Primary Care Research & Teaching Blog – Page 14 – A blog by academics from the Centre for Academic Primary Care (CAPC), University of Bristol. Opinions expressed are those of the authors and not of CAPC, the University, research funders or partners.

What is the ‘3D approach’ for managing multiple long-term conditions?

Posted on March 13, 2017April 10, 2017 by capcbristol

by Dr Mei-See Man
Trial Manager
Centre for Academic Primary Care

The 3D study, led by researchers from the Centre for Academic Primary Care (CAPC), is examining a new approach for GP practices to manage patients with multiple long-term health problems.

Meeting a need

Existing treatment is based on guidelines for each separate condition meaning that patients often attend multiple appointments for each disease which can be repetitive, inconvenient and inefficient. They see different nurses and doctors who may give conflicting advice. These patients frequently get depressed and they also sometimes complain that no-one treats them as a ‘whole person’ or takes their views into account.

The 3D approach was developed by patients and GPs together to address these issues. Based around patient-centred care, the approach focuses on three ‘D’s: Depression, Drugs and the patient’s Dimensions of health, such as their quality of life, priorities and … Read more

How do we support GPs providing end of life care?

Posted on March 10, 2017March 12, 2017 by capcbristol

by Dr Lucy Selman
Research Fellow (Qualitative Research in Randomised Trials)
Centre for Academic Primary Care

GPs are vital to the delivery of end of life care. They coordinate care, provide generalist palliative care, help prevent unnecessary hospital admissions, and, in England, commission local health and social care services. Crucially, they help shift care from hospitals to the community, which is where most people would prefer to die.

But providing good care at the end of life is not always straightforward. There’s evidence that GPs can find it challenging, and that the quality of end of life care by GPs can be problematic. The Royal College of General Practitioners and the House of Commons Health Committee therefore recognise the urgent need for evidence-based education in end of life care for GPs. However, the evidence base for GP training in end of life care is unclear, and no rigorous evaluations … Read more

Translating research into an art performance

Posted on January 16, 2017 by capcbristol

by Dr Johanna Spiers
Senior Research Associate
Centre for Academic Primary Care

I am a qualitative health psychologist. That’s who I’ve been for about eight years.

However, before I even knew what that term meant, I was several other things: a writer, a performer, a poet. I am drawn to words, and to the stories that they form. This is why I am passionate about qualitative research. I also love performance, and believe it is a fantastic mechanism for powerfully communicating important messages about humanity.

On my arrival at the University of Bristol, I was therefore thrilled to learn that the project I would be working on with Principal Investigator Ruth Riley included a collaboration with a performance artist, who would be communicating our findings about GPs’ mental health to an audience. This performance was to happen as part of the Elizabeth Blackwell Institute’s (EBI) Feel It Festival. … Read more

A Painful Silence: bringing domestic violence into conversation

Posted on January 5, 2017January 16, 2017 by capcbristol

by Gene Feder, Professor of Primary Care
and
Lucy Potter, Academic Clinical Fellow in Social and Community Medicine
Centre for Academic Primary Care

Seek the truth, not what is comfortable. Seek the real, not the easy.
— Gerald May

Talking about domestic violence and abuse can be uncomfortable. Avoiding talking about uncomfortable subjects keeps them hidden, fails to challenge injustice and arguably colludes with perpetration. We have a responsibility to shine a light into these dark corners.

In the Centre for Academic Primary Care at the University of Bristol we conduct research on improving the health care response to domestic violence and abuse. We have measured the prevalence and impact of domestic violence in patients in general practice and sexual health services; developed and rigorously tested training for doctors and nurses in general practice to ask about DVA and link patients disclosing abuse to specialist domestic violence advocates; run programmes … Read more

Are some patients more equal than others? Looking back at the Cancer Drugs Fund

Posted on May 13, 2016May 13, 2016 by capcbristol

by Dr Padraig Dixon
Senior Research Associate
Centre for Academic Primary Care

Imagine being given £400m of taxpayers’ money to spend on drugs for the benefit of NHS cancer patients. How would you decide which therapies to fund? Would you decide that all cancer patients should benefit equally, or would you decide to spend more on particular types of cancer, or on particular types of patient?

These issues were confronted by the Cancer Drugs Fund (CDF), the 2014/15 expenditures of which were £416m (against a budget of £280m). The CDF was created to make available to patients in England cancer drugs not recommended by the National Institute of Health and Care Excellence (NICE) on the basis of cost-effectiveness, not yet appraised by NICE or which were being used outside market authorisations.

The effects of the CDF on population health are controversial: one estimate is that the CDF has caused five … Read more

Creating a data archive of GP consultations – the motivations and challenges

Posted on April 15, 2016April 19, 2016 by capcbristol

By Dr Rebecca Barnes
Senior Research Fellow
Centre for Academic Primary Care

Nearly 14 years ago in summer school at University of California Santa Barbara, Professor Don Zimmerman provided my introduction to the analysis of institutional, in particular medical, interaction.

Those studies set the benchmark for my own research ambitions but the main obstacle I faced was getting access to data.

For all the right reasons, medical consultations data are challenging to collect. Where ethical approval is in place for reuse it is often restricted to the original research team. Sometimes retrospective approvals for reuse of existing data are possible but even then, consultations data that has been collected without reuse in mind is often of variable quality; the process of data collection and participant characteristics are not well-documented, recordings can be incomplete and they are often audio-only.

The idea for the Primary Care Consultations Archive was born with this … Read more

Listening to the child’s voice in research on domestic violence and abuse

Posted on April 13, 2016April 13, 2016 by capcbristol

By Lisa Arai
Senior Research Associate
Centre for Academic Primary Care

Anybody who has worked on a systematic review will know you spend a lot of time thinking about the type of research papers to include in your review and those you will exclude. Tightly defined inclusion criteria, as well as critical appraisal, an explicit synthesis stage and measures to reduce reviewer bias (such as inter-rater checks), are what distinguish systematic from traditional reviews (a point usefully made by Mark Petticrew more than a decade ago, when he sought – among other things – to debunk the notion that systematic reviews are simply larger versions of traditional reviews).

Over many years teaching research methods, I’ve noticed students often regard this early stage of the review process as troublesome. It’s often approached with an uncertainty that, if not properly resolved, can render the review unwieldy. Or its significance might be underestimated; … Read more

Why GPs need training about domestic violence and children

Posted on March 2, 2016March 8, 2016 by capcbristol

by Eszter Szilassy
Senior Research Associate
Centre for Academic Primary Care

While violence against men continues to fall in the UK, women affected by violence and domestic abuse are bearing the brunt of a hidden rise in violent crime. This rise coincides with the austerity-led cutting of domestic violence services.

Domestic violence and abuse (DVA) damages physical and mental health resulting in increased use of health services by survivors of abuse. The prevalence of DVA among women attending general practice is higher than in the wider population. Women experiencing DVA are more likely to be in contact with GPs than with any other professionals. Reduced investment in specialist domestic violence services further increases the demand for direct general practice responses to DVA. Although victims tend not to disclose spontaneously to their GP, they have an expectation, often unfulfilled, that doctors can be trusted with disclosure, and can offer them … Read more

To test or not to test, that is the question

Posted on February 10, 2016February 25, 2016 by capcbristol

by Dr Jessica Watson
Research Fellow
Centre for Academic Primary Care

‘If you can afford to have your blood tested for everything available, do it quarterly so you have a baseline of your own personal health’
– Mark Cuban, Twitter

With this one tweet Mark Cuban started a twitter storm. Advocates argued that the future of medicine lies with new technologies, with online companies and even future smartphone dongles allowing patients’ to test their own blood for everything from allergies to zinc.

This brave new world overlooks the responsibility of doctors to ‘first do no harm’. I have been qualified as a doctor for over 10 years but am still in training as a GP registrar and ‘junior doctor’. I have gradually learned that my well-meaning enthusiasm to do more and more tests to try to find out what is wrong with patients can quickly lead to … Read more

Who do GPs go to when they need help?

Posted on February 9, 2016February 9, 2016 by capcbristol

By Johanna Spiers
Research associate
Centre for Academic Primary Care

GPs often say they make the worst patients, but who do they turn to when they need help? That’s what I aim to find out on a new research project about GPs with mental health issues.

My new job is firmly at the centre of the zeitgeist. GPs are all over the news on a daily basis. Doctors are judged by journalists and picked apart by politicians for running unsafe surgeries, for closing their doors to new patients, and for long waiting lists. If you read (and believe) certain sectors of the UK press, you might be forgiven for thinking that GPs have a lot to answer for.

The reality is, of course, way more complex than the Daily Fail might have us believe. Yes, GPs are retiring early. Yes, many practices are unable to add new names … Read more