Category Archives: Publications

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To be or not to be LGBT in Primary Health Care

An analysis and commentary paper on lesbian, gay, bisexual and transgender primary care has been published in the British Journal of General Practice.

Lesbian, Gay, Bisexual and Transgender (LGBT) primary healthcare will, increasingly, be a feature of the primary care repertoire. Pride in Practice, which is supported by the RCGP, provides a rating system that judges primary care surgeries on a welcoming environment, access, the general practitioner (GP) – patient consultation, staff awareness and training and health promotion for LGBT people. For those surgeries signed up to the initiative, plans to address shortfalls will be developed in consultation with the Lesbian and Gay Foundation.

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Pay-for-performance with caution: new systematic review published in Annals of Family Medicine

A new systematic review of the UK Quality and Outcomes Framework (QOF) is published in the Annals of Family Medicine today. The QOF, a controversial program of financial incentives and information technology to promote structured and team-based care, is the most comprehensive national primary care pay-for-performance (P4P) program in the world.

The authors, Steve Gillam (University of Cambridge), Niro Siriwardena (University of Lincoln) and Nick Steel (University of East Anglia) found, despite an annual investment of over a billion pounds per year in incentives,  only modest improvements since the QOF was introduced in 2004. The systematic review follows on from a book, co-edited by Steve Gillam and Niro Siriwardena entitled ‘The QOF: transforming general practice’ published in 2010.

The QOF has also contributed to reduced continuity of care and may have detracted from patient-centred care. In view of the findings policy makers should be cautious about implementing similar P4P programs.  Systems need to be developed which improve quality while minimizing costs and unintended consequences.

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Women and men doctors differ in their knowledge of sex-specific complaints during general practice training

A new study from the University of Lincoln and the Royal College of General Practitioners (RCGP) Applied Knowledge Test Development Group reveals that women doctors have greater knowledge about women’s medical problems than men doctors during their training to become general practitioners. The study entitled, ‘Comparing performance among male and female candidates in sex- specific clinical knowledge in the MRCGP‘, was published in the British Journal of General Practice this month and is the first to look at sex-specific clinical knowledge in a medical licensing examination. The Applied Knowledge Test is a component of the Membership of the Royal College of General Practitioners, which doctors training to be GPs need to pass to be deemed fit for independent practice.

Many female patients choose to see a woman doctor, because they feel more at ease with their communication style or feel more confident in their knowledge of women’s medicine. This study shows that on average women doctors know more about women’s medicine than men at a similar stage of training and after taking other factors into account – so women may be justified in choosing a woman doctor on this basis. Conversely male doctors in training did not appear to know more about men’s problems.

The reason for this difference is a matter for speculation. Women doctors are much more likely to see more female patients during training and might be encouraged to learn more about women’s problems as a result of this greater exposure as well as through their own personal experience. The implication for GP training schemes is that they should ensure that male GP trainees are enabled to see more women patients or learn more about women’s medicine so that patients consulting male trainees are not disadvantaged.

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ASCQI presented at International Forum on Quality and Safety in Health Care in Paris, April

In April 2012 Professor Niro Siriwardena and Fiona Togher travelled to Paris with colleagues, Nadya Essam, Debbie Shaw (East Midlands Ambulance Service [EMAS]) and David Francis (East of England Ambulance Service) to attend the 17th International Forum on Quality and Safety in Healthcare.

The team presented work undertaken as part of the Ambulance Service Cardiovascular Quality Initiative (ASCQI) a two year nationwide project involving all 12 ambulance trusts in England and the University of Lincoln funded by the Health Foundation.

From the 2,000 poster submissions that were originally received, around 900 were selected for display following a two stage peer review process. Fiona, Nadya and Debbie were all invited to present their work during the poster presentation session held. This provided a brilliant opportunity to talk to interested delegates from around the world about the quality improvement work and research that is being undertaken at the University and East Midlands Ambulance Service.

Fiona Togher

Fiona represented the IS-PROVE team, which also includes Professor Siriwardena and Dr Zowie Davy. Their poster entitled “The importance of qualitative methods for generating patient reported outcome measures and patient reported experience measures for pre-hospital and emergency care of stroke and heart attack” attracted attention from French, Swedish and American delegates that were keen to find out more. Nadya Presented on ergonomic redesign to improve care for heart attack and Debbie presented on ‘Joining the dots’ and the use of annotated control charts for quality improvement in ASCQI.

Debbie Shaw

With a tough act to follow from last years’ excellent event in Amsterdam, Paris was just as enjoyable,  thought provoking and inspiring. The key note speakers were again outstanding and captivated the audiences with their motivational reflections on working in health care and how to improve the quality of care provided to patients.

The opening keynote by Maureen Bisagnano from the Institute for Healthcare Improvement focused on goal oriented patient care, ‘what matters to patients’ and the redesign of services for patients. We heard about leadership from Dr David Williams, a Canadian professor of surgery who has been an astronaut and now leads a regional health organisation in Toronto.

Another highlight of the conference was the session entitled “Delivering better care to rural communities inAfrica” which focused on the application of quality improvement methods including Plan, Do, Study, Act cycles, to reducing asphyxia in newborn babies and mortality rates in children under the age of five. The success of the initiatives was amazing, more so because of the limited resources of equipment and manpower available.

Nadya Essam

One of the most inspiring speeches was given by Dr. Nancy Snyderman, who is not only a paediatrician and an ENT surgeon but also chief medical editor for NBC news in America – and an award winning journalist! Her speech focused on the importance of listening to patients and hearing what they are actually saying as opposed to what health care professionals presume they are saying. This central message resonated with what we are aiming to achieve through the patient experience studies that we are conducting in prehospital care in Lincoln and EMAS.

The take home message from this conference was that the application of quality improvement methodologies makes a real difference to the standard of care that is provided to patients; there were hundreds of examples of fantastic successes from around the world and in some instances the evidence translated to a significant contribution of quality improvement projects to saving lives.

Fiona Togher and Niro Siriwardena

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Strategies to increase influenza vaccination rates in general practice features in annual Chief Medical Officer’s guidance

A new study has been published on organisational factors associated with practice success in the annual seasonal influenza vaccination programme in BMJ Open, the new open access journal from the BMJ.

 

The study entitled ‘Strategies to increase influenza vaccination rates: outcomes of a nationwide cross-sectional survey of UK general practice‘ was led by Dr Laura Dexter, virologist, while based in Sheffield University under Prof Robert Read with collaboration from Niro Siriwardena at the University of Lincoln.

The study was funded by the NIHR Policy Research Programme to determine how to improve flu vaccination rates in at-risk groups in the UK. Flu vaccine uptake is below the national and international target of 75% particularly in the under 65-year-old age group. This study used an online survey to GPs, nurses and practice managers to identify which strategies and procedures reported were associated with higher rates of flu vaccine uptake. The recommendations have been summarised in annual guidance in the seasonal flu plan (Annex B – GP practice checklist p11-12) from the UK Chief Medical Officer, Dame Professor Sally Davies.

The study builds on previous work led by Niro Siriwardena on methods to improve influenza and pneumococcal vaccination rates in primary care and in general practice in Lincolnshire which led to a definitive cluster randomised controlled study of an educational intervention for general practice. The Community and Health Research Group are also working on the role of influenza vaccination in preventing cardiovascular disease. After studies showing a reduction in risk of heart attack linked to influenza vaccination (published in the Canadian Medical Association Journal and Vaccine) the team are now working on a case-control study to investigate potential role for influenza and/or pneumococcal vaccination in prevention against stroke and transient ischaemic attack (IPVASTIA), funded by the NIHR Research for Patient Benefit programme.

The new study in BMJ Open has identified seven key strategies that were significantly associated with the success of practices’ seasonal flu vaccination campaigns which include leadership (a named responsible flu lead), ordering sufficient vaccines, up-to-date registers of patients at risk, starting the programme early, robust call and recall arrangements, offering appointments and opportunistically vaccination, and working with community midwives for vaccination in pregnancy. If widely implemented by general practices, these strategies could improve vaccination rates by 7% to 8%. The learning has been publicised in professional magazines and translated into an online learning module for GPs which is having impact on professional practice.