Is there value in GPs diagnosing an anxiety disorder?

 

 

 

by Charlotte Archer, Senior Research Associate in Primary Care Mental Health, and Katrina Turner, Professor of Primary Care Research, Centre for Academic Primary Care, University of Bristol

Research has shown that fewer people in primary care are now being diagnosed with anxiety than in the past, despite reports that rates of anxiety have increased in the general population. Individuals with anxiety may be reluctant to seek help for their symptoms. They may also find it difficult to talk to their GP about their mental health or may normalise their symptoms.

Although most anxiety is managed in primary care by GPs, we know very little about whether GPs and patients think it is important to diagnose and manage anxiety disorders. Knowing this might help us identify possible reasons for the decline in their recording, and the potential impact of this on patient care and … Read more

International Women’s Day 2021 – Q&A with Dr Alison Gregory

As a research centre, we are proud to host a fantastic team specialising in sexual and domestic violence and abuse and their impacts on health. What better way to mark this year’s International Women’s Day than to focus on the work of an outstanding member of the team, Dr Alison Gregory, whose recent investigations have focused on the role of friends, family, neighbours and colleagues (informal supporters) in the lives of domestic abuse survivors.

In this Q&A, Alison reflects on the challenges of working on a sensitive topic with a vulnerable population group, made all the more critical during this time of pandemic and the ‘shadow’ pandemic, which has seen rates of domestic abuse soar globally.

Your research activities have focused on Covid-19 recently. Could you tell us a little more? 
I’ve been researching the role of friends, family members, neighbours, and colleagues (informal supporters) in the lives of … Read more

Extending the IRIS domestic violence model to other patient groups

 

 

by Dr Eszter Szilassy, Research Fellow, Centre for Academic Primary Care, University of Bristol

Primary care plays a key role in responding to patients experiencing or perpetrating domestic violence and abuse regardless of their gender, age, sexuality, or experience. There is, however, uncertainty about the value and effectiveness of integrated training and support programmes addressing the needs of all patients affected by domestic abuse.

IRIS (Identification and Referral to Improve Safety) is a broadly commissioned, evidence-based primary care training and support programme designed to reach female survivors of domestic violence and abuse through general practice. The IRIS+ (Enhanced Identification and Referral to Improve Safety) study tested the feasibility of an adaptation of IRIS for all patients affected by domestic abuse, including men and children.

Reaching everyone in general practice?

Challenges to applying the IRIS domestic violence model to other patient groups have been highlighted by the … Read more

Should we be concerned about declining continuity of primary care?

 

 

 

by Peter Tammes, Mairead Murphy and Chris Salisbury, Centre for Academic Primary Care, University of Bristol

Decreasing trend of continuity of care

Seeing the same GP over time is highly valued by most patients and GPs in the UK. This is known as ‘continuity of care’ and it is linked with lower healthcare costs, more satisfied patients, fewer emergency hospital admissions and even with reduced mortality.

Given these multiple benefits, one would expect it to be highly prioritised. However, our recently published study in the British Journal of General Practice shows that continuity of care declined steadily between 2012 and 2017. On average, the percentage of patients who reported to have a preferred GP declined by nine percentage points and the percentage who can usually see their preferred GP declined by 10 percentage points.

Is decreasing continuity of care a concern?

Decreasing continuity is … Read more

Primary care and the maintenance of abstinence in alcohol dependence: what might work?

 

 

 

 

by Dr Vincent Cheng, Senior Research Associate in Research Synthesis, Bristol Medical School and Professor David Kessler, Professor of Primary Care, Centre for Academic Primary Care and Centre for Academic Mental Health,  University of Bristol

The problem

Specialist alcohol treatment services cannot cope with the growing problem of alcohol use disorder. Even before the recent COVID-19 lockdown, it was estimated that more than 80% of those in need of treatment were not receiving it. The predicted economic downturn is not likely to improve this figure. Given that primary care is universally accessible in the UK, we were interested in bringing together the evidence on what interventions could be delivered in primary care.

We conducted a systematic review and network meta-analysis of treatments (psychological, pharmacological, or both) for maintaining abstinence in recently detoxified, alcohol dependent adults that could be delivered in a community setting. … Read more

Tech-enhanced academic writing

 

 

by Dr Yvette Pyne, GP and Academic Clinical Fellow, Centre for Academic Primary Care, University of Bristol

Coronavirus has completely changed how we work across most professions including in academic research. While those impromptu conversations around the coffee machine at work, or over drinks at academic conferences seem both a distant memory and a far-flung future dream, there have been some wins for collaborative working as well. Lockdown has brought both technological improvements and culture-change around the use of video conferencing and collaboration tools. A colleague – Dr Stuart Stewart based at the University of Manchester and I (based at the University of Bristol) have been “meeting” once a week to discuss the creation of a concept paper covering ideas that have been percolating for years after a fortuitous meeting at a conference in 2018. Both of us are tech-adept and we often discuss ways … Read more

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

‘Not just on the surface’: Improving support for patients with skin problems

by Emma Le Roux, GP with a dermatology special interest. Formerly Senior Clinical Research Fellow (NIHR-in-Practice) at the Centre for Academic Primary Care, University of Bristol

Skin problems are among the most common reasons patients to go to the doctor. As a GP, I often reflect on the patients I see, such as the 35-year-old man who suffers with psoriasis. Over 15 years he has struggled with managing his itchy skin symptoms but of more concern to him is his related low self-esteem. Because of the appearance of his skin he felt unable to take part in leisure activities, such as taking his son swimming. He lacked understanding of treatment options and was unaware of the condition’s associations with arthritis and cardiovascular disease. His experience reflects the evidence that skin problems are known to have a heavy physical and psychosocial burden.

Most patients with skin problems … 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