Destabilising primary health care: digitalised remote consulting and post-COVID-19 patient care

 

 

by Sophie Park, Professor of Primary Care and Medical Education, Research Department of Primary Care and Population Health, University College London, Yathavan Premadasan, BSc Medical Student, University College London and Chris Salisbury, Professor of Primary Health Care, Centre for Academic Primary Care, University of Bristol

The COVID-19 pandemic has changed primary care dramatically, with most consultations conducted remotely by telephone, video or online messaging. But is this a short-term adjustment or the future norm? In general practice, clinical care has been based on long term face-to-face contact, establishing trusting relationships through continuity of care, and using knowledge of patients’ personal circumstances and social context to provide holistic support. Now, these fundamental principles are challenged.

Matt Hancock (UK Health Secretary) has welcomed rapid changes towards digitalised clinical practice as an overdue development, stating that wherever possible, all future consultations should be conducted remotely. But is the … Read more

Conducting research during COVID-19: a medical student’s perspective

 

 

by Kelly Cheng, Medical Student, University of Bristol

 

“Cancelled due to COVID-19” – a rare opportunity to practise lifesaving pre-hospital emergency medicine skills in the French Alps was abruptly transformed into another cancellation email, as with many other glorious plans for 2020. Before I knew it, hospital placements had also been suspended until further notice. Instead, I found myself back home, huddled before my laptop, about to embark on a 6-week long student choice project working with highly-experienced academics for the first time – over Zoom, of course.

In this post, I share my experience as a third year medical student undertaking a research project alongside Dr Lorna Duncan from the Centre of Academic Primary Care (CAPC), and explore the methods we used to successfully gather primary data from all regions of England amid a national lockdown. Ironically, the chance to carry out a project focused on … Read more

Why does the type of moisturiser matter to a child with eczema? A research nurse’s perspective

 

 

By Sue Davies-Jones, Research Nurse, Faculty of Medicine and Health Sciences, Nottingham University

I have worked as a research nurse at the Centre of Evidence Based Dermatology for 13 years, working on various dermatology research projects. The Best Emollients for Eczema (BEE) study aims to answer the important question of whether some types of emollient (moisturisers) are better than others in the treatment of childhood eczema.

In an ideal world, patients would be able to sample different emollients before deciding which one they preferred, but this is not usually practical. The BEE Trial has been designed to help doctors and patients to decide which types of emollient are best to try first.

GPs are under pressure to prescribe on cost, but we don’t know whether a more watery or cheaper moisturiser is as good as a thicker or more expensive one. Helping families find the “right” moisturiser … Read more

Phone, video and online consultations: will Covid-19 change general practice for ever?

 

 

 

by Chris Salisbury, Mairead Murphy and Polly Duncan, Centre for Academic Primary Care, University of Bristol

Because of the COVID-19 pandemic, general practices have rapidly shifted to offering consultations remotely by telephone, video or online messaging rather than face-to-face. Many general practices are considering whether they should continue these new ways of working into the future and some commentators are arguing that general practice will be changed forever. Remote consultations could be more convenient for patients and reduce workload pressures on general practices.

Just before the COVID-19 pandemic we wrote a paper which modelled how an increasing use of online, video and telephone consultations would affect GPs’ workload. Our conclusion was that a reduction in workload should not be assumed, and remote consulting could instead lead to an increase in GP workload over time. It all depends on how remote consultations are used.

The paper … Read more

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

 

 

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

A GP reads ‘The Plague’ during the COVID-19 pandemic

Prof Gene Feder

 

 

by Gene Feder, GP and Professor of Primary Care, Centre for Academic Primary Care, University of Bristol

The Plague, a novel by Albert Camus, published in 1947, tells the story of Oran, a city struck by bubonic plague. It was an extended metaphor for living under fascism and the way society and individuals behave under occupation.

I found an English translation at the back of a book shelf, having first read it as a teenager over half a century ago. On the title page there is a stamp: ‘Rainbow Library Salzburg THIS BOOK IS A [sic] PROPERTY OF THE UNITED STATES’. My father – working with Holocaust* survivors in Germany and Austria – must have forgotten to return it.

In 2020, it turns out that the book – partially – exemplifies our response to the pandemic du jour: COVID-19.

Everybody knows that pestilences have

Read more

What we know about ACE inhibitors, high blood pressure and COVID-19

 

 

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

The COVID-19 pandemic has unsurprisingly been associated with a similar epidemic of social media misinformation. But there are also some genuine clinical issues of relevance to people with existing health conditions, who are known to be more vulnerable to the disease. One particular topic that has left patients and health professionals alike confused and alarmed is the suggestion that ACE inhibitor drugs may increase the dangers of COVID-19.

First introduced in the early 1980s, ACE (angiotensin-converting enzyme) inhibitors were initially used for the treatment of high blood pressure, but their role has grown over the years to include the management of heart failure, heart attacks, diabetes and kidney disease. Given that roughly one-fifth of the adult population in the UK has diagnosed hypertension, and other … Read more

What are the causes of unnecessary antibiotic prescribing?

 

 

By Christie Cabral, Research Fellow, Centre for Academic Primary Care, University of Bristol

Why do parents seeking evaluation, reassurance and information about their child’s cough end up with antibiotics from their GP? Research fellow Christie Cabral looks at the evidence.

GPs see a lot of children with respiratory tract infections (RTIs), usually presenting with a cough, high temperature or both. RTIs can be distressing and disruptive for children and parents but are mostly viral illnesses that will get better on their own: there is little that a GP can do to treat them.

However, many are prescribed unnecessary antibiotics that can lead to resistant bacteria. From our previous research, we know that parents often feel uncertain about the severity of an RTI and feel that it’s safer to consult a doctor.

They are usually seeking a medical evaluation, reassurance and information to help them understand and … Read more

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

 

 

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

 

 

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