Tag: General practice

Why GPs and patients need to talk more openly about death

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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

Children with eczema: the link to food allergies is not clear cut

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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

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

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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

What’s normal in children’s respiratory infections? Bristol parents helped us find out

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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

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

Why it’s important to pre-test patient-reported questionnaires

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Insights from testing MYMOP and PEI

Dr Mairead Murphy

 

by Dr Mairead Murphy
Senior Research Associate
Centre for Academic Primary Care

In research studies, we use patient-reported questionnaires a lot to test if healthcare interventions work or not. Given that the correct completion of these questionnaires underpins our research conclusions, it’s important to know how patients interpret them.

We decided to look more closely at how people interpreted questionnaires. We asked people who had recently visited their GP to complete two commonly-used questionnaires in primary care and tell us their thought processes as they did this. The questionnaires we chose were:

  1. The patient enablement instrument (PEI): This questionnaire has six questions, all related to how “enabled” a patient feels following a GP consultation. It asks patient to rate their improvements in coping, understanding, self-help and other aspects of “enablement”.
  2. Measure Yourself Medical Outcomes Profile (MYMOP): This questionnaire measures symptoms, daily activities
… Read more

Medicines have revolutionised treatment in the NHS – can this progress be sustained?

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Dr Rupert Payne

 

by Dr Rupert Payne
Consultant Senior Lecturer in Primary Health Care
Centre for Academic Primary Care

The seventieth anniversary of the NHS has made me reflect on how proud I am to have contributed to its work for over the past twenty-odd years. Founded on 5 July 1948, the service continues to this day to operate to the same three core principles – meeting the needs of everyone, free at the point of delivery, and based on clinical need.

Aside from providing comprehensive, high-quality healthcare services to virtually the entire UK population, the other thing that the NHS is known for is the constant political bickering that carries on in the background, with criticisms about chronic under-funding and stealth privatisation. However, these are not new issues, with medicines an important reason for the challenges the NHS now faces.

In a response to concerns about rising costs, perhaps the first … 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