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      Exploring lessons from Covid‐19 for the role of the voluntary sector in integrated care systems

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          Abstract

          Integrated care systems (ICS) in England are partnerships between different health and social care organisations, to co‐ordinate care and therefore provide more effective health and social care provision. The objective of this article is to explore the role of the ‘Voluntary, Community and Social Enterprise’ (VCSE) sector in integrated care systems. In particular, the paper aims to examine recent experiences of the voluntary sector in responding to the Covid‐19 pandemic, and the lessons that can be learnt for integrated care provision. The article focuses on the case of Oxfordshire (UK), using a mixed methods approach that included a series of semi‐structured interviews with key informants in health and the VCSE sector as well as online surveys of GPs and organisations in the VCSE sector. These were complemented by two contrasting geographical case studies of community responses to Covid‐19 (one urban, one rural). Data were collected between April and June 2021. Interviewees were recruited through professional and community networks and snowball sampling, with a total of 30 semi‐structured interviews being completed. Survey participants were recruited through sector‐specific networks and the research arm of doctors.net.uk, with a total of 57 survey respondents in all. The research demonstrated the critical role of social prescribing link workers and locality officers in forging connections between the health and VCSE sectors at the hyper‐local level, particularly in the urban case study. In the rural case study, the potential role of the Parish Council in bringing the two sectors together was highlighted, to support community health and well‐being through stronger integrated working between the two sectors. The article concludes that enhanced connections between health and the VCSE sector will strengthen the outcomes of ICS.

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          Drug-resistant enteric fever worldwide, 1990 to 2018: a systematic review and meta-analysis

          Background Antimicrobial resistance (AMR) is an increasing threat to global health. There are > 14 million cases of enteric fever every year and > 135,000 deaths. The disease is primarily controlled by antimicrobial treatment, but this is becoming increasingly difficult due to AMR. Our objectives were to assess the prevalence and geographic distribution of AMR in Salmonella enterica serovars Typhi and Paratyphi A infections globally, to evaluate the extent of the problem, and to facilitate the creation of geospatial maps of AMR prevalence to help targeted public health intervention. Methods We performed a systematic review of the literature by searching seven databases for studies published between 1990 and 2018. We recategorised isolates to allow the analysis of fluoroquinolone resistance trends over the study period. The prevalence of multidrug resistance (MDR) and fluoroquinolone non-susceptibility (FQNS) in individual studies was illustrated by forest plots, and a random effects meta-analysis was performed, stratified by Global Burden of Disease (GBD) region and 5-year time period. Heterogeneity was assessed using the I 2 statistics. We present a descriptive analysis of ceftriaxone and azithromycin resistance. Findings We identified 4557 articles, of which 384, comprising 124,347 isolates (94,616 S. Typhi and 29,731 S. Paratyphi A) met the pre-specified inclusion criteria. The majority (276/384; 72%) of studies were from South Asia; 40 (10%) articles were identified from Sub-Saharan Africa. With the exception of MDR S. Typhi in South Asia, which declined between 1990 and 2018, and MDR S. Paratyphi A, which remained at low levels, resistance trends worsened for all antimicrobials in all regions. We identified several data gaps in Africa and the Middle East. Incomplete reporting of antimicrobial susceptibility testing (AST) and lack of quality assurance were identified. Interpretation Drug-resistant enteric fever is widespread in low- and middle-income countries, and the situation is worsening. It is essential that public health and clinical measures, which include improvements in water quality and sanitation, the deployment of S. Typhi vaccination, and an informed choice of treatment are implemented. However, there is no licenced vaccine for S. Paratyphi A. The standardised reporting of AST data and rollout of external quality control assessment are urgently needed to facilitate evidence-based policy and practice. Trial registration PROSPERO CRD42018029432.
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            Social prescribing: less rhetoric and more reality. A systematic review of the evidence

            Objectives Social prescribing is a way of linking patients in primary care with sources of support within the community to help improve their health and well-being. Social prescribing programmes are being widely promoted and adopted in the UK National Health Service and so we conducted a systematic review to assess the evidence for their effectiveness. Setting/data sources Nine databases were searched from 2000 to January 2016 for studies conducted in the UK. Relevant reports and guidelines, websites and reference lists of retrieved articles were scanned to identify additional studies. All the searches were restricted to English language only. Participants Systematic reviews and any published evaluation of programmes where patient referral was made from a primary care setting to a link worker or facilitator of social prescribing were eligible for inclusion. Risk of bias for included studies was undertaken independently by two reviewers and a narrative synthesis was performed. Primary and secondary outcome measures Primary outcomes of interest were any measures of health and well-being and/or usage of health services. Results We included a total of 15 evaluations of social prescribing programmes. Most were small scale and limited by poor design and reporting. All were rated as a having a high risk of bias. Common design issues included a lack of comparative controls, short follow-up durations, a lack of standardised and validated measuring tools, missing data and a failure to consider potential confounding factors. Despite clear methodological shortcomings, most evaluations presented positive conclusions. Conclusions Social prescribing is being widely advocated and implemented but current evidence fails to provide sufficient detail to judge either success or value for money. If social prescribing is to realise its potential, future evaluations must be comparative by design and consider when, by whom, for whom, how well and at what cost. Trial registration number PROSPERO Registration: CRD42015023501.
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              Social prescribing

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                Author and article information

                Contributors
                juliet.carpenter@kellogg.ox.ac.uk
                Journal
                Health Soc Care Community
                Health Soc Care Community
                10.1111/(ISSN)1365-2524
                HSC
                Health & Social Care in the Community
                John Wiley and Sons Inc. (Hoboken )
                0966-0410
                1365-2524
                03 October 2022
                November 2022
                03 October 2022
                : 30
                : 6 ( doiID: 10.1111/hsc.v30.6 )
                : e6689-e6698
                Affiliations
                [ 1 ] University of Oxford Oxford UK
                [ 2 ] Oxford Brookes University Oxford UK
                [ 3 ] University of Liverpool Liverpool UK
                Author notes
                [*] [* ] Correspondence

                Juliet Carpenter, Global Centre on Healthcare and Urbanisation (GCHU), Kellogg College, University of Oxford, Oxford OX2 6PN, UK.

                Email: juliet.carpenter@ 123456kellogg.ox.ac.uk

                Article
                HSC14062 HSCC-ERMM-22-0154.R1
                10.1111/hsc.14062
                9874554
                36190115
                9c822600-4667-4302-aa91-fe58180c312a
                © 2022 The Authors. Health and Social Care in the Community published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 06 August 2022
                : 03 February 2022
                : 12 September 2022
                Page count
                Figures: 1, Tables: 1, Pages: 10, Words: 8092
                Funding
                Funded by: Oxford Brookes University , doi 10.13039/100010053;
                Categories
                Empirical Research Mixed Methods
                Empirical Research Mixed Methods
                Custom metadata
                2.0
                November 2022
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.2.3 mode:remove_FC converted:25.01.2023

                Health & Social care
                community and voluntary sector,covid‐19,integrated care systems,neighbourhood,oxfordshire,qualitative research,vcse

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