Vickers Ms Tina Patel Study public contributors: Mary Murphy Margaret Beetham PPIE Workshop participants from Greater Manchester, Devon and East Midlands Our Partners: NIHR ARC Greater Manchester , NIHR ARC South West Peninsula , Health Innovation South West , Royal Society for the Prevention of Accidents, Health Innovation Manchester, Later Life Training, Torbay and South Devon NHS Foundation Trust, Leicester-shire and Rutland Sport. Research sites: Devon Integrated Care System (ICS), Manchester combined authority, Leicester, Leicestershire and Rutland ICS, Derby and Derbyshire ICS Starts: 1/10/2021 Ends: 30/9/2025 Lay summary below Falling can cause injury, pain, loss of confidence and independence. This is undesirable for the individual and their families, and places significant demands on health and social care services. Falls are not inevitable. By improving an individual’s strength and balance, alongside skills to help getting up from a fall (should this happen), the likelihood of a fall occurring or having damaging consequences, such as a long lie on the floor, can be minimised. The Falls Management Exercise (FaME) programme is a group-based, face-to-face, six-month exercise programme specifically aimed at improving the strength and balance of people aged 65 and over. Research has shown that FaME results in fewer falls, improved confidence, and reduced fear-of-falling. Despite this, FaME is still not available everywhere across England. More needs to be understood about how best to increase its availability and ensure high quality delivery. To improve our understanding of this, we previously studied FaME’s set-up, delivery and quality in the East Midlands. We learnt a lot about how to get FaME running and showed that the programmes worked outside of a research setting. Using learning from the East Midlands, we developed a guide for implementing FaME called the implementation toolkit . This evidence-based toolkit contains all the information needed to set up and run a FaME programme, from making the initial business case to promoting it to participants. We now want to use this toolkit to see if FaME can be made more available in two new, and very different, regions: Greater Manchester and Devon, and assess whether FaME works in these populations too, particularly if adaptations are made because of Coronavirus. We aim to: 1) Understand how best to increase availability of FaME in two new areas and assess the role that the toolkit plays in this. Using the toolkit we will work with local experts to promote FaME to organisations that decide what health services should be funded locally. 2) Study the delivery of FaME in the new areas and see if programmes work in these populations by measuring improvements in participating individuals. 3) Test ways of maintaining the quality of FaME programmes over time. Working with Later Life Training, a national not-for-profit organisation with expertise in FaME, we will measure the quality of programmes and test what works to make them better. We will use this information to improve the implementation toolkit and develop plans to support national implementation of FaME. Publications Factors influencing fall prevention programmes across three regions of the UK: the challenge of implementing and spreading the Falls Management Exercise (FaME) programme in a complex landscape | Age and Ageing | Oxford Academic https://vimeo.com/616877571

Impact Since ARC Wessex began in October 2019 it focussed on the tackling the health and care challenges of our communities and beyond. In addition to our four research themes, ARC Wessex developed a Mental Health Hub and secured funding to look at the challenges and needs of our social care systems. We also led on the National efforts to increase the number of researchers working on dementia (DEM-COM ) and the Healthy Ageing, Dementia and Frailty National Priority Programme with collaborated with the ARC network across England. Here we show examples of the impact of our completed research and the benefits to patients and the wider communities in Wessex. Read ARC at 5 - The story so Far | here Find out how our research has helped people at risk of food insecurity During the Covid-19 outbreak hospital beds were under immense pressure learn about how we created a safe way to care for people at home Many people take multiple medications as they age. Our research has helped safely reduce medications where they aren't needed. Adult social care supports some of the most vulnerable people in society. We helped train social workers to use research to improve services. Around 20% of people in the UK experience domestic abuse in their lifetime. Our research has helped test ways to reduce it. There has been a sharp rise in 999 calls for those at end of life. Our researchers looked at how paramedics are coping with this pressure. People at the end of life, through cancer or other illnesses can be vulnerable to abuse. Researchers created a tool to help spot the signs Around 30,000 people are seriously injured and 1,700 are killed in road traffic collisions in England every year. Research could improve safety Improving physical activity and lives in care homes The ImPACT study looked to create and test the feasibility of using trained exercise volunteers in care home settings to increase the amount of physical activity for older people living there. Are we making the right decisions on nursing numbers? In England a general yardstick is used to work out the number of nursing staff needed to look after patients on a ward in hospital. Recent research has now updated NHS guidance with its findings Online tool for Long Covid support A website to support people living with Long Covid offers a symptom checker, advice on seeking support, and encourages people to talk about their symptoms with professionals, friends and family. Clever help matches care and skills for district nurses The complexity of managing a busy team of district nurses has been made simpler by using computer and mathematical modelling to schedule visits - and the system could go further. Researchers test new ways to help tackle childhood obesity In England, over a fifth of children aged 4–5 years were classed as overweight or obese in 2021/22. A team of ARC Wessex researchers has been testing a way to help families improve kids diets. Helping older people get the right medicine 1 in 3 people aged 65 and older take 5 or more medicines every day. Some of these drugs may no longer be appropriate. We developed tools to help safely reduce medications where needed and review what people want from their medications. Building research capacity in Wessex 100 + 10 + £2M Invested We have trained more than 100 health and care professionals to make their first steps into research ... more than 10 PhD students are making their next move in research ..and growing numbers of Post Doctorate researchers getting to grips with the issues that effect us all

15c54097-9d85-4170-b90f-d0f5767a45d4 Predicting Patient Deterioration Risks in COMMunities https://vimeo.com/689303375 Team: Principle Investigator – Professor Michael Boniface, University of Southampton Co-Investigator - Dr Francis Chmiel and Dr Dan Burns, University of Southampton Clinical Lead – Dr Matt Inada-Kim, Hampshire Hospitals NHS Foundation Trust Completed What did we learn? We found evidence for policies and practices supporting safe COVID-19 integrated care pathways in community settings for early identification of deterioration and timely escalation to hospital. Research validating home oxygen saturations as a marker of clinical deterioration in patients with suspected COVID-19 informed national policies and was critical and rapid evidence necessary to support the COVIDoximetry@home ( https://doi.org/10.1101/2020.11.06.20225938 under peer review at BMJ Open) What difference did it make? £ 500K NHSx RECOxCARE (Remote COVID oximetry care) project for COVID Virtual Wards in collaboration with HHFT, North Hants Primary Care Network, Mid Hants Primary Care Network, South Central Ambulance Service NHS Foundation Trust, WAHSN and University of Southampton IT Innovation Centre. Scaling nationally as the COVID oximetry@home programme, the guidance for people at home to purchase a pulse oximeter published on the BBC News Website https://www.bbc.co.uk/news/health-55733527 and broadcast on BBC News at 10 on Thursday 21st January 2021 (citing the ARC publication) Clinical model was adopted by the World Health Organisation Digital and data analytics approach for remote monitoring of patients in communities was presented by Inada-Kim and Boniface as part of the NHSx@home innovators engagement event 16th Sept 2021. COVID oximetry@home received the overall winner of the prestigious for HSJ Patient Safety Award 2021 Service evaluation demonstrated improved patient outcomes Boniface, M., Burns, D., Duckworth, C., Ahmed, M., Duruiheoma, F., Armitage, H., Ratcliffe, N., Duffy, J., O’Keeffe, C. and Inada-Kim, M., 2022. COVID-19 Oximetry@ home: evaluation of patient outcomes. BMJ Open Quality, 11(1), p.e001584. What impact has it had on patient and the health system? Remote monitoring of patients in communities is important for improved patient outcomes, hospital attendance/admissions avoidance and resource planning. Remote monitoring is a key NHS transformation within the NHS@Home programme Remote monitoring is being extended from COVID to all Acute Respiratory Infections, and is likely to be extended to other conditions in the future What's next? We are working with Hampshire Hospitals and NHS England to transfer the learning from COVID to more general approaches. This research is being conducted in: HDRUK rapid insight project (Jan22-Sep23) called PHILOSARIP “ Predicting Hospital Length of Stay in Acute Respiratory Infections Patients” Wessex ARC PARIEDA project which is tacking “ Prediction of Acute Respiratory Infection outcomes prior to Emergency Department Attendance” Resources Covid Oximetry at Home Toolkit - via AHSN Wessex Publications https://doi.org/10.1101/2020.11.06.20225938 https://doi.org/10.1136/bmjopen-2022-067378 Original Project outline ARC Wessex is supporting research to explore COVID patient risks (deterioration, admission and readmission) in community settings working with Hampshire Hospitals NHS Foundation (HHFT) Trust who are co-leading the development of national pathways linking community, primary and secondary care. According to leading acute care clinicians (Dr. Inada-Kim - HHFT) working at the forefront of UK’s COVID-19 emergency response and policymaking, two of most pronounced COVID-19 Unmet Medical Care Needs (UMCN) include: UMCN-1) Risk prediction tools on triage and admission to emergency care: Evidence shows that early identification of physiological deterioration risks improves patient outcomes through timely and appropriate interventions, including escalations to higher levels of acute care through hospital admissions and intensive care [1] . UMCN-2) Rapid follow up of patients post discharge: There is little evidence to predict the occurrence of COVID19-related complications following discharge, particularly for vulnerable patients with multiple long term conditions at high risk of adverse complication events, and therefore rapid follow up and continuous monitoring of a patients recovery is needed to reduce risk of readmission to hospital. In addition, consideration of population infection risks resulting from contact and transmission from infected individuals has demanded alternative care delivery models. During the initial phase of the pandemic patients freely made their way to GPs and hospitals increasing infection rates within the general population and the healthcare workforce, leading to policies aimed at reducing contact between infected patients and health care workers (HCWs) [2] . This has driven then need to reimagine care pathways that minimise physical interaction using virtual care (video conferencing, mobile symptom reporting/scores, real-time remote sensing, and surveillance) delivered through telemedicine solutions. Virtual care not only protects the population and HCWs during highly infectious periods of a pandemic but importantly offers significant benefits to patients who can now be treated longer in community settings reducing the number of admissions to hospital, the length of stay and mortality. PPDRCOMM proposes to undertake research to develop predictive models for early warning detection arising from a COVID-19 infection, capable of running in residential settings such as care homes. Models will use near-patient observation data (e.g., temperature, respiration rate, and blood oxygen levels), patient demographics, and comorbidities from patients in the community who are in the early stages of a COVID-19 infection. The measurements will be collected with high frequency such that machine-learning algorithms will be able to report real-time risk scores of imminent deteriorations. Overall, this models will allow for real-time detection of deterioration earlier than currently possible with conventional techniques. This will help address the clinical need for pre-emptively stopping the severe deterioration of those with a seemingly mild case of COVID-19. Read the Evaluation Pre-Print evaluation paper

c07181de-349f-421b-8259-3fdae15d93ab Development of a structured deprescribing intervention for people with dementia or mild cognitive impairment in primary care (STOP-DEM) Project partners Memory Assessment and Research Centre ( Hampshire and Isle of Wight NHS Foundation Trust was a Participant Identification Centre (PIC) Portsmouth Older Person’s Mental Health (OPMH) Service (Hampshire and Isle of Wight NHS Foundation Trust) was a Participant Identification Centre (PIC) Full team Dr Kinda Ibrahim (CI), Dr Nicola Andrews, Cindy Brooks, Dr Jay Amin, Prof Sue Latter, Prof Simon Fraser (University of Southampton), Dr Rosemary Lim (University of Reading), Dr Michele Board (Bournemouth University) Assisted with the systematic review: Dr Eloise Radcliffe, Paula Sands (University of Southampton), Dr Kirsty Aplin, Dr Beth McCausland (NHS OPMH), Dr Ellen van Leeuwen (Ghent University) PPI: members of Friends of MARC group and members of Dementia Support – Hampshire and Isle of Wight’s Eastleigh support group Started: October 2022 Ended : September 2024 Jump to publications The team produced a video about their work: https://vimeo.com/1125514599 Team video about experiences of people living with dementia and their family carers Lay Summary Most people with dementia or mild cognitive impairment (MCI) have multiple chronic conditions and take five or more regular medications (polypharmacy). Polypharmacy in people with dementia/MCI can lead to increased risk of drug interactions, side effects such as falls and cognitive decline, and sometimes hospitalisation and death. Some types of medications (such as strong anticholinergic drugs) can increase risk of developing dementia and cognitive impairment. It is estimated that over £400 million is spent annually in the UK in hospital admissions related to harm from medications. Identifying harmful medications and stopping or switching to safer alternative (deprescribing) has the potential to reduce the risk of developing dementia and improve outcomes for people already living with dementia. However, to date, deprescribing interventions for people with dementia/MCI have focused on specific drug classes (e.g., anti-psychotics) or have been limited to inpatient or nursing home setting. In the UK, it is estimated that 61% of people with dementia live at home where medication is a part of daily living. Most studies also focused on medication-related outcomes (e.g. discontinuation of high-risk medications) rather than patient-centred outcomes, and did not involve the person with dementia and their carer. Therefor it is essential to understand how primary care staff could involve people with dementia/MCI and their caregivers in shared-decision making about stopping medications safely. Summary of findings We reviewed existing evidence on interventions to reduce or stop (deprescribe) medications for people with dementia or mild cognitive impairment (MCI). We found that most studies focused on medications that affect behaviour, mood, or perceptions and people in residential care. Many interventions reduced numbers of medications and improved appropriateness of medications. However, there was limited evidence on outcomes relating to safety and outcomes such as falls, quality of life and cognition. There was limited involvement of patients and informal carers in the interventions. We interviewed people with dementia or MCI, informal carers, primary care professionals and professionals working in memory clinics. We found that patients, carers and healthcare staff need to be involved in the deprescribing process. This process needs to consider patient cognitive abilities and independence. It also needs to consider carer experiences. Flexible medication management processes are needed to support successful deprescribing. These should be adapted to each person. These should involve joint working across the healthcare system. Deprescribing discussions need to be held in-person and in a safe setting. There needs to be enough time. Discussions should be led by a professional who knows the patient and can answer their questions. The possible impact of deprescribing decisions should be carefully considered. This includes impact on how medication is managed day-to-day and allso, carer burden. See the summary report Summary report for participants .pdf Download PDF • 559KB See the Key Practical Implications What we did with the new knowledge Sharing with frontline health and care professionals We shared our findings at a Hampshire and Isle of Wight Integrated Care Board (ICB) Medicines Optimisation webinar, engaging with an audience of 110 professionals, mostly pharmacists. We were invited to present the work at the RCGP Wessex Faculty Conference in March 2025 with around 100 attendees We shared our findings at a Wessex Older People’s Mental Health Academic meeting involving more than 50 professionals working in this area, primarily doctors. Meeting with the national lead for NHS prescribing to present the study. Academic Publications We have published two papers, one reporting the systematic review in Drugs and Aging and the other reporting the qualitative study in Dementia. The Importance of a Relationship-Centred Approach to Deprescribing for People with Dementia or Mild Cognitive Impairment in Primary Care: A Qualitative Study (November 20, 2025) Medicine Optimisation and Deprescribing Intervention Outcomes for Older People with Dementia or Mild Cognitive Impairment: A Systematic Review (March 2025) Oral and poster presentations at the European Geriatric Medicine Society Conference in Reykjavik, 24-26 September 2025 Presentation about using “photo elicitation” as a creative qualitative methodology at the ARC Qualitative Network Sharing with policy makers We have presented the study findings to MPs and representatives from royal colleges (RCGP, RPS, BGS) in a policy roundtable discussions in Westminster Nov 2025 We have produced a policy brief and shared it with relevant parties Nov 2025 We have presented the findings in an ARC Wessex stakeholder event Feb 2026 Sharing with the wider community including patient and public Summary findings and infographics from the qualitative study have been shared on social media, with a post on the ARC Twitter/X, LinkedIn and Facebook pages, and the ARC website. University of Southampton website link - Deprescribing for Dementia MSN News - Why good healthcare can mean stopping medications Daily Expresss coverage - Link Radio coverage - Greatest Hits Radio Video featuring members of our PPI group and other members of the dementia support group sharing the findings of the qualitative study. The video is being used in undergraduate and postgraduate teaching in Faculty of Medicine at the University of Southampton. Where Next? Grants : Dr Kinda Ibrahim (University of Southampton) and Dr Rosemary Lim (University of Reading) submitted Research for Patient Benefit grant application to develop and test and deprescribing intervention for people with dementia or mild cognitive impairment in primary care. Academic conferences: The Society of Academic Primary Care conference attended mainly by GPs and academics.

8d1b2f3a-906f-4fe9-8d9a-bf4679c7d6ec StOP UTI project: Strategies in older people's care settings to prevent infection Background Urinary tract infection is more common in older people living in care homes but can be difficult to recognise. This can lead to overuse of antibiotics and may result in antibiotic-resistant infection and hospital admission. We wanted to find out what can work in care homes to prevent and recognise UTI and what support care home staff need to enable safe care for all residents. What we did We reviewed evidence from a range of sources, including research studies and improvement projects. We also asked care home staff, residents, family carers and healthcare professionals about their experiences. We combined these experiences and ideas with the evidence we found from published literature to develop an understanding of what needs to happen in care homes for older people to prevent and recognise UTI. What we found out What difference will this make? UTI can be prevented by embedding prevention activities in care routines: ensuring residents are hydrated ensuring residents with recurrent UTI are managed actively with preventative treatment avoiding the use of urinary catheters wherever possible Unnecessary antibiotic use can be avoided by: involving the whole care team, resident and family in recognising UTI using active monitoring when there is uncertainty about UTI supporting care staff to develop the skills to accurately recognise UTI using tools that support decision-making and communication across the wider care team Safe care for each resident can be achieved when: care staff receive education that is contextualised to their role and helps them to prioritise and deliver person-centred care care home managers are committed to supporting the delivery of best practice commissioners and regulators promote UTI prevention and recognition as a priority area for care homes Why is this important? Our findings suggest ways that care home providers and policy makers can support the prevention and recognition of UTI in the care of older people living in care homes. A system-wide approach is vital to enable care home managers and their staff to prioritise UTI prevention and recognition as part of person-centred care. At policy level, there is a need to integrate UTI prevention with diagnostic and antimicrobial stewardship and to unify the content of education and decision-support resources so that care staff can see the value of their role in prevention as well as supporting diagnosis and treatment of UTI. What next? Our research is the start of a process of understanding what works in care home settings and will identify where further research is needed. A report, summary and articles provide practical examples and recommendations relevant to care home staff, care home managers, researchers, educators, carers and relatives for use to improve the prevention and recognition of UTI in older people’s long-term care and to plan further research to investigate them. We are turning our findings into a range of different resources and digital communications, with input from experts who support the adoption and spread of innovation, for sharing via care home networks and associations. Publications Realist synthesis protocol for understanding which strategies are effective to prevent urinary tract infection in older people in care homes Preventing urinary tract infection in older people living in care homes: the ‘StOP UTI’ realist synthesis | BMJ Quality & Safety Strategies for older people living in care homes to prevent urinary tract infection: the StOP UTI realist synthesis | NIHR Journals Library Link to University of Southampton site Research team: • Dr Jacqui Prieto, Joint Chief Investigator, University of Southampton • Professor Heather Loveday, Joint Chief Investigator, University of West London • Professor Jennie Wilson, Co-investigator, University of West London • Mrs Alison Tingle, Co-investigator, University of West London • Mrs Emily Cooper, Co-investigator, UK Health Security Agency • Dr Melanie Handley, Co-investigator, University of Hertfordshire • Professor Jo Rycroft-Malone, Co-investigator, University of Lancaster • Dr Lynne Williams, Co-investigator, Bangor University • Mrs Jennifer Bostock, Co-investigator, Patient and public involvement • Lois Woods, Information Specialist, University of Southampton • Simon Briscoe, Information Specialist, University of Exeter • Jemima Kakpa, Research assistant, University of Southampton • Christine Logan, Administrative assistant, University of West London Project Advisory Group: • Jennifer Bostock (Chair) • Professor Lona Mody • Mr Mark Stott • Dr Leah Jones • Mrs Susan Bennett • Mr James McMahon • Mrs Annabelle Stigwood • Mrs Anita Astles

5241b3d8-a7e9-409f-8d8a-e86421d8cdd5 Evaluating impact of personalised care at service at service and system levels: Learning from the Wessex Academy for Skills in Personalised Care (WASP) programme. Chief Investigators: Professor Mari Carmen Portillo, Professor of Long-Term Conditions. School of Health Sciences. University of Southampton, Dr Louise Johnson, Consultant Therapist and WASP Project Lead, University Hospitals Dorset Team: Dr Beth Clark, WASP Personalised Care Facilitator, University of Southampton Matthew Wood, WASP Digital Lead and current ARC Wessex Statistical Intern Dr Hayden Kirk, Consultant Physiotherapist & Clinical Director Adults Southampton, Solent NHS Trust Janine Ord, Head of Population Health, Dorset Integrated Care Board Fran White, Director of Policy, Innovation and Partnerships, Hampshire and Isle of Wight Integrated Care Board Aisling Flynn, Lecturer in Occupational Therapy and Post-Doctoral Researcher, Bournemouth University Sally Dace, Patient and Public Involvement Representative Luisa Holt, Research Fellow, University of Southampton Partners: Dorset Integrated Care Board, Hampshire and Isle of Wight Integrated Care Board, Dorset County Hospital NHS Foundation Trust, University Hospitals Dorset NHS Foundation Trust, Hampshire and Isle of Wight NHS Foundation Trust, Bournemouth University, University of Southampton. Start: 1 October 2024 End: 31 March 2026 Aim(s) To evaluate if and how the Wessex Academy for Skills in Personalised Care (WASP) programme has led to improvements within healthcare services, and the impacts for patients, services and the wider health system. Background Personalised care focuses on tailoring health services to individuals’ needs and preferences. People who receive personalised care have greater satisfaction, and are more likely to feel in control of their own health and wellbeing. Services that work in a personalised way are likely to use their resource more efficiently - by offering people the right support, in the right way, at the right time. Despite the benefits, widespread adoption of personalised care has been slow. There are many reasons for this – including having healthcare staff who are trained and believe in its importance, and having systems that support its delivery. Since 2018, the Wessex Academy for Skills in Personalised Care (WASP) has been helping NHS services to improve personalised care delivery. This support involves three parts: EVALUATION –understanding current care by collecting the views of service users, frontline clinicians, managers and people who plan services (commissioners) LEARN – training healthcare teams, so they have the knowledge, skills and confidence to change how they work IMPLEMENT – supporting services to identify and deliver improvement projects, with measurable benefits for patients In this research, we will evaluate impact of the programme. This is important to: · know how to improve WASP in the future; · learn how to accelerate the adoption of personalised care within the NHS; · demonstrate impact, so we can spread the benefits more widely. Design We will create a series of case studies from services that have already completed WASP, highlighting learning from the programme, if/how this has been put into practice, and the benefits to service users. We will use interviews and surveys to collect information from healthcare staff, who are working in services that completeWASP in 2024/25. This will allow us to understand peoples experience of the programme, and the impacts this leads to. Interviews will take place at several timepoints, understanding learning development over time. Results will be considered together. Patient, public and community involvement Patient and public feedback has been incorporated into this proposal. Throughout the research, we will work with patient contributors, including a co-applicant, to shape and develop the research programme, ensure we are capturing the most important impacts, and to develop accessible ways to share our findings. Dissemination We will use the findings to create recommendations for how the WASP programme can be improved and spread in the future, reaching more people with long term conditions. We will share results at conferences and in academic journals; and presenting in a range of accessible formats, using the WASP website, social media and in the community.

8549d888-5b96-445e-9088-9a757edd9282 ADOPTED: IneQUIty in end of life care for children: Investigating experiences and families’ Needs after sudden and unexpecTEd deaTh in children and young people – the QUINTET study Chief Investigators: Professor Anne-Sophie Darlington, School of Health Sciences, University of Southampton and Dr Katherine Hunt, Senior Research Fellow, School of Health Sciences, University of Southampton Team: Dr Vicky Payne, School of Health Sciences, University of Southampton, Miss Sarah Hodkinson, Associate Professor, Department of Music, University of Southampton, Professor Heather Gage, Professor of Health Economics, School of Biosciences and Medicine, University of Surrey, Dr Emily Cooper, Law and Policing, University of Central Lancashire, Dr Jamal Hossain, Lecturer in Applied Statistics, School of Health Sciences, University of Southampton, Dr Joanna Garstang, Consultant Community Paediatrician, University of Birmingham, Dr Nicola Speed, SUDC (UK), Miss Emma Kneebone, 2wish, Miss Stacey John, Forget Me Not Children's Hospice. From: 01/12/2024 to: 30/11/2027 BACKGROUND Around 3000 children die each year in England and Wales, and 30% of deaths represent infants and children who die unexpectedly or suddenly from accidents, suicide or unexplained deaths. Clear guidance and palliative care services exist for children who die of a life-limiting condition, including emotional and psychological support for their families, which extends into bereavement. However, clear guidance and care are not available for sudden and unexpected infant and child deaths, even though these are often the most tragic, brutal and shocking deaths. We do not know very much about what it is like for families, what care they need, what care is available, how they manage and cope in the longer term after their child’s death, and how professionals need to be supported after often traumatic experiences. PLAN We recently brought together organisations and professionals who care for families when a child has died suddenly (e.g., health professionals, fire department, police, hospices, charities, schools) to commit to working together to improve care for these families, and improve training and support for professionals. This network helped develop this project. We want to investigate these aspects (organised in Work Packages -WPs), focusing on different questions: WP1: What care is available for these families – around the time of the death and into bereavement, and where do children die. We will investigate this through 1) past research, and 2) existing database with information on child deaths. WP2: Which services are available to families and who provides that care, and what are the experiences and needs of the professionals providing that care? We will 1) interview professionals who carry out the Child Death Review and 2) interview professionals who provide care in different settings. WP3: What are the experiences of families, what care helped and what do they need? And what are the long-term consequences for parents, such as grief and depression and physical health? - we will investigate this by 1) interviewing bereaved parents about their experiences, and 2) asking bereaved parents to complete a questionnaire about grief, depression and quality of care. WP4: What recommendations around care and support should we make? We will use the information from the previous work packages to develop recommendations on how to improve care around the time of the death and in bereavement. We will agree what the needs are for training and supporting professionals. INVOLVING FAMILIES We will involve bereaved parents though the organisations included in our network. We have two parent and two other lay members as co-applicants on the study. A formal parent advisory group will be set up to help us with research questions, materials, design of the study, recruiting parents, content, social media presence and study branding, and dissemination. We will also work with a team of parent investigators who will provide guidance to the researcher and support participants during interviews. DISSEMINATION We will produce scientific papers, develop recommendations for care and maintain a network of parents and professionals to support the project. We will create national awareness of the needs of these families and work with a policy engagement organisation to influence policy and change practice. We will produce newsletters, social media posts, and result postcards to update families and the wider network.

9e2c7f6f-813a-4237-9695-46d21cbe9cea Development, evaluation and provision of an intervention for primary and community NHS staff to help carers and homecare workers supporting people living at home with dementia with their continence. NIHR Three Schools Dementia Research Programme: NIHR School for Social Care Research, NIHR School for Primary Care Research and NIHR School for Public Health Research Team Lead investigator : Dr Cathy Murphy, Senior Research Fellow, School of Health Sciences, University of Southampton Co-i: Prof Mandy Fader, Professor of Continence Technology, School of Health Sciences, University of Southampton Co-i: Prof Miriam Santer, Professor of Primary Care Research, Faculty of Medicine, University of Southampton, NIHR School for Primary Care Research, Bournemouth based GP Co-i: Dr Leanne Morrison, Lecturer in Health Psychology, School of Psychology & Primary Care Research Centre, University of Southampton, NIHR School for Primary Care Research Co-i (PPI): Jane Ward, Alzheimer’s Society Research Network Member, co-founder of Dementia Friendly Hampshire, Patient Research Ambassador Co-i: Prof Jill Manthorpe, Professor of Social Work, Director of NIHR Policy Research Unit in Health & Social Care Workforce, King’s College London – Associate Director of NIHR School for Social Care Research Start date: 1st June 2022 End date: 28th Feb 2024 We found that Healthcare professionals wanted an easy and quick to use intervention to sign-post carers to continence care guidance. Homecare workers would welcome resources aimed at having difficult continence conversations The findings led us to develop the first evidence-based website to support healthcare professionals to provide continence advice to the carers of people living with dementia. The intervention also provides carers with detailed, practical self-management guidance. The website is www.demcon.org.uk A summary of the work can be found in this article: C Murphy, B Bradbury, M Fader, L Morrison, M Santer, J Ward, H Chester. Supporting continence care for people living at home with dementia. 22 APRIL, 2024. Nursing Times What we did with the new knowledge The findings have led to the first evidence-based intervention to support healthcare professionals to provide continence advice to the carers of people living with dementia. The intervention supports healthcare professionals to initiate conversations and then to sign-post carers to detailed, evidence based self-management guidance. The website can be accessed here: www.demcon.org.uk What are we doing next? The project has provided foundational findings for the next phase of work which includes developing a new intervention to support homecare workers to initiate continence conversations with people living at home with dementia. This work (DemCon2) is being funded by NIHR Three School’s Dementia Research Programme and will start Autumn 2024.

93e2e1bd-cd98-479a-93a0-a105e734b0c3 ADOPTED: Exploratory research to examine the health impact of scams and fraud and the current knowledge and systems in the police and partner agencies for targeting and delivering victim support services Lead research ers: Ms Ruth Halkon and Dr Michael Skidmore, The Police Foundation; Professor Mark Button, Director of the Centre for Cybercrime and Economic Crime, University of Portsmouth; Dr Amy Meenaghan, School of Criminology and Criminal Justice, University of Portsmouth. Aims We aim to help the police find those who are most likely to suffer the worst damage to their mental and physical health from falling victim to fraud and make sure they receive the support they need to prevent that damage happening. Background Fraud is the most common and fastest growing crime in England and Wales. Many people do not report fraud and those who do often don’t receive help to reduce the crime's impact on their wellbeing. People affected by fraud can suffer serious physical and mental health problems which can lead to poor physical health, anxiety, depression and suicide. Many factors can shape how victims are affected: stress caused by losing what to them are big sums of money feeling betrayed by someone they thought was their friend or partner blaming themselves feeling friends, family and service providers do not understand them struggling to recover due to existing social or health needs. The police know less about the needs of fraud victims than victims of other crimes like domestic abuse. They are under pressure to improve the service they offer but there are many gaps: Fraud is common crime and can affect victims in many ways, which hinders finding victims who need the most support Those police think are most likely to be harmed, known as ‘vulnerable’, may not suffer the worst effects It is not clear what being 'vulnerable' in a crime context actually means Current systems to address 'vulnerability' mainly focus on cutting crime rather than victim health Research by Which? suggests the impact of fraud on victims' wellbeing amounts to £9.3bn, but we need more data Design and methods Our research will focus on two police forces who work jointly to provide support to victims which is widely seen as the best in the country. The project will focus on their systems, data and services to measure their success and produce a case study for understanding and addressing fraud's health impacts. This will be done via: Reading research papers to find out more about fraud victim impact, vulnerability and victim needs Looking at police and health and welfare data to learn about health impacts of different fraud types Talking to those working for the police, social services, victim support services and key health services Interviews with national subject matter experts Interviews with fraud victims who have been given support after fraud impacted their health to learn how this helped them Patient and public involvement Our overall aim is to involve fraud victims in finding a support framework that works for them Dissemination The report will be launched at an event and published on the Police Foundation website. It will be promoted on our blog, newsletter and social media channels. This fact finding project is a first step to creating a new framework that will be used to find those who need the most help to stop their mental and physical health being badly hit and make sure they are given it. The future project would involve: Organising roundtable events with people Bringing police, health and welfare services together to trial the framework Sharing findings and learning points across the country

National Festival of Applied Dementia Research During Dementia Action week | 19 - 25 May 2025 we are celebrating the work of applied dementia researchers from across England. Find and event near you. Browse our DEMFEST Events Download all the events in this printable brochure > Dementia Research Festival events from around England Filter by Region Select Region Join in the conversation online - just look out for the #DEMFEST tag for pictures and news on our events SUPPORT THAT MATTERS: PREVIEW a Dementia Art & Research Exhibition May 8, 2025 5.30-7.30pm (opening night) Skyway Gallery, 2 Pond Road, Shoreham-by-sea BN43 5WU Exhibition: 9 – 15 May 2025 10am – 4pm - Wheelchair accessible Do you want to help improve care and support for people with memory problems and dementia – but don’t know where to start? May 17, 2025 1.00pm-2.00pm New Art Exchange, 39 Gregory Boulevard, Nottingham NG7 6BE Also runs Tuesday 20th May 1.00pm-2.00pm - Just drop in Dementia Community Research Network (DCRN) Public Conference May 19, 2025 2.00pm-4.30pm Stanstead Lodge 260 Stanstead Road SE23 1DD https://www.eventbrite.co.uk/e/dementia-community-research-conference-tickets-1255488202009 Dementia Care Research: What’s that all about then? May 19, 2025 Runs from 19-25 May Online Find out more: https://arc-swp.nihr.ac.uk/news/ Day 1 of our Mental Stimulation & Social Engagement event (Afternoon Tea) May 19, 2025 2.00-4.30pm Fulham Pier at Fulham Football Stadium, Stevenage Road, London SW6 6HH p.nair@imperial.ac.uk Day 2 of our Mental Stimulation & Social Engagement event (Virtual Reality) May 20, 2025 10:30am to 1:00pm Danehust Centre, Brentford TW8 8HX p.nair@imperial.ac.uk SUPPORT THAT MATTERS: a Dementia Art & Research Exhibition May 20, 2025 5.00pm-8.00pm (opening night) Creative Space Art Gallery, 1 Red Lion Lane, Whitstable CT5 1FG Runs 21 – 26 May 2025 10.00am - 6.00pm Drop in, no booking needed Dementia Action Week – Dementia Research and Me May 20, 2025 12.00-4.00pm The Royal Hotel, Weston-super-Mare, BS23 1JP Contact: katie.breheny@bristol.ac.uk Link: https://arc-w.nihr.ac.uk/events/dementia-action-week-dementia-research-and-me/ What is happening in dementia research in the West Midlands? May 20, 2025 12.45pm-4.00pm Stoke-on-Trent Film Theatre, Wade Centre, Hartshill Road. ST4 7NY Link: https://www.arc-wm.nihr.ac.uk/news-events/ Day 3 of our Physical Activity & Social Engagement event (Yoga) May 21, 2025 10:30- 1:00pm London Care, 42 Westbourne Park Road, W2 5PH p.nair@imperial.ac.uk Workshop | How do we foster dementia-friendly communities? May 21, 2025 10:00-12:00pm Stevenage Arts & Leisure Centre, Lytton Way, Stevenage SG1 1LZ Contact: g.windle@herts.ac.uk for venue details. Dementia research in the North East – how can it help me? May 21, 2025 11.30am-1.00pm Newcastle United Foundation, Diana Street, Newcastle upon Tyne, NE4 68Q To book this event contact marie.poole@newcastle.ac.uk Chai and Chat: South Asian Dementia Cafe May 22, 2025 1pm-3pm Mary Sunley House, Banstead Street West, Leeds, LS8 5RU Contact: A.Akhtar46@bradford.ac.uk Dementia Knowledge Exchange Event in the South Asian Community May 22, 2025 12.00-1.00pm TBC Manchester Liverpool Contact: sarah.smith-10@manchester.ac.uk Seeing Dementia Differently: A Journey Through Research & Lived Experience May 22, 2025 2.00pm-5.00pm St Pancras & Somers Town Living Centre, 2 Ossulston Street, London NW1 1DF Contact on the day: Jess Wright (jess.wright@ucl.ac.uk) Dementia Tea Dance: Connecting Communities, Sharing Knowledge May 22, 2025 1.00pm-3.00pm The Old School House (TOSH) Gladstone Mews, Bournemouth. BH7 6BG Call Pippa 07780 004101 Day 4 of our Healthy Diet event May 22, 2025 10:30am to 1:00pm Loveday Kensington, 2 Kensington Square, London W8 5EP p.nair@imperial.ac.uk Let’s Talk: 3D May 23, 2025 10-12pm Cloth Hall Court, Quebec Street Leeds LS1 2HA http://s.raman@leeds.ac.uk Life in Embrace – Navigating the realities of dementia in the UK and India May 23, 2025 2.00pm - 4.00pm Reading Biscuit Factory Unit 1A, Queen’s Walk (Corner of Oxford Road), Reading RG1 7QE https://www.readingbiscuitfactory.co.uk/ Day 5 of our Community Health Checks May 23, 2025 1:00- 4:00pm Kensington Town Hall, Hornton St, London W8 7NX p.nair@imperial.ac.uk SUPPORT THAT MATTERS +: a VIRTUAL Dementia Art & Research Exhibition May 23, 2025 12.00-1.00pm Online http://Register: https://tinyurl.com/supportthatmatters Brain Health & Dementia Prevention in the Black African Community May 25, 2025 5pm-8pm Blackburn Hall, Commercial Street Rothwell, Leeds. LS26 0AW Contact: e.s.nwofe@bradford.ac.uk

3163bb6a-69ec-4161-8433-72a5810416ad POST DOCTORAL PROJECT: Understanding, addressing, and meeting the complex needs of people living with long term physical and mental health conditions: a qualitative study POST DOCTORAL PROJECT: Understanding, addressing, and meeting the complex needs of people living with long term physical and mental health conditions: a qualitative study Chief Investigator: Dr Leire Ambrosio – University of Southampton Project Team Members: Professor David Baldwin – University of Southampton. Professor Mari Carmen Portillo – University of Southampton, Dr Kate Lippiett – University of Southampton, Dr Lindsey Cherry – University of Southampton, Dr Pritti Aggarwal – Living well partnership – NHS Southampton CCG, Mr Barney Williams Jones – University Hospital Southampton NHS Foundation Trust, Dr Sara Mckelvie – University of Southampton, Ms Linda Lamond – PPI co-applicant Organisations Involved: University of Southampton, Hampshire and Isle of Wight Integrated Care System, Living well Partnership – Southampton CCG. Oxfordshire Primary Care System, Anxiety UK, Mind, Oxfordshire. Background: People with long term physical conditions are 2-3 times more likely to experience mental health problems than the general population, particularly depression and anxiety. At least 30% of all adults with long term physical conditions also have mental health problems. People living with long term physical and mental conditions not only experience hardships relating to health but also have complex psychosocial, environmental, economic, and spiritual needs. Healthcare professionals find it difficult to deliver fully integrated care for these populations, partly due to systematic barriers and the fragmentation of health and social services. The advent of social prescribing link workers as a priority for the NHS provides an opportunity to address some of these hardships and needs. Social prescribing link workers aim to connect people to community local services to address their complex needs through a person- centred approach. However, approaches to social prescribing link worker implementation are variable, with potential pathway gaps, and there is unclear guidance for primary care networks about how to integrate this novel workforce into efforts to address and meet the complex needs of people living with long term physical and mental conditions.