There is good agreement about the sort of care that people with multimorbidity need. But can it be delivered in the busy setting of general practice, and does it improve outcomes? In this blog we discuss the results of the 3D trial, the largest study of an intervention for multimorbidity published to date.
Managing multimorbidity is a litmus test for modern health care systems. Patients with many long-term conditions face major challenges in managing their conditions and need significant support, which means that these patients are often associated with high costs.
Despite the complexity of caring for these patients, there is also significant agreement about what sort of care they need. Many authors have highlighted that patient-centred care is crucial, … Read more
Person-centred healthcare is accepted as desirable on moral grounds and because it potentially leads to better health outcomes, greater efficiency and less waste. It means both involvement of individuals in their healthcare and individualisation of care.
The NHS has been chasing the goal of person-centred care planning for several years and there are many good examples of innovation. The ‘House of Care’ describes what it might mean in practice for people with long-term conditions. At its heart is personalised care planning, taking account of patients’ expressed needs and priorities. The national new models of care programme, involving 50 vanguard sites, is also pursuing this goal and recently reported on lessons learnt. Many of the vanguards have invested in health coaching and communication skills training for clinicians.
I recently worked on a large research project, … Read more
“How important are informal supporters of women experiencing domestic violence?”: “Very” – a simple answer to a complicated question. The bottom line, in terms of statistics, is that if survivors disclose their situation to anyone, it will most likely be to informal supporters (friends, relatives, neighbours and colleagues) rather than professionals.1 And this is true across the world, with research indicating that sometimes a disclosure to an informal supporter happens alongside a disclosure to a professional, but frequently this is not the case.2-5 In addition, it is not unusual for informal supporters to witness abusive behaviours, but commonly they are uncertain about what exactly it is that they are seeing, in particular, what it means, and what their role in the situation should be.6 ,7
Have you ever planned to do some writing, only to find yourself distracted by emails and ‘urgent’ tasks? Do you find you have a growing list of unpublished papers and grant proposals to write? Does it feel as if there is never enough time to get going with your writing?
As academics, writing is arguably our most important task. The mantra ‘publish or perish’ is not just a matter of prestige and a means to academic career progression. Nor is it simply about keeping our University rankings within the Research Excellence Framework. It is an ethical imperative.
Most medical research is funded either through taxpayers’ money or through charitable donations and relies on the trust and goodwill of voluntary research participants. This is both a privilege and responsibility. We must ensure that money … Read more
Image credit: Doctor and patient – Government of Alberta. Creative Commons License 2.0 (Non-commercial No Derivatives). Source: Flickr: https://www.flickr.com/photos/governmentofalberta/21221196734
In a systematic review published this month, we identified 153 communication skills training interventions for generalists in end of life care. In randomised controlled trials, training improved showing empathy and discussing emotions in simulated interactions (i.e. with actor patients) but evidence of effect on clinician behaviours during real patient interactions, and on patient-reported outcomes, was inconclusive.
The global increase in the proportion of older people and length of life means providing end of life care is now increasingly the responsibility of generalist as well as specialist palliative care providers. But many clinicians find communicating about end of life issues challenging: how do you best discuss imminent mortality, limited treatment options, what to … Read more
When I first became a health researcher, I felt that people would see taking part in research as a bother, a pain, or a waste of their time and that, by association, they would see me as akin to a nuisance caller, intent on coercing them into some unwanted activity. Thankfully, after 10 years doing research, it’s become apparent to me that this is far from the truth.
For a start, the tentativeness with which most of the researchers I know proceed as they recruit participants is anything but a hard-sell. In fact, due to necessarily stringent ethics and governance processes and practices, strict eligibility criteria, and a healthy dose of ‘only wanting to do what’s best for people’, we are possibly more in danger of being talked out of … Read more
A partnership and panel event to support NIHR School for Primary Care Research (SPCR) FR15/16 applications
Pre-grant public involvement is vital to relevant and successful research. It is considered the gold-standard approach. In practice, the issue is that before the grant is awarded, there are often no resources available to conduct high quality public and patient involvement (PPI).
With SPCR funding for pre-grant PPI supporting FR15/16 applications, we developed an event to carry out and promote early PPI at the Centre for Academic Primary Care. This served to achieve PPI for these rounds of SPCR applications, foster links between members of the public and researchers and establish early PPI as achievable and accepted culture.
The event comprised a public panel and parallel sessions of Partneropoly – an interactive game … Read more
Two individuals are supported by the NIHR School for Primary Care Research (NIHR SPCR) to attend the Oxford Leadership Programme every year. This year researchers Drs Alyson Huntley from the Centre for Academic Primary Care, University of Bristol and Sarah Tonkin-Crine, from the Nuffield Department of Primary Care Health Sciences, University of Oxford attended the first week of events at St Hughs’ College, Oxford.
As cohort#12 of the International Primary Care Research Leadership Programme we were lucky to stay at St Hugh’s College, Oxford during a very hot and sunny week in July. After arriving at the college on Sunday afternoon we were given our timetable and a list of our cohort members spanning the UK, Catalonia and … Read more
Most clinical trials are pragmatic in nature and aim to assess the effectiveness of a new treatment against ‘treatment as usual’. When interpreting trial results, researchers tend to focus primarily on what treatment participants in different trial arms received. This may be difficult in the usual care arm, as this arm is often poorly defined, whereas the intervention arm is often clearly defined prior to the trial starting. In addition, this focus is very narrow. Treatment is a process and patients’ experiences of accessing and receiving care could also influence their treatment outcomes, and thus the trial’s results.
A paper recently published in Trials highlights that differences do exist between the experiences of participants randomised to usual care and intervention arms. These differences relate not only to what treatment participants receive, but also how they access and engage with … Read more
I know this from working in both general practice and as a hospital doctor in A&E.
During the early stages of an illness it can be difficult for even the most experienced healthcare professionals to determine whether a patient has a minor self-limiting illness or is harbouring a more serious condition. In addition, growing problems such as antibiotic resistance and multimorbidity mean that sometimes even when a doctor makes a correct diagnosis, patients do not always get better with the first round of treatment and may require further medical help.
We cannot, and it is not clinically appropriate, to admit everyone to hospital to observe them until they feel 100% better.
That is why it is important that healthcare professionals provide patients with safety-netting advice. Safety-netting … Read more