By Dr Lucy Pocock, GP Career Progression Fellow, Centre for Academic Primary Care, University of Bristol
Dealing with death is part of the job description for all doctors. For those working in general practice, this often means planning ahead, with GPs encouraged to keep a register of patients thought to be in the last year of their life.
One reason for this is to identify which patients might benefit from palliative and supportive care – the kind of care which focuses on symptom control, rather than cure. At the moment, these registers appear to consist mainly of patients with cancer. Yet most people (72%) in England don’t actually die of cancer. So why aren’t other dying patients being registered?
To answer this question, it is helpful to think about how we die. As a GP, I can often predict, to some degree, a decline … Read more
By Dr Matthew Ridd, GP and Senior Lecturer in Primary Healthcare, Centre for Academic Primary Care, University of Bristol
and Dr Robert Boyle, Consultant Paediatric Allergist, Imperial College London
Around one in five children have eczema – and even mild cases can have a big impact on both the child and their family. For many, symptoms will come and go before they start primary school, but for others it can indicate the beginning of a genetic tendency to develop allergic conditions such as hay fever or asthma (or both).
We also know that children with eczema are more likely to develop food allergies, especially if the condition starts in the first few months of life and is severe. Often parents will make the allergy diagnosis themselves – at the sudden onset of vomiting, diarrhoea or rash after eating scrambled egg, for example.
This can be frightening, but … Read more
By Dr Natalia Lewis, Research Fellow, Centre for Academic Primary Care, University of Bristol
A new paper by researchers from the University of Bristol and NIHR CLAHRC North Thames highlights the post-trial journey of an evidence-based domestic violence and abuse (DVA) intervention to the NHS front-line, and the human and contextual factors that influence how its effect is sustained over time.
IRIS (Identification and Referral to Improve Safety) is a general-practice-based DVA training, support and referral programme. The programme develops DVA awareness and skills among general practice staff and provides a referral pathway to a named DVA advocate (IRIS advocate educator) based in a third sector agency. IRIS advocate educators provide IRIS training and ongoing support, consultancy to practice staff, and advocacy to referred patients.
Following a successful randomised controlled trial, IRIS has been implemented in over 30 local authorities in the UK. The trial … Read more
By Dr Jeremy Horwood, Senior Research Fellow, Centre for Academic Primary Care, University of Bristol and NIHR CLAHRC West, and Dr Andrew Turner, Senior Research Associate, NIHR CLAHRC West
Researchers from the DECODE study hosted a workshop late in 2018 to explore the unintended consequences of digital health tools used in primary care. The workshop was attended by members of the public, technology developers, GPs and key researchers in the field.
Digital health tools, such as health monitoring apps and online patient portals, are becoming commonplace, with NHS England supporting their use to improve patient access and care. But this increase in their use could lead to unintended consequences, both positive and negative. An understanding of these consequences is vital, so we can minimise the negative effects and harness the positive.
DECODE aims to improve how digital health tools are used in primary care by investigating … Read more
Guest blog by Dr James Dodd
Consultant Senior Lecturer
Academic Respiratory Unit, University of Bristol
and Southmead Hospital, Bristol
What is COPD?
Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term which includes ‘chronic bronchitis’ and ‘emphysema’. It causes a progressive decline in lung function and health. It is common, affecting 2% of the adult population, and is projected to become the third leading cause of death in the UK. People with COPD experience breathlessness, cough and wheeze and often suffer with repeated chest infections. These ‘exacerbations’ are the second most common reason for emergency admissions to hospital.
Sadly, around two of the three million people with COPD in the UK remain undiagnosed, meaning that they live with debilitating symptoms for many years before receiving the support and advice they need. These ‘missing millions’ are the driving force behind COPD awareness month and World COPD Day.
It is … Read more
by Dr Jeremy Horwood and Professor Chris Salisbury, Centre for Academic Primary Care and NIHR CLAHRC West
NHS England’s long-term plan released on 7 January sets out a commitment that over the next five years every patient will get the right to telephone or online GP consultation as part of its ‘digital first primary care offer‘.
Online consultations are seen as a solution to improve patient access to primary care, increase convenience (saving time waiting and travelling) and reduce face-to-face appointments, freeing up GP time. But our research has found that unless these systems are carefully implemented, the benefits policy makers are hoping for in relation to reductions in GP workload and increases in available appointments for patients might not be realised.
The Centre for Academic Primary Care-led Alt-Con study examined how a variety of technological alternatives to face-to-face GP consultations were being used in … Read more
by Dr Emma Anderson
Senior Research Associate
Centre for Academic Primary Care
As any parent knows, children get coughs, colds and ear infections all the time. Symptoms of these respiratory infections – including runny nose, cough and sore throat – can seem never-ending.
In the EEPRIS Study, led by Professor Alastair Hay from the University of Bristol’s Centre for Academic Primary Care, we recruited parents across Bristol to tell us about their children’s respiratory symptoms as they became ill. Gathering information in the community means we are able to find out more about common respiratory illnesses than when we study those who have decided to consult their GP. It also gives us a more accurate picture of how likely parents are to consult for these common illnesses, something which has been surprisingly unclear.
Two of our main findings were that:
- it takes up to three weeks for most
… Read more
By Dr Sarah Sullivan
Centre for Academic Primary Care
Psychosis is a serious and long-term mental illness. Unfortunately, for many sufferers the outcomes are poor. Many may relapse again after recovery, suffer long-term residual symptoms and have poor social functioning.
Primary care is an important part of the care pathway for patients with psychosis, so GPs need to be able to accurately identify those at high risk. The task is difficult because high-risk symptoms are frequently not specific to psychosis.
We also know that the greater the delay between someone’s first psychotic symptom and receiving specialist mental health treatment is associated with poorer outcomes. GPs play an important role in this, because most people are referred to mental health services by their GP.
In a study recently published in JAMA Network Open, we set out to find out if people had previously consulted their GP … Read more
by By Dr Eileen Sutton
Senior Research Associate, Qualitative Lead on the STAMINA Study
Centre for Academic Primary Care
STAMINA is a five-year study funded by the NIHR’s Programme Grants for Applied Research scheme and is led by researchers from Sheffield Hallam University, with collaborators from Sheffield Teaching Hospitals, University of Leeds, University of Sheffield, Queen Mary University London, University of Bristol, University of York, Cardiff University, University of Edinburgh and Queen’s University, Belfast in partnership with Nuffield Health.
Why are we doing the research?
Prostate cancer is the most common cancer in men in the UK, with around 47,000 cases diagnosed each year. Androgen deprivation therapy (ADT) is a standard treatment for men with advanced prostate cancer but it is associated with significant side-effects which include fatigue, depression, sexual dysfunction, impairment of memory and concentration, increased fat mass and loss of muscle strength. ADT also increases the risk … Read more
Guest blog by Medina Johnson (left), Chief Executive
and Lucy Downes (right), National Implementation Manager
As we gear up for events and conversations to mark the 16 Days of Activism against Gender-based Violence, it’s timely to reflect on the importance of the healthcare response to gender-based violence. IRISi’s vision is a world in which gender-based violence is consistently recognised and addressed as a health issue.
Violence against women is a global health problem of epidemic proportions. Dr Margaret Chan, World Health Organization Director-General
The IRIS programme is our flagship intervention working with primary care to change and improve clinical practice and to provide patients affected by domestic abuse with access to specialist advice and support. It provides training and support to GPs, practice nurses and other primary care clinicians to help them identify and refer women with experience of domestic violence and abuse (DVA) to … Read more