Category: Organisation and delivery of care

Help us identify the unintended consequences of digital health tools in primary care

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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

Is it possible to detect future risk of psychosis from a patient’s primary care consultation history?

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By Dr Sarah Sullivan
Research Fellow
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

Domestic violence and abuse: ‘If we all work together, it will make a difference’

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Guest blog by Medina Johnson (left), Chief Executive
and Lucy Downes (right), National Implementation Manager
IRIS Interventions

 

 

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

Can we eliminate human papilloma virus?

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by Dr Sam Merriel
GP and Honorary Lecturer
Centre for Academic Primary Care

and

 

Dr Joanna Kesten
Senior Research Associate
NIHR Health Protection Research Unit in Evaluation of Interventions

Researchers from the Centre for Academic Primary Care and Population Health Sciences, Bristol Medical School, with colleagues from Queens University Belfast, Ulster University, and Southampton University, have published an editorial in the British Journal of General Practice (BJGP) in response to Public Health England’s (PHE) recommendation to roll out a targeted Human papillomavirus (HPV) vaccination programme for men who have sex with men (MSM) through genitourinary medicine (GUM) and HIV clinics across England. 

The editorial argues that although this announcement is a positive step, it would be more effective to follow more recent recommendations to introduce gender neutral HPV vaccination to achieve total elimination of HPV, rather than a reduction. The PHE proposal means MSM who do … Read more

Redesigning primary care for the people who use it

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Unveiling the results of the 3D trial for patients with multimorbidity in general practice

Blog authors

 

by Chris Salibsury, Peter Bower, Stewart Mercer and Bruce Guthrie
@prof_tweet

There is good agreement about the sort of care that people with multimorbidity need. But can it be delivered in the busy setting of general practice, and does it improve outcomes? In this blog we discuss the results of the 3D trial, the largest study of an intervention for multimorbidity published to date.

Managing multimorbidity is a litmus test for modern health care systems. Patients with many long-term conditions face major challenges in managing their conditions and need significant support, which means that these patients are often associated with high costs.

Despite the complexity of caring for these patients, there is also significant agreement about what sort of care they need. Many authors have highlighted that patient-centred care is crucial, with a … Read more

Finding a better way to identify children experiencing domestic violence

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by Dr Natalia Lewis
Research Fellow
Centre for Academic Primary Care
@DV_Bristol

 

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

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

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Dr Rupert Payne
Centre for Academic Primary Care
@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 the UK’s Pharmaceutical Services … Read more

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

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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, The … Read more

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

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by Professor Richard Morris
Professor in Medical Statistics
Centre for Academic Primary Care
@richard2morris

 

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?

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

 

“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