Imperial College London

DrYannisPappas

Faculty of MedicineSchool of Public Health

Honorary Research Fellow
 
 
 
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Contact

 

+44 (0)20 7594 8595y.pappas Website

 
 
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Location

 

314Reynolds BuildingCharing Cross Campus

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Summary

 

Publications

Publication Type
Year
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27 results found

Kassianos A, Ignatowicz, Greenfield, Majeed, Car, Pappaset al., 2015, ‘Partners rather than just providers…’: A qualitative study on healthcare professionals’ views on implementation of multidisciplinary group meetings in the North West London Integrated Care Pilot, International Journal of Integrated Care, Vol: 15, ISSN: 1568-4156

Introduction: Multidisciplinary group meetings are one of the key drivers of facilitating integrated care. Health care professionals attending such groups have a key role in the success of these discussions and hence, in the forming of multi-professional integrated care. The study aimed to explore the professionals’ experiences and views of participating and implementing the groups in integrated care context.Methods: A qualitative study including 25 semi-structured interviews with professionals participating in the Northwest London Integrated Care Pilot analysed using thematic content analysis.Results: Participants mentioned a number of benefits of participating in the meetings, including shared learning and shared decision-making between different services and specialties. Yet, they perceived barriers that diminish the efficiency of the groups, such as time constraints, group dynamics and technicalities. The participants felt that the quality of discussions and facilitation could be improved, as well as technical arrangements that would make them easier to participate. Most of the participants perceived the groups to be beneficial for providers mostly questioning the benefits for patient care.Conclusion: Findings provide an insight into how health professionals’ views of their participation to the multidisciplinary group meetings can be more effectively translated into more tangible benefits to the patients. To benefit patient care, the multidisciplinary groups need to be more patient-oriented rather than provider-oriented, while overcoming professional boundaries for participating.

Journal article

Ignatowicz A, Greenfield G, Pappas Y, Car J, Majeed A, Harris Met al., 2014, Achieving Provider Engagement: Providers' Perceptions of Implementing and Delivering Integrated Care, Qualitative Health Research, Vol: 24, Pages: 1711-1720, ISSN: 1552-7557

The literature on integrated care is limited with respect to practical learning and experience. Although some attention has been paid to organizational processes and structures, not enough is paid to people, relationships, and the importance of these in bringing about integration. Little is known, for example, about provider engagement in the organizational change process, how to obtain and maintain it, and how it is demonstrated in the delivery of integrated care. Based on qualitative data from the evaluation of a large-scale integrated care initiative in London, United Kingdom, we explored the role of provider engagement in effective integration of services. Using thematic analysis, we identified an evolving engagement narrative with three distinct phases: enthusiasm, antipathy, and ambivalence, and argue that health care managers need to be aware of the impact of professional engagement to succeed in advancing the integrated care agenda.

Journal article

Greenfield G, Ignatowicz AM, Belsi A, Pappas Y, Car J, Majeed A, Harris Met al., 2014, Wake up, wake up! It's me! It's my life! patient narratives on person-centeredness in the integrated care context: a qualitative study., BMC Health Services Research, Vol: 14, ISSN: 1472-6963

BackgroundPerson-centered care emphasizes a holistic, humanistic approach that puts patients first, at the center of medical care. Person-centeredness is also considered a core element of integrated care. Yet typologies of integrated care mainly describe how patients fit within integrated services, rather than how services fit into the patient¿s world. Patient-centeredness has been commonly defined through physician¿s behaviors aimed at delivering patient-centered care. Yet, it is unclear how `person-centeredness¿ is realized in integrated care through the patient voice. We aimed to explore patient narratives of person-centeredness in the integrated care context.MethodsWe conducted a phenomenological, qualitative study, including semi-structured interviews with 22 patients registered in the Northwest London Integrated Care Pilot. We incorporated Grounded Theory approach principles, including substantive open and selective coding, development of concepts and categories, and constant comparison.ResultsWe identified six themes representing core `ingredients¿ of person-centeredness in the integrated care context: ¿Holism¿, ¿Naming¿, ¿Heed¿, ¿Compassion¿, ¿Continuity of care¿, and ¿Agency and Empowerment¿, all depicting patient expectations and assumptions on doctor and patient roles in integrated care. We bring examples showing that when these needs are met, patient experience of care is at its best. Yet many patients felt `unseen¿ by their providers and the healthcare system. We describe how these six themes can portray a continuum between having own physical and emotional `Space¿ to be `seen¿ and heard vs. feeling `translucent¿, `unseen¿, and unheard. These two conflicting experiences raise questions about current typologies of the patient-physician relationship as a `dyad¿, the meanings patients attributed to `care&

Journal article

Mastellos N, Gunn L, Harris M, Majeed A, Car J, Pappas Yet al., 2014, Assessing patients' experience of integrated care: a survey of patient views in the North West London Integrated Care Pilot., International Journal of Integrated Care, Vol: 14, ISSN: 1568-4156

INTRODUCTION: Despite the importance of continuity of care and patient engagement, few studies have captured patients' views on integrated care. This study assesses patient experience in the Integrated Care Pilot in North West London with the aim to help clinicians and policymakers understand patients' acceptability of integrated care and design future initiatives.METHODS: A survey was developed, validated and distributed to 2029 randomly selected practice patients identified as having a care plan.RESULTS: A total of 405 questionnaires were included for analysis. Respondents identified a number of benefits associated with the pilot, including increased patient involvement in decision-making, improved patient-provider relationship, better organisation and access to care, and enhanced inter-professional communication. However, only 22.4% were aware of having a care plan, and of these only 37.9% had a copy of the care plan. Knowledge of care plans was significantly associated with a more positive experience.CONCLUSIONS: This study reinforces the view that integrated care can improve quality of care and patient experience. However, care planning was a complex and technically challenging process that occurred more slowly than planned with wide variation in quality and time of recruitment to the pilot, making it difficult to assess the sustainability of benefits.

Journal article

Harris M, Greaves F, Gunn L, Patterson S, Greenfield G, Car J, Majeed A, Pappas Yet al., 2013, Multidisciplinary integration in the context of integrated care - results from the North West London Integrated Care Pilot, INTERNATIONAL JOURNAL OF INTEGRATED CARE, Vol: 13, ISSN: 1568-4156

Background:In the context of integrated care, Multidisciplinary Group meetings involve participants from diverse professional groupsand organisations and are potential vehicles to advance efficiency improvements within the local health economy. We advance a novelmethod to characterise the communication within Multidisciplinary Group meetings measuring the extent to which participants integrateand whether this integration leads to improved working.Methods:We purposively selected four Multidisciplinary Group meetings and conducted a content analysis of audio-recorded and tran-scribed Case Discussions. Two coders independently coded utterances according to their‘integrative intensity’which was defined againstthree a-priori independent domains - the Level (i.e. Individual, Collective and Systems); the Valence (Problem, Information and Solution);the Focus (Concrete and Abstract). Inter- and intra-rater reliability was tested with Kappa scores on one randomly selected Case Discus-sion. Standardised weighted mean integration scores were calculated for Case Discussions across utterance deciles, indicating how inte-grative intensity changed during the conversations.Results:Twenty-three Case Discussions in four different Multidisciplinary Groups were transcribed and coded. Inter- and intra-rater relia-bility was good as shown by the Prevalence and Bias-Adjusted Kappa Scores for one randomly selected Case Discussion. There were differences in the proportion of utterances per participant type (Consultant 14.6%; presenting general practitioner 38.75%; Chair 7.8%; non-presenting general practitioner 2.25%; Allied Health Professional 4.8%). Utterances were predominantly coded at low levels of integrativeintensity; however, there was a gradual increase (R2= 0.71) in integrative intensity during the Case Discussions. Based on the analysis ofthe minutes and action points arising from the Case Discussions, this improved integration did not translate into actions moving for

Journal article

Curry N, Harris M, Gunn LH, Pappas Y, Blunt I, Soljak M, Mastellos N, Holder H, Smith J, Majeed A, Ignatowicz A, Greaves F, Belsi A, Costin-Davis N, Jones Nielsen JD, Greenfield G, Cecil E, Patterson S, Car J, Bardsley Met al., 2013, Integrated care pilot in north west London: a mixed methods evaluation, International Journal of Integrated Care, Vol: 13, ISSN: 1568-4156

Journal article

Greaves F, Pappas Y, Bardsley M, Harris M, Curry N, Holder H, Blunt I, Soljak M, Gunn L, Majeed A, Car Jet al., 2013, Evaluation of complex integrated care programmes: the approach in North West London, International Journal of Integrated Care, Vol: 13, ISSN: 1568-4156

Background: Several local attempts to introduce integrated care in the English National Health Service have been tried, with limited success. The Northwest London Integrated Care Pilot attempts to improve the quality of care of the elderly and people with diabetes by providing a novel integration process across primary, secondary and social care organisations. It involves predictive risk modelling, care planning, multidisciplinary management of complex cases and an information technology tool to support information sharing. This paper sets out the evaluation approach adopted to measure its effect. Study design: We present a mixed methods evaluation methodology. It includes a quantitative approach measuring changes in service utilization, costs, clinical outcomes and quality of care using routine primary and secondary data sources. It also contains a qualitative component, involving observations, interviews and focus groups with patients and professionals, to understand participant experiences and to understand the pilot within the national policy context. Theory and discussion: This study considers the complexity of evaluating a large, multi-organisational intervention in a changing healthcare economy. We locate the evaluation within the theory of evaluation of complex interventions. We present the specific challenges faced by evaluating an intervention of this sort, and the responses made to mitigate against them. Conclusions: We hope this broad, dynamic and responsive evaluation will allow us to clarify the contribution of the pilot, and provide a potential model for evaluation of other similar interventions. Because of the priority given to the integrated agenda by governments internationally, the need to develop and improve strong evaluation methodologies remains strikingly important.

Journal article

Harris M, Greaves F, Gunn L, Patterson S, Vaschitz G, Car J, Majeed A, Pappas Yet al., 2013, Multidisciplinary group performance – measuring integration intensity in the context of the North West London Integrated Care Pilot, International Journal of Integrated Care, Vol: 13, ISSN: 1568-4156

Introduction: Multidisciplinary Group meeting (MDGs) are seen as key facilitators of integration, moving from individual to multi-disciplinary decision making, and from a focus on individual patients to a focus on patient groups. We have developed a method for coding MDG transcripts to identify whether they are or are not vehicles for delivering the anticipated efficiency improvements across various providers and apply it to a test case in the North West London Integrated Care Pilot. Methods: We defined 'integrating' as the process within the MDG meeting that enables or promotes an improved collaboration, improved understanding, and improved awareness of self and others within the local healthcare economy such that efficiency improvements could be identified and action taken. Utterances within the MDGs are coded according to three distinct domains grounded in concepts from communication, group decision-making, and integrated care literatures - the Valence, the Focus, and the Level. Standardized weighted integrative intensity scores are calculated across ten time deciles in the Case Discussion providing a graphical representation of its integrative intensity.Results: Intra- and Inter-rater reliability of the coding scheme was very good as measured by the Prevalence and Bias-adjusted Kappa Score. Standardized Weighted Integrative Intensity graph mirrored closely the verbatim transcript and is a convenient representation of complex communication dynamics. Trend in integrative intensity can be calculated and the characteristics of the MDG can be pragmatically described.Conclusion: This is a novel and potentially useful method for researchers, managers and practitioners to better understand MDG dynamics and to identify whether participants are integrating. The degree to which participants use MDG meetings to develop an integrated way of working is likely to require management, leadership and shared values.

Journal article

Cash-Gibson L, Pappas Y, Car J, 2012, Computer-assisted versus oral-and-written history taking for the management of cardiovascular disease., Cochrane Database of Systematic Reviews

Journal article

Cash-Gibson L, Pappas Y, Car J, 2012, Computer-assisted versus oral-and-written history taking for the prevention of cardiovascular disease., Cochrane Database of Systematic Reviews

Journal article

Harris M, Greaves F, Patterson S, Jones Nielsen JD, Pappas Y, Car Jet al., 2012, The North West London Integrated Care Pilot – innovative strategies to improve care coordination for the elderly and people with diabetes, Journal of Ambulatory Care Management, Vol: 35, Pages: 216-225

Journal article

Pappas Y, Car J, 2011, Emerging technologies for health communication, The Knowledgeable Patient: Communication and Participation in Health, Editors: Hill, Hill, Publisher: John Wiley & Sons, ISBN: 9781444346824

1 Megan Prictor and Sophie Hill Chapter 2 A new conceptual framework for advancing evidence-informed communication and participation, 12 Sophie Hill and ...

Book chapter

Sheikh A, McLean S, Cresswell K, Pagliari C, Pappas Yet al., 2011, The Impact of eHealth on the Quality and Safety of Healthcare. An updated systematic overview & synthesis of the Literature. Final report for the NHS Connecting for Health Evaluation Programme (NHS CFHEP 001).

Report

Wei I, Pappas Y, Car J, Sheikh A, Majeed Aet al., 2011, Computer-assisted versus oral-and-written dietary history taking for diabetes mellitus, COCHRANE DATABASE OF SYSTEMATIC REVIEWS, ISSN: 1469-493X

Journal article

Pappas Y, Wei I, Car J, Majeed A, Sheikh Aet al., 2011, Computer-assisted versus oral-and-written family history taking for identifying people with elevated risk of type 2 diabetes mellitus, COCHRANE DATABASE OF SYSTEMATIC REVIEWS, ISSN: 1469-493X

Journal article

Pappas Y, Anandan C, Liu J, Car J, Sheikh A, Majeed Aet al., 2011, Computer-assisted history taking systems in healthcare: benefits, risks, and potential for further development. Informatics in Primary Care (in press).

Journal article

Pappas Y, Atherton H, Car J, 2011, Email for clinical communication between healthcare professionals. Issue 3. Art. No.: CD007979. DOI: 10.1002/14651858.CD007979., Cochrane Database of Systematic Reviews Issue

Journal article

Felix L, Pappas Y, Car J, Atun Ret al., 2011, Automated telephone communication for primary preventive healthcare. Cochrane Database of Systematic Reviews (forthcoming).

Journal article

Pappas Y, Anandan C, Liu J, Car J, Sheikh A, Majeed Aet al., 2011, Computer-assisted history-taking systems (CAHTS) in health care: benefits, risks and potential for further development., Inform Prim Care, Vol: 19, Pages: 155-160, ISSN: 1476-0320

BACKGROUND: A computer-assisted history-taking system (CAHTS) is a tool that aids clinicians in gathering data from patients to inform a diagnosis or treatment plan. Despite the many possible applications and even though CAHTS have been available for nearly three decades, these remain underused in routine clinical practice. OBJECTIVE: Through an interpretative review of the literature, we provide an overview of the field of CAHTS, which also offers an understanding of the impact of these systems on policy, practice and research. METHODS: We conducted a search and critique of the literature on CAHTS. Using a comprehensive set of terms, we searched: MEDLINE, EMBASE, The Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, The Cochrane Central Register of Controlled Trials, The Cochrane Methodology Register, Health Technology Assessment Database and the NHS Economic Evaluation Database over a ten-year period (January 1997 to May 2007) to identify systematic reviews, technical reports and health technology assessments, and randomised controlled trials. RESULTS: The systematic review of the literature suggests that CAHTS can save professionals' time, improve delivery of care to those with special needs and also facilitate the collection of information, especially potentially sensitive information (e.g. sexual history, alcohol consumption). The use of CAHTS also has disadvantages that impede the process of history taking and may pose risks to patients. CAHTS are inherently limited when detecting non-verbal communication, may pose irrelevant questions and frustrate the users with technical problems. Our review suggests that barriers such as a preference for pen-and-paper methods and concerns about data loss and security still exist and affect the adoption of CAHTS. In terms of policy and practice, CAHTS make input of data from disparate sites possible, which facilitates work from disparate sites and the collection of data for nationwi

Journal article

Felix L, Pappas Y, Kis-Rigo J, Atun R, Majeed A, Car Jet al., 2011, Automated telephone communication for management disease and care. Cochrane Database of Systematic Reviews (accepted).

Journal article

Pappas Y, Seale C, 2010, The physical examination in telecardiology and televascular consultations: A study using conversation analysis, PATIENT EDUCATION AND COUNSELING, Vol: 81, Pages: 113-118, ISSN: 0738-3991

Journal article

Pappas Y, 2009, Unknown conventions in telemedicine consultations: an analysis of interaction, SAPC National Conference

Conference paper

Pappas Y, Seale C, 2009, The opening phase of telemedicine consultations: An analysis of interaction, SOCIAL SCIENCE & MEDICINE, Vol: 68, Pages: 1229-1237, ISSN: 0277-9536

Journal article

Kulendran L, Atherton H, Pappas Y, Car Jet al., 2009, Accuracy of online health information about controlling childhood fever during the H1N1 influenza pandemic, Informatics In Primary Care, Vol: 4, Pages: 261-262

Journal article

Whiteford A, Allen A, Car J, Pappas Yet al., 2009, “Have swine flu vaccine or risk losing your job” – is this the answer?, BMJ: British Medical Journal

Journal article

Pappas Y, 2006, Towards telemedicine-specific skills: a comparative analysis of real-time telemedicine and face-to-face consultations. Fourth Interdisciplinary Conference on Communication, Medicine and Ethics

Conference paper

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