Finding a better way to identify children experiencing domestic violence

 

by Dr Natalia Lewis
Research Fellow
Centre for Academic Primary Care

 

Around one in five children in the UK have been exposed to domestic violence or abuse between their parents or caregivers. When adults are involved in an abusive relationship, their children bear the consequences.

The effects of domestic violence on a child can range from emotional and behavioural problems to physical injury and death when children are caught up in the violence between adults.

Even when not directly involved, children’s exposure continues through witnessing and being aware of the violence – and through its health, social and financial consequences.

Health and social care workers are often the first professionals to have contact with a child experiencing these situations. This could be when the abused parent seeks help, or when children undergo health checks. It can happen during assessments for emotional or behavioural problems, or when social services, … Read more

Multimorbidity Treatment Burden Questionnaire (MTBQ) – a new measure of treatment burden

 

 

 

 

By Dr Polly Duncan and Professor Chris Salisbury
Centre for Academic Primary Care

We have developed a new, simply-worded, concise questionnaire – the Multimorbidity Treatment Burden Questionnaire (MTBQ) – to measure treatment burden in patients with multimorbidity (multiple long-term conditions).

Treatment burden is the perceived effort of looking after one’s health and the impact this has on day-to-day life. It includes everything that the patient has to do to look after their health including: ordering, collecting and taking medicines; coordinating and arranging transport for, and attending, health appointments with multiple health professionals; monitoring blood sugar or blood pressure levels; learning about own health conditions; and taking on lifestyle advice.

To understand how new health care interventions impact on treatment burden, we need to be able to measure it. A recent study published in the Annals of Family Medicine highlighted treatment burden as one of the core … Read more

Repeat prescriptions are expensive and time consuming – it’s time for an NHS rethink

 

Dr Rupert Payne
Centre for Academic Primary CareUniversity of Bristol
@DrRupertPayne

 

 

 

Dr Céline Miani
University of Bielefeld
@celine_miani

Over a billion NHS prescription medicines are issued by pharmacists in England every year – at a cost of over £9 billion. Many of these are prescribed by GPs to manage long-term health conditions, such as diabetes or cardiovascular disease.

The current “repeat prescription” system allows patients to request a further supply of medicines without the inconvenience of another doctor’s appointment.

The UK Department of Health advises that the frequency of repeat prescriptions should “balance patient convenience with clinical appropriateness, cost-effectiveness and patient safety”.

However, it does not recommend a specific time period. As a result, local health service commissioners have developed their own guidance, with many encouraging GPs to issue short-term supplies of repeat medications, typically 28 days in length. This is supported by … Read more

Collaborative action planning is key to person-centred healthcare but how can we make it happen?

 

by Cindy Mann
Senior Research Associate
Centre for Academic Primary Care
@Jcindymann


Person-centred healthcare
is accepted as desirable on moral grounds and because it potentially leads to better health outcomes, greater efficiency and less waste. It means both involvement of individuals in their healthcare and individualisation of care.

The NHS has been chasing the goal of person-centred care planning for several years and there are many good examples of innovation. The ‘House of Care’ describes what it might mean in practice for people with long-term conditions. At its heart is personalised care planning, taking account of patients’ expressed needs and priorities. The national new models of care programme, involving 50 vanguard sites, is also pursuing this goal and recently reported on lessons learnt. Many of the vanguards have invested in health coaching and communication skills training for clinicians.

I recently worked on a large research project, … Read more

How gut feeling guides clinician treatment decisions and why it’s not always enough

 

by Sophie Turnbull
PhD Student
Centre for Academic Primary Care

 

Clinician intuition and gut feelings are often talked about in health care but are largely mysterious. Clinicians describe just knowing that there was something wrong with a patient but not exactly how they came to that conclusion.

In a recent study we aimed to unpick how clinicians form their gut feelings, how they use them to influence treatment decisions, and whether their gut feeling was good at predicting whether a child with infectious cough would get sicker in the 30 days after seeing them.

Using gut feeling to predict outcome in children with infectious cough

Infectious cough in children is the most common problem managed by health services internationally.  Although the majority of children get better on their own, a small proportion end up hospital with a serious illness. Clinicians do not always find it easy to … Read more

Why the annual winter health crisis could be solved in homes, not hospitals

 

by Professor Richard Morris
Professor in Medical Statistics
Centre for Academic Primary Care

 

As winter continues, so does the usual soul searching about the state of the UK’s National Health Service (NHS). Images of ambulances backing up outside emergency departments and patients lying on trolleys in corridors haunt politicians and the public alike.

Demand on the NHS, which is always high, increases over the coldest of seasons, when threats to health are greatest. Generally, more than 20,000 extra deaths occur from December to March than in any other four-month period in England and Wales. That number varies considerably, however – from 17,460 in 2013-4 to 43,850 in 2014-5 (which was not even a particularly cold winter). And there has been no evidence of a decreasing trend since the early 1990s, despite the national flu immunisation programme.

The percentage increase in deaths seen each winter in England and Wales … Read more

How important are informal supporters of women experiencing domestic violence?

 

by Dr Alison Gregory
Research Fellow (Traumatised and Vulnerable Populations)
Centre for Academic Primary Care

 

“How important are informal supporters of women experiencing domestic violence?”: Very” – a simple answer to a complicated question. The bottom line, in terms of statistics, is that if survivors disclose their situation to anyone, it will most likely be to informal supporters (friends, relatives, neighbours and colleagues) rather than professionals.1 And this is true across the world, with research indicating that sometimes a disclosure to an informal supporter happens alongside a disclosure to a professional, but frequently this is not the case.2-5 In addition, it is not unusual for informal supporters to witness abusive behaviours, but commonly they are uncertain about what exactly it is that they are seeing, in particular, what it means, and what their role in the situation should be.6 ,7

Why are informal

Read more

Struggling to write? Start your own writers’ retreat!

 

by Dr Jessica Watson
NIHR Doctoral Senior Clinical Research Fellow
Centre for Academic Primary Care

 

Have you ever planned to do some writing, only to find yourself distracted by emails and ‘urgent’ tasks? Do you find you have a growing list of unpublished papers and grant proposals to write? Does it feel as if there is never enough time to get going with your writing?

As academics, writing is arguably our most important task. The mantra ‘publish or perish’ is not just a matter of prestige and a means to academic career progression. Nor is it simply about keeping our University rankings within the Research Excellence Framework. It is an ethical imperative.

Most medical research is funded either through taxpayers’ money or through charitable donations and relies on the trust and goodwill of voluntary research participants. This is both a privilege and responsibility. We must ensure that money … Read more

Why doctors need to improve the way we discuss assisted dying

Paul Teed
PhD candidate
Centre for Academic Primary Care 
University of Bristol

Assisted dying can be a divisive and polarising subject. But there is one aspect on which most people probably agree – the need to improve the conversations people have about death.

At the moment, there is uncertainty in the UK regarding what people – especially health professionals – can and cannot say when the topic of assisted dying comes up. Conversation can become especially stilted when it turns to patients obtaining the medical documentation required for an assisted death abroad.

The situation requires clarification. Currently, if a doctor in the UK writes a specific report to help with an assisted death abroad (three organisations in Switzerland accept UK citizens), the General Medical Council (GMC) may view this as a “fitness to practice” issue.

However, if a doctor provides copies of medical records, even with the knowledge that … Read more

How we learned to love doing workshops

 

by Jessica Roy
Research Associate
Centre for Academic Primary Care
@DV_Bristol


The prospect of running a three-hour conference workshop can provoke anxiety even for the most seasoned conference-goer. Last month, I was a member of the IRIS+ research team, led by Dr Eszter Szilassy, that attended and presented a workshop at the Second European Conference of Domestic Violence in Porto, Portugal.

The conference brings together researchers, practitioners and policy makers from all corners of the globe to discuss, debate and exchange knowledge regarding domestic violence and abuse (DVA).

For context, the IRIS+ project is a training and intervention programme to support clinicians (GPs and nurses) to identify, document and refer female and male victims and perpetrators of DVA, as well as their children, to our dedicated specialist support service.

Before presenting, we had concerns that our workshop might not attract an audience, partly because we thought our … Read more