General practice – Page 7 – Primary Care Research & Teaching Blog

Why healthcare services have a problem with gambling

Posted on June 13, 2017 by capcbristol

by Dr Sean Cowlishaw, University of Bristol

I have a problem with gambling. There’s not enough of it.

That was the admission from billionaire Steve Wynn, a major figure in the casino industry, speaking at a recent gambling research conference in (where else?) Las Vegas. And sure, it made for a good quote. But it’s also a rather glib dismissal of a serious issue that affects many thousands of people across the world.

The UK certainly has a problem with gambling. At least it has since 2007, when laws were changed to allow for huge growth in gambling opportunities and exposure. It has been hard to ignore the subsequent explosion in industry advertising, which increased by around 500% between 2007 and 2013. By contrast, you may have missed the increased numbers of high intensity electronic gambling … Read more

Why GPs should teach

Posted on April 25, 2017 by capcbristol

by Simon Thornton
GP Engagement Lead
Centre for Academic Primary Care

‘Encourage more GP practices to teach medical students‘.

Sounds simple doesn’t it? That was the brief for me starting as GP Engagement Lead in September 2016. Teaching is something I’m passionate about and is one of the highlights of my week in practice. It’s always a good day at work when I’ve had students with me and I love to share my enthusiasm for teaching with other GPs.

However, encouraging GPs to take on new work, as exciting and rewarding as it is, is difficult at a time of unprecedented workload and pressure in general practice. Enter ‘Step up and Teach’ – a campaign we’re running to highlight the benefits to practices of teaching medical students. The question we want practices to ask themselves is ‘can we afford not to teach?’.

Reasons to teach

We already know … Read more

World Health Day 2017 – ‘Depression: let’s talk’

Posted on April 7, 2017April 7, 2017 by capcbristol

By Dr David Kessler
Reader in Primary Care
Centre for Academic Mental Health &
Centre for Academic Primary Care

There has been a transformation in social and scientific attitudes to depression in my working lifetime. It is no longer acceptable to stigmatise mental illness or psychological distress. The idea that the common mental disorders of depression and anxiety are an inescapable part of being human has been replaced by a belief that these disabling extremes of sadness and worry are treatable conditions.

Changes in the treatment of depression have been part of wider cultural changes. There is an increased openness about sadness and distress, and a widespread belief, beginning with Freud, that at the very least ‘neurotic misery can be transformed into ordinary unhappiness’. The invention of psychotherapy has spawned numerous schools and sub-disciplines, but all hold to the common belief that with help, … Read more

Why gender can’t be ignored when dealing with domestic violence

Posted on March 28, 2017 by capcbristol

by Gene Feder and Lucy Potter
Centre for Academic Primary Care

First published in The Conversation

Domestic violence is a violation of human rights with damaging social, economic and health consequences. It is any incident of controlling, coercive, threatening behaviour, violence or abuse. That abuse can be psychological, emotional, physical, sexual and financial.

The “domestic” element refers to abuse between people aged 16 or over who are, or have been, intimate partners or family members, regardless of gender or sexuality. Men, women or transgender people in straight, gay or lesbian relationships can perpetrate or experience it. So does this mean domestic violence is gender neutral? Is gender irrelevant to prevention efforts and to responding to survivors’ needs? We do not think so.

Globally, direct experience of being subjected to domestic violence is greater among women then among men. In the UK, 27% of women and 13% of men … Read more

The doctor will Skype you now: the value of telehealth in managing long-term conditions

Posted on March 28, 2017 by capcbristol

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

People are increasingly living with long-term health conditions. Management of these conditions is expensive, and their increased prevalence challenges health system sustainability and current service models. Can alternative models of care meet the needs of patients with long-term conditions at an acceptable cost?

One growing area of healthcare that could serve as a replacement or adjunct to traditional care models is telehealth, which is the remote provision of healthcare by a variety of communication tools. Telehealth advocates argue that the wider use of technology and a greater reliance on self-management in supporting patients with long-term conditions may produce the same or better health outcomes, but at a lower cost, than traditional care modalities. Is this optimism justified, and might telehealth be good value for the NHS?

Recent work, funded by the National Institute for Health … Read more

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

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