New study on GP and patient experiences of primary care for insomnia published in Health Expectations

Meeting1A new interview study from members of the CaHRU team, ‘Patients’ and clinicians’ experiences and perceptions of the primary care management of insomnia: qualitative study‘ provides further insights into primary care management of insomnia. The study team interviewed 28 patients and 23 health professionals (GPs, nurse, mental health workers and community pharmacists) and analysed the transcripts of these discussions.


Desk1They found that practitioners focused on treating the cause of insomnia rather than the insomnia itself, used sleep hygiene (which patients often disregarded) rather than cognitive behavioural therapy for insomnia and were ambivalent towards hypnotic drugs. They often prescribed hypnotics in ‘collusion’ with patients to prescribe to avoid confrontation or express empathy. Patients sometimes took hypnotics in ways that were not intended by their doctors, for example together with over-the-counter medication.


P011354Both practitioners and patients were sometimes but not always concerned about addiction which led practitioners to sometimes prescribe despite these concerns but at other times withdraw hypnotics abruptly. Both patients and practitioners wanted more options and better training for the management of insomnia in primary care. The authors concluded that a better understanding of the current approaches and difficulties in the management of insomnia will help to inform more therapeutic options and health professional training. These findings build on previous work as part of the REST project ( which also led to development of an e-learning programme on insomnia (

New study on GPs’ experiences of benzodiazepine prescribing published in BMC Family Practice

Left to right: Hanne Creupelandt, Sibyl Anthierens, Susan Chipchase and Coral Sirdifield

Left to right: Hanne Creupelandt, Sibyl Anthierens, Susan Chipchase and Coral Sirdifield

A new study has been published in BMC Family Practice on’General practitioners’ experiences and perceptions of benzodiazepine prescribing: systematic review and meta-synthesis‘. The study was conducted by teams of researchers from the Universities of Lincoln (Coral Sirdifield, Susan Chipchase, Niro Siriwardena), Antwerp (Sibyl Anthierens) and Ghent (Hanne Creupelandt, Thierry Christiaens) who have been working on benzodiazepine and sleeping tablet prescribing by family doctors over the past decade.


Ghentc750The investigators systematically reviewed and synthesised the qualitative literature on benzodiazepine prescribing by family doctors. The analysis of eight studies from seven countries published between 1993 and 2010 showed that prescribing decisions for benzodiazepines were complex, uncomfortable, and demanding. There was variation between GPs and in individual GPs in the extent to which they were willing to prescribe benzodiazepines. GPs were ambivalent and inconsistent in attitudes towards benzodiazepines prescribing because of the changing context of prescribing, differing perceptions of the role and responsibility of the GP, variation in GPs’ attitudes to benzodiazepines, perceived lack of alternative treatment options and GPs’ perception of patient expectations and the doctor-patient relationship.

Model of factors influencing benzodiazepine prescribing

Model of factors influencing benzodiazepine prescribing

The model developed by the research team could be used to inform future interventions to improve adherence to benzodiazepine prescribing guidance and improve prescribing. This could be brought about through various means including education and training of professionals on benzodiazepine use and withdrawal, greater provision of alternatives to drugs, reflective practice, and better communication with patients.

First published randomised controlled trial of paramedic administered therapy for ultra-acute stroke


Professor Niro Siriwardena from the Community and Health Research Unit joined study lead, Professor Philip Bath, and Dr Sandeep Ankolekar (from the University of Nottingham) together with a team from Nottingham University Hospitals and East Midlands Ambulance Service (EMAS) NHS trusts to complete the first ever randomised trial worldwide of paramedic treatment of ultra-acute stroke, the RIGHT trial published in the journal Stroke.

There is a strong link between (both high and low) blood pressure in patients in the early stages of stroke and future death and disability. Glyceryl trinitrate (GTN) or nitroglycerin, which is more commonly used in the treatment of angina or heart attack, was administered by paramedics from EMAS as a skin patch to lower blood pressure in the RIGHT (Rapid Intervention with GTN in Hypertensive Stroke) trial.

The trial was designed to test the safety of GTN in ultra-acute stroke and the feasibility of paramedics diagnosing, consenting, randomising and treating intervention patients in the emergency prehospital setting. In the study, published this month in the journal Stroke, 41 patients were randomised by 23 (out of 78) trained paramedics to GTN or no GTN.

Intervention patients had a significantly lower systolic blood pressure at two hours and also significantly improved functional status at 90 days with treatment. Patients given GTN were no more likely to die or suffer and adverse event. GTN may act by lowering systolic blood pressure which may be harmful in acute stroke or through some other mechanism such as neuroprotection, immunoregulation or vasodilation of cerebral arteries or small blood vessels. The study will form the basis for future studies of ambulance-based trials of stroke.

New book published on Prehospital Emergency Medicine

ABCPHMcoverA new book, the ABC of Prehospital Emergency Medicine, edited by Tim Nutbeam and Matthew Boylan has been released this month. The book is written for doctors (emergency physicians, general practitioners), nurses and paramedics training in prehospital emergency health care.

It includes a final chapter on ‘Research and development in Prehospital Emergency Medicine‘ written by Profs. Suzanne Mason (Sheffield University) and Niro Siriwardena (University of Lincoln).

The text includes 38 chapters covering a wide scope of causative factors, clinical conditions, and patients seen in this setting and as the editors state in their preface, seeks to provide an “accessible, cutting edge, expert opinion on core PHEM topics”.

Building bridges in primary care: International Federation launch


The Bosphorus Bridge joining Europe and Asia

Members of the European Forum for Primary Care (EFPC) and delegates from over 30 countries joined together in the EFPC conference whose theme was Balancing The Primary And Secondary Care Provision For More Integration and Better Health Outcomes“. This was a landmark conference, symbolic in being held in the historic city of Istanbul, Turkey where Europe bridges Asia across the Bosphorus.

New members of the EFPC advisory board

New members of the EFPC advisory board: Sophie Rodebjer (Dietician, Sweden) and Marije Bolt (Occupational Therapist, Netherlands)

The conference was an opportunity to build new bridges and restate the values of the EFPC which include community and person-orientated primary care, multiprofessionalism, social justice and inclusivity. As a result of a reorganisation the EFPC established a smaller executive chaired by Jan de Maeseneer (Gent, Belgium) and a new larger interdisciplinary advisory board which includes nursing, allied health (occupational therapy, dietetics, physiotherapy), health economics and general practice from many of the EU member states. In addition, the EFPC Alliance for Community Oriented Primary Care joined with counterparts in Australia, Canada, the United States and globally to form the International Federation of Community Health Centres (IFCHC)to share experiences and knowledge on the potential for CHCs to improve health and access to health care for populations around the world.



The conference had excellent keynotes on “Future challenges for the EU health workforce” (Katja Neubauer, EC), Developing regional action framework for coordinated/integrated health services delivery in the WHO European region” (Dr Hans Kluge, WHO), “The contribution of nurses in future proof health care” (Marieke Schuumans, University of Applied Sciences

The blue mosque

The blue mosque

Utrecht) and “Integration: examples from Turkey and Europe” (Prof. Mehtap Tatar). There were also keynotes from Dr Pavlos Theodorakis (Greek Ministry of Health) on the financial crisis and primary care in Greece and from Dr Cagri Kalaca (CEO Saglik Bahcesi) on learning pathways.

Making wishes

Lighting wishes over the Bosphorus

The conference was also an opportunity for Prof. Niro Siriwardena (EFPC advisory board) to present joint work from the Universities of Lincoln and Gent on “A meta-synthesis of clinicians’ experiences and perceptions of benzodiazepine prescribing: developing and integrated approach for care of insomnia and sleep problems”.