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W3C-validated transitional XHTML 2.4 First steps: Models of information prescribing
The pilot sites did not produce a single model of IP delivery. Rather, each site developed its own unique approach to IP prescribing and dispensing.
Nevertheless, the overall evaluation of the IP pilot identified three broad approaches that sites took to the issuing of IPs, depending upon how they related to the following two dimensions:
1. How will prescribing work?
- The evaluation identified two main approaches to information-giving: 'light-touch' and 'greater support'.
- Light touch models (such as described in Model 1 below) are those which do not undertake detailed tailoring of information or provide substantial additional support from professionals to help users. Light touch models often involve signposting approaches, rapid single stage prescribing approaches and of self dispensing through websites.
- Greater support models (such as described in Model 2 below) are those which involve a more tailored prescribing process (usually involving a multi-stage process for prescribing) followed by more extensive exploration of needs and delivery of information by hospital information centre, NHS Direct or national charity helpline, or dedicated local help centre.
2. How will information be dispensed?
- Is information delivered through a local information centre, remote or linked fulfilment points (i.e. other agencies, supporting the principal prescribing agency) or will the patient self-dispense? (An example of such a model is described in Model 3 below)
In thinking about the specific approach you will adopt, you may wish to consider the three broad models summarised below. It may be that one model fulfils all your requirements or that, alternatively, you wish to combine elements from more than one.
Model 1: Light-touch prescribing/ self-dispensing
What happens?
This model operates predominately in primary care. The prescribing process is quick and involves either a simple 'tick box' template or signposting postcard. Dispensing is carried out by the user themselves via the internet or through help-lines, voluntary sector organisations and libraries, where support is available from a professional to help the user find information if requested. The pilots using this model are usually working with conditions which are relatively stable and do not require significant involvement from secondary care.
The IT systems used in these sites rely heavily on sophisticated websites which can provide open access to all. Some of the IT systems were also designed to enable users to develop their own IPG save this and print off themselves, while other are limited to fixed web pages on health-related topics.
Who could you involve?
You may want to involve GPs and nurses in primary care, as well as patient representative groups such as PALS, 'Expert Patients' and condition-specific charity organisations. As this model allows open access to a publicly available information point, there is scope for a wide range of organisations to be involved, i.e. any local agencies/professionals in contact with people who have health needs. You may, therefore, want to consider community sector and social care agencies. [see also engaging people]
Model 2: In-depth prescribing/ linked dispensing
What happens?
In this model a specialist worker — such as a care worker or case manager — completes the IP alongside the service user, during a consultation session and then the dispensing takes place after the consultation at another point. Dispensing takes place externally through a range of channels including NHS Direct and community information points.
Typically, prescribing will take place during a pre-arranged consultation session that is part of the usual service provided to someone on the care pathway in question. This could be, for example, a review session or a new referral appointment that is extended to take account of IP issuing. The service user is provided with a list of recommended sources, tailored to their particular needs and condition, which they will then take to a designated dispenser.
The IT systems used to support these models varied from highly sophisticated systems to relatively manual systems. In the cases where sophisticated systems were used, dispensing was supported through a range of help-lines and had the capacity to email information to users and carers.
Who could you involve?
Care workers, practice nurses and/or case managers are examples of professionals who could be involved as 'prescribers' this model. IP could be built in to the ongoing service user review process and/or new referral consultations.
You will need to identify appropriate linked dispensing point(s). Options include: the telephone help line of a national charity; NHS Direct; or the local office of a national charity or other local support group. [see also engaging people]
You may wish to consider the amount of support that you wish to provide to patients, when deciding with which dispensing point(s) you will link. For example, if a patient rings NHS Direct and is asked to give detailed information on their condition, this may result in greater supported information provision than if a patient walks into the local office of a national charity and helps themselves to information leaflets. Alternatively, a patient could attend a local charity office and have an in-depth discussion about their condition, and their information needs, with one of the charity's representatives, with could also mean that greater support is on offer.
Model 3: In-depth prescribing with information centre
What happens?
This model operates predominately in secondary care, with the exception of one pilot based in primary care. In these Pilots most of the conditions being treated tend to be either high risk or are highly complex and therefore require significant care from acute services. The prescribing is predominately carried out by a consultant, care manager or specialist nurse. The IP process is usually quite structured and tailored around a care pathway. The prescribing process usually involves more than one stage, with the first stage involving a professional making an initial assessment of the user information needs, and a second stage during which another professional conducts a more detailed assessment. In this model, dispensing usually takes place in an information centre, which is staffed by a nurse, NHS information specialist or someone from the voluntary sector.
Who could you involve?
Health and social care professionals working within secondary care — clinicians, specialist nurses and care managers, for example — are central to the prescribing process. This model also relies on the trained volunteers and paid staff working in the local support centre(s) with whom you partner. Indeed, the specialist support centre plays a pivotal role in the prescribing element of the IP process; it may be worth scoping existing information sources in order to identify potential partner organisation(s) at the outset and engage them throughout. [see also engaging people]
If looking at these models is not the way in for you, an alternative starting point is to ask yourself three basic questions that pilot sites found it helpful to ask themselves. We look at these next.
