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  • 1
    Online Resource
    Online Resource
    Provision of services in primary care for type 2 diabetes: a qualitative study with patients, GPs, and nurses in the East of England
    Royal College of General Practitioners ; 2020
    In:  British Journal of General Practice Vol. 70, No. 698 ( 2020-09), p. e668-e675
    Details
    In: British Journal of General Practice, Royal College of General Practitioners, Vol. 70, No. 698 ( 2020-09), p. e668-e675
    Abstract: There is little evidence on the impact of national pressures on primary care provision for type 2 diabetes from the perspectives of patients, their GPs, and nurses. Aim To explore experiences of primary care provision for people with type 2 diabetes and their respective GPs and nurses. Design and setting A qualitative primary care interview study in the East of England. Method Semi-structured interviews were conducted, between August 2017 and August 2018, with people who have type 2 diabetes along with their respective GPs and nurses. Purposive sampling was used to select for heterogeneity in glycaemic control and previous healthcare experiences. Interviews were audio-recorded and analysed thematically. The consolidated criteria for reporting qualitative research were followed. Results The authors interviewed 24 patients and 15 GPs and nurses, identifying a changing landscape of diabetes provision owing to burgeoning pressures that were presented repeatedly. Patient responders wanted GP-delivered care with continuity. They saw GPs as experts best placed to support them in managing diabetes, but were increasingly receiving nurse-led care. Nurses reported providing most of the in-person care, while GPs remained accountable but increasingly distanced from face-to-face diabetes care provision. A reluctant acknowledgement surfaced among GPs, nurses, and their patients that only minimum care standards could be maintained, with aspirations for high-quality provision unlikely to be met. Conclusion Type 2 diabetes is a tracer condition that reflects many aspects of primary care. Efforts to manage pressures have not been perceived favourably by patients and providers, despite some benefits. Reframing expectations of care, by communicating solutions to both patients and providers so that they are understood, managed, and realistic, may be one way forward.
    Type of Medium: Online Resource
    ISSN: 0960-1643 , 1478-5242
    URL: Article
    DOI: 10.3399/bjgp20X710945
    RVK:
    XA 34050
    Language: English
    Publisher: Royal College of General Practitioners
    Publication Date: 2020
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  • 2
    Online Resource
    Online Resource
    Clustering populations by health and social care with multiple long-term conditions: a cohort study — the English Longitudinal Study of Ageing (ELSA)
    Royal College of General Practitioners ; 2023
    In:  British Journal of General Practice Vol. 73, No. suppl 1 ( 2023-07), p. bjgp23X734337-
    Details
    In: British Journal of General Practice, Royal College of General Practitioners, Vol. 73, No. suppl 1 ( 2023-07), p. bjgp23X734337-
    Abstract: The integration of health and social care services is a potential solution for improving care, despite monetary constraints and increasing demand. How two or more multiple long-term conditions (MLTC) cluster, interact and associate with socioeconomic factors, and affect access to unscheduled primary healthcare services is understudied. Aim To cluster an MLTC population by health and social care, examine clusters, and quantify associations with health outcomes. Method A retrospective cohort study was conducted using the ELSA database (2002 to 2019) on 19802 participants aged ≥50 years. Ten major health conditions, and social care need, including difficulty in activities of daily living (ADL) and mobility, for example, were used to cluster MLTC by latent class modelling. Multivariate logistic regression models were used to establish further association. Results The mean age of the participants at baseline (wave 2) was about 66 years and 55% of participants were female, with more than 60% developing MLTC in their lifetime (waves 2 to 9). Of the five distinct latent clusters, cluster 5 was the most significant cluster composed of lung diseases, stroke, dementia, and high ADL and mobility difficulty scores. The majority of the participants were aged 70–79 years, female, and married. The odds of having a longer nursing home stay were 8.97 (95% confidence interval = 4.36 to 18.45), and death was 10% higher in this cluster compared to the highest probability cluster 4 in the maximally adjusted regression model. Conclusion This study identified MLTC clusters by social care need with the highest primary care demand. Targeting clinical practice to prevent MLTC progression for these groups may lessen future pressures on primary care demand.
    Type of Medium: Online Resource
    ISSN: 0960-1643 , 1478-5242
    URL: Article
    DOI: 10.3399/bjgp23X734337
    RVK:
    XA 34050
    Language: English
    Publisher: Royal College of General Practitioners
    Publication Date: 2023
    detail.hit.zdb_id: 2097982-4
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  • 3
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    Quantifying empathy levels among UK undergraduate medical students: an online survey
    Royal College of General Practitioners ; 2020
    In:  British Journal of General Practice Vol. 70, No. suppl 1 ( 2020-06), p. bjgp20X711293-
    Details
    In: British Journal of General Practice, Royal College of General Practitioners, Vol. 70, No. suppl 1 ( 2020-06), p. bjgp20X711293-
    Abstract: Empathy is a key health care concept and refers to care that incorporates understanding of patient perspective’s, shared decision making, and consideration of the broader context in which illness is experience. Evidence suggests experiences of doctor empathy correlate with improved health outcomes and patient satisfaction. It has also been linked to job satisfaction, and mental wellbeing for doctors. To date, there is a paucity of evidence on empathy levels among medical students. This is critical to understand given that it is a key point at which perceptions and practices of empathy in the longer term might be formed. Aim To quantify the level of empathy among UK undergraduate medical students Method An anonymised cross-sectional online survey was distributed to medical students across three universities. The previously validated Davis’s Interpersonal Reactivity Index was used to quantify empathy. The survey also collected information on age, sex, ethnicity, year of medical school training and included a free-text box for ‘any other comments’. Results Data analysis is currently underway with high response rates. Mean empathy scores by age, sex, year of study and ethnic group are presented. A correlation analysis will examine associations between age and year of study, and mean empathy sores. Conclusion These data will help to provide a better understanding of empathy levels to inform the provision of future empathy training and medical school curriculum design. Given previous evidence linking experiences of empathy to better health outcomes, the findings may also be significant to future patient care
    Type of Medium: Online Resource
    ISSN: 0960-1643 , 1478-5242
    URL: Article
    DOI: 10.3399/bjgp20X711293
    RVK:
    XA 34050
    Language: English
    Publisher: Royal College of General Practitioners
    Publication Date: 2020
    detail.hit.zdb_id: 2097982-4
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  • 4
    Online Resource
    Online Resource
    The diabetes annual review in a postal box: a qualitative study exploring views of people with diabetes
    Royal College of General Practitioners ; 2023
    In:  British Journal of General Practice Vol. 73, No. suppl 1 ( 2023-07), p. bjgp23X733605-
    Details
    In: British Journal of General Practice, Royal College of General Practitioners, Vol. 73, No. suppl 1 ( 2023-07), p. bjgp23X733605-
    Abstract: People with diabetes who do not attend their annual review appointments often have poorer glycaemic control and increased complication rates. A postal kit for self-collection of blood tests, urine samples, and anthropometric data may facilitate remote annual reviews and improve uptake. Aim To explore views on a postal kit for annual review among people with diabetes and to collaborate with people living with diabetes to design and expand the scope of an annual review postal kit. Method We conducted semi-structured interviews and focus groups with adults with type 1 and type 2 diabetes. Purposive sampling was used to ensure 50% of study invites went to infrequent attenders of annual review appointments. Transcripts were collated and analysed thematically. Results Twenty-two participants took part, including nine infrequent attenders. All infrequent attenders and the majority of regular attenders responded positively to a postal kit, with convenience being the most prominent value described. Concerns raised related to personal capability of self-collection and the accuracy of results. Participants were asked for suggestions to improve the kit. The most common themes related to communication; participants wanted clearer information regarding the purpose of each test; they wanted feedback of their results through either a website or app with tailored advice for each result; and they wanted to utilise the kit to communicate their priorities for discussion at future consultations. Conclusion Postal kits for annual reviews were well-received by people living with diabetes. Designed well, they have the potential to overcome far more than just the physical barriers to annual review attendance.
    Type of Medium: Online Resource
    ISSN: 0960-1643 , 1478-5242
    URL: Article
    DOI: 10.3399/bjgp23X733605
    RVK:
    XA 34050
    Language: English
    Publisher: Royal College of General Practitioners
    Publication Date: 2023
    detail.hit.zdb_id: 2097982-4
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  • 5
    Online Resource
    Online Resource
    Sickle Cell Disorders and Severe COVID-19 Outcomes: A Cohort Study
    American College of Physicians ; 2021
    In:  Annals of Internal Medicine Vol. 174, No. 10 ( 2021-10), p. 1483-1487
    Details
    In: Annals of Internal Medicine, American College of Physicians, Vol. 174, No. 10 ( 2021-10), p. 1483-1487
    Type of Medium: Online Resource
    ISSN: 0003-4819 , 1539-3704
    URL: Article
    DOI: 10.7326/M21-1375
    RVK:
    XA 23600
    Language: English
    Publisher: American College of Physicians
    Publication Date: 2021
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  • 6
    Online Resource
    Online Resource
    Patients’ views on interactions with practitioners for type 2 diabetes: a longitudinal qualitative study in primary care over 10 years
    Royal College of General Practitioners ; 2018
    In:  British Journal of General Practice Vol. 68, No. 666 ( 2018-01), p. e36-e43
    Details
    In: British Journal of General Practice, Royal College of General Practitioners, Vol. 68, No. 666 ( 2018-01), p. e36-e43
    Abstract: It has been suggested that interactions between patients and practitioners in primary care have the potential to delay progression of complications in type 2 diabetes. However, as primary care faces greater pressures, patient experiences of patient–practitioner interactions might be changing. Aim To explore the views of patients with type 2 diabetes on factors that are of significance to them in patient–practitioner interactions in primary care after diagnosis, and over the last 10 years of living with the disease. Design and setting A longitudinal qualitative analysis over 10 years in UK primary care. Method The study was part of a qualitative and quantitative examination of patient experience within the existing ADDITION-Cambridge and ADDITION-Plus trials from 2002 to 2016. The researchers conducted a qualitative descriptive analysis of free-text comments to an open-ended question within the CARE measure questionnaire at 1 and 10 years after diagnosis with diabetes. Data were analysed cross-sectionally at each time point, and at an individual level moving both backwards and forwards between time points to describe emergent topics. Results At the 1-year follow-up, 311 out of 1106 (28%) participants had commented; 101 out of 380 (27%) participants commented at 10-year follow-up; and 46 participants commented at both times. Comments on preferences for face-to-face contact, more time with practitioners, and relational continuity of care were more common over time. Conclusion This study highlights issues related to the wider context of interactions between patients and practitioners in the healthcare system over the last 10 years since diagnosis. Paradoxically, these same aspects of care that are valued over time from diagnosis are also increasingly unprotected in UK primary care.
    Type of Medium: Online Resource
    ISSN: 0960-1643 , 1478-5242
    URL: Article
    DOI: 10.3399/bjgp17X693917
    RVK:
    XA 34050
    Language: English
    Publisher: Royal College of General Practitioners
    Publication Date: 2018
    detail.hit.zdb_id: 2097982-4
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  • 7
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    Online Resource
    Clinical scores in primary care
    Royal College of General Practitioners ; 2020
    In:  British Journal of General Practice Vol. 70, No. 693 ( 2020-04), p. 163-163
    Details
    In: British Journal of General Practice, Royal College of General Practitioners, Vol. 70, No. 693 ( 2020-04), p. 163-163
    Type of Medium: Online Resource
    ISSN: 0960-1643 , 1478-5242
    URL: Article
    DOI: 10.3399/bjgp20X708941
    RVK:
    XA 34050
    Language: English
    Publisher: Royal College of General Practitioners
    Publication Date: 2020
    detail.hit.zdb_id: 2097982-4
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  • 8
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    Change in treatment burden among people with multimorbidity: a follow-up survey
    Royal College of General Practitioners ; 2022
    In:  British Journal of General Practice Vol. 72, No. 724 ( 2022-11), p. e816-e824
    Details
    In: British Journal of General Practice, Royal College of General Practitioners, Vol. 72, No. 724 ( 2022-11), p. e816-e824
    Abstract: Treatment burden is the effort required of patients to look after their health and the impact this has on their functioning and wellbeing. Little is known about change in treatment burden over time for people with multimorbidity. Aim To quantify change in treatment burden, determine factors associated with this change, and evaluate a revised single-item measure for high treatment burden in older adults with multimorbidity. Design and setting A 2.5-year follow-up of a cross-sectional postal survey via six general practices in Dorset, England. Method GP practices identified participants of the baseline survey. Data on treatment burden (measured using the Multimorbidity Treatment Burden Questionnaire; MTBQ), sociodemographics, clinical variables, health literacy, and financial resource were collected. Change in treatment burden was described, and associations assessed using regression models. Diagnostic test performance metrics evaluated the revised single-item measure relative to the MTBQ. Results In total, 300 participants were recruited (77.3% response rate). Overall, there was a mean increase of 2.6 (standard deviation 11.2) points in treatment burden global score. Ninety-eight (32.7%) and 53 (17.7%) participants experienced an increase and decrease, respectively, in treatment burden category. An increase in treatment burden was associated with having 〉 5 long-term conditions (adjusted β 8.26, 95% confidence interval [CI] = 4.20 to 12.32) and living 〉 10 minutes (versus ≤10 minutes) from the GP (adjusted β 3.88, 95% CI = 1.32 to 6.43), particularly for participants with limited health literacy (mean difference: adjusted β 9.59, 95% CI = 2.17 to 17.00). The single-item measure performed moderately (sensitivity 55.7%; specificity 92.4%. Conclusion Treatment burden changes over time. Improving access to primary care, particularly for those living further away from services, and enhancing health literacy may mitigate increases in burden.
    Type of Medium: Online Resource
    ISSN: 0960-1643 , 1478-5242
    URL: Article
    DOI: 10.3399/BJGP.2022.0103
    RVK:
    XA 34050
    Language: English
    Publisher: Royal College of General Practitioners
    Publication Date: 2022
    detail.hit.zdb_id: 2097982-4
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  • 9
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    Online Resource
    Books: The 10-Minute Clincial Assessment : A Systematic and Easy to Follow Guide — From Hirsutism to Heart Failure to Self-Harm
    Royal College of General Practitioners ; 2017
    In:  British Journal of General Practice Vol. 67, No. 658 ( 2017-05), p. 224.1-224
    Details
    In: British Journal of General Practice, Royal College of General Practitioners, Vol. 67, No. 658 ( 2017-05), p. 224.1-224
    Type of Medium: Online Resource
    ISSN: 0960-1643 , 1478-5242
    URL: Article
    DOI: 10.3399/bjgp17X690737
    RVK:
    XA 34050
    Language: English
    Publisher: Royal College of General Practitioners
    Publication Date: 2017
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  • 10
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    Integrating primary care and social services for older adults with multimorbidity: a qualitative study
    Royal College of General Practitioners ; 2021
    In:  British Journal of General Practice Vol. 71, No. 711 ( 2021-10), p. e753-e761
    Details
    In: British Journal of General Practice, Royal College of General Practitioners, Vol. 71, No. 711 ( 2021-10), p. e753-e761
    Abstract: Growing demand from an increasingly ageing population with multimorbidity has resulted in complex health and social care needs requiring more integrated services. Integrating primary care with social services could utilise resources more efficiently, and improve experiences for patients, their families, and carers. There is limited evidence on progress including key barriers to and drivers of integration to inform large-scale national change. Aim To elicit stakeholder views on drivers and barriers of integrated primary care and social services, and highlight opportunities for successful implementation. Design and setting A qualitative interview study. Method Semi-structured interviews with maximum variation sampling to capture stakeholder views across services and professions. Results Thirty-seven interviews were conducted across England with people including GPs, nurses, social care staff, commissioners, local government officials, voluntary and private sector workers, patients, and carers. Drivers of integration included groups of like-minded individuals supported by good leadership, expanded interface roles to bridge gaps between systems, and co-location of services. Barriers included structural and interdisciplinary tension between professions, organisational self-interest, and challenges in record sharing. Conclusion Drivers and barriers to integration identified in other contexts are also present in primary care and social services. Benefits of integration are unlikely to be realised if these are not addressed in the design and execution of new initiatives. Efforts should go beyond local- and professional-level change to include wider systems- and policy-level initiatives. This will support a more systems-wide approach to integrated care reform, which is necessary to meet the complex and growing needs of an ageing multimorbid population.
    Type of Medium: Online Resource
    ISSN: 0960-1643 , 1478-5242
    URL: Article
    DOI: 10.3399/BJGP.2020.1100
    RVK:
    XA 34050
    Language: English
    Publisher: Royal College of General Practitioners
    Publication Date: 2021
    detail.hit.zdb_id: 2097982-4
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