Category: Organisation and delivery of care

Do web-based self-care interventions reduce health inequalities for people with chronic conditions?

Posted on by capcbristol

 

 

by Dr Sophie Turnbull, Senior Research Associate, Centre for Academic Primary Care, University of Bristol

Digital interventions have become increasingly popular due to their potential to increase access to healthcare for people with chronic conditions and reduce the burden on a stretched healthcare system.

This has been amplified during the COVID-19 crisis, where much face-to-face support has been reduced or is no longer available. However, there are concerns that digital health provision may exacerbate existing health inequalities.

Chronic or long-term conditions, such as diabetes, are estimated to account for 87% of deaths and have a significant impact on an individual’s quality of life. Even in high-income countries, people with lower socioeconomic status experience chronic illness more commonly and with greater severity than average for the rest of the population.

We also know that people with existing health conditions, in low paid or insecure work and … Read more

Why new guidance on domestic abuse for GPs is vital during COVID-19

Posted on by capcbristol

 

 

by Dr Eszter Szilassy, Research Fellow, Centre for Academic Primary Care, University of Bristol

GPs and other primary health care professionals play a vital role in addressing domestic violence and abuse (DVA). This is especially true during the current coronavirus pandemic, when individuals and families are isolated from potential sources of help and support.

Home during lockdown may not be a safe place for those affected. In England, the National Domestic Abuse Helpline, run by Refuge, has seen a 50 per cent increase in calls compared to pre-COVID-19, along with a 400 per cent increase in web traffic.

We know that the pandemic is having a detrimental impact on the health and wellbeing of people affected by DVA and their children. Extensive periods of self-isolation and social distancing compounded by increasing uncertainty over jobs and financial security for families may be a dangerous and profoundly … Read more

Coronavirus: how accurate are coronavirus tests?

Posted on by capcbristol

by Dr Jessica Watson, GP and NIHR Doctoral Senior Clinical Research Fellow, Centre for Academic Primary Care, University of Bristol and Dr Penny Whiting, Associate Professor in Clinical Epidemiology, NIHR ARC West and University of Bristol

Coronavirus testing has been the subject of huge interest, frustration and confusion. The UK has come under worldwide criticism for its lack of mass testing, despite the director general of WHO encouraging countries to “test, test, test”. Health Secretary Matt Hancock announced that the UK now aims to test 100,000 people a dayfor COVID-19 by the end of April.

There are two main types of COVID-19 tests. Swab tests, which usually take a sample from the throat or nose, to detect viral RNA. These determine if you currently have COVID-19. Blood tests, which detect antibodies, can determine if you have had COVID-19, and are therefore immune.

No test … Read more

How coronavirus has transformed the grieving process

Posted on by capcbristol

 

 

Dr Lucy Selman, Senior Research Fellow, Centre for Academic Primary Care, University of Bristol

As I write this, the UK government has just announced that 13,729 people have died in hospitals from COVID-19. Care England estimates more than 1,400 people have now died in care homes. As you read this, those appalling figures will have grown. The national medical director, Stephen Powis, has said that if the UK death tally comes in below 20,000, “we will have done very well”.

As a result, a wave of grief will swell in the coming months, with more and more people experiencing a close bereavement related to COVID-19. The disease brings new challenges in caring for patients and supporting their family and friends. A particularly cruel one is that patients must be isolated to control the spread of infection.

Since a patient’s loved ones are often unable to accompany … Read more

Prescribing and the environment

Posted on by capcbristol

 

 

by Dr Rupert Payne, Consultant Senior Lecturer in Primary Health Care, Centre for Academic Primary Care, University of Bristol

Boots pharmacies made the mainstream news headlines in May this year when it became apparent that some prescriptions which were being prepared using an automated centralised system were being distributed using plastic bags. Lloyds pharmacies have a similar process in place.

The argument is that the centralised assembly process is more efficient and safer than the old-fashioned local approach which used paper bags. The bags can be recycled but, as many of us know, that isn’t necessarily straightforward. Given the backlash against plastic that has been seen recently, and particularly given the fact that pharmacies have always been well known for using paper bags, it is unsurprising that this change has been received negatively by consumers.

But the impact of prescribing on the environment is not just … Read more

Health Data Science: the next key development in patient-centred research will be data-led

Posted on by capcbristol

 

 

by Dr Yvette Pyne, Academic Clinical Fellow, Centre for Academic Primary Care, University of Bristol

The breadth of conditions doctors are expected to manage continues to grow as people and society become ever more complex and it is in GP surgeries up and down the country where this is most starkly seen. The volume of work expected of GPs is taking its toll on individual doctors and the service as a whole.

My previous career designing and developing information technology (IT) systems gives me insight into the huge potential computers and machine learning have to help us in this increasingly challenging environment. Artificial Intelligence (AI) can enable us to provide the best evidence-based medicine to our patients while also freeing us from mundane administration to spend more time connecting with the human beings in front of us.

In the UK, Primary Care is already leading … Read more

Wanted: GPs who understand that evidence alone does not create policy

Posted on by capcbristol

 

 

by Dr Jason Sarfo-Annin, Honorary Research Fellow, Centre for Academic Primary Care, University of Bristol

Debate surrounding the future of general practice is usually rooted in the context of the primary care workforce, the introduction of new roles and developing practitioners with a new skill-mix.
Such solutions are rooted in the medical model of health. I share the Marmotian view that health care is just one dimension of improving individual and population health.

As GPs, we often consult with patients who cannot be helped by our services. We are also often unable to effectively signpost patients or help navigate them to services that can support them. Consequently, I believe the future involves working as part of a collaboration of services – delivered optimally by co-location. Provision of these services would be based on the geographical location of patients and include amenities already provided by local authorities … Read more

Male victims of domestic abuse face barriers to accessing support services – new study

Posted on by capcbristol

 

 

by Dr Eszter Szilassy, Research Fellow, Centre for Academic Primary Care, University of Bristol

Men who experience domestic violence and abuse face significant barriers to getting help and access to specialist support services, our latest study shows.

Although the amount, severity and impact of domestic violence and abuse experienced by women is much higher than that experienced by men, men can also suffer significantly as a result of abuse from a partner, ex-partner or an adult family member.

An earlier study of 1,368 male patients in GP clinic waiting rooms in the UK found that more than one in four had experienced abusive behaviour from a partner or ex-partner. They were also between two and three times more likely to have symptoms of depression and anxiety.

The experiences of many men who are survivors of domestic violence and abuse are similar to those of women. Like … Read more

Why GPs and patients need to talk more openly about death

Posted on by capcbristol

 

 

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

After the trial: how a programme to improve the health care response to domestic violence and abuse fares in the real-world NHS

Posted on by capcbristol

 

 

 

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