Members of the CaHRU team attended the Society for Academic Primary Care Trent Regional Spring conference on Tuesday 15 March 2016 at College Court Conference Centre in Leicester. At the meeting were Drs. Zahid Asghar and Coral Sirdifield and PhD student Joseph Akanuwe (giving oral presentations), Dr Jo Middlemass and Jolien Vos (who led a workshop on multimorbidity), and Despina Laparidou, who gave a poster presentation. Prof Siriwardena was in attendance to support the team.
The Leicester Department of Primary Care and Diabetes Centre hosted the event on behalf of the Universities of Leicester, Nottingham, Sheffield and Lincoln, and as always it proved to be a worthwhile event with excellent keynote speakers and high quality presentations of research including from members of CaHRU. The opening keynote was given by Prof Maureen Baker, a Lincolnshire GP, who spoke on the ‘Future of General Practice’, describing the current problems of underfunding and poor morale and how general practice which deals with 90% of patient contacts with 9% of NHS funding can develop in future.
In the multimorbidity workshop Jolien Vos presented her doctoral study on, ‘Care networks of older people with multimorbidity: social network analysis and qualitative study’ and led a discussion on patient vignettes derived from these. Jo Middlemass presented a European study, ‘Perceptions and experiences of telemonitoring in older patients with multimorbidity: a qualitative study’ and discussed implementation of remote monitoring technologies with delegates. They were joined by Steve Leven from Leicester who presented on the link between pay-for-performance with deprivation and multimorbidity.
Despina Laparidou gave a poster session on ‘Challenges for carers of people with dementia and their support needs from health and social care providers: a qualitative study’. After lunch, Prof Richard McManus, from Oxford presented his groundbreaking TASMINH studies on ‘Self-management of hypertension – can patients do it better?’ The answer, a qualified yes but with help from primary care practitioners, is a triumph for supported self-care.
At the final session Dr Zahid Asghar presented his work with Dr Jon Dixon (Sheffield University) and Prof Siriwardena on ambulance care for people with convulsions, ‘Exploratory cross-sectional study of factors associated with transport to hospital after suspected seizure’ and Joseph Akanuwe described his doctoral study, ‘Exploring patient and practitioner perspectives of QCancer use in primary care consultations’. The session was attended by Prof Carol Coupland from Nottingham University, one of the originators of QCancer.
The latest edition of the CaHRU Newsletter (Autumn2015) was published in November. The newsletter presents the work of the research centre over the previous three months and includes articles from the CaHRU blog covering publications, conferences and funding. The newsletter is written by members of the CaHRU team and [su_document url=”https://communityandhealth.dev.lincoln.ac.uk/files/2016/01/CaHRU-Newsletter-Autumn-2015.pdf” responsive=”no”]Multi-morbidity, goal-oriented care, the community and equity[/su_document]produced by Sue Bowler, CaHRU administrator.
Prevention through identifying risk factors and health promotion to address these is becoming standard practice, for example in programs supporting patients to stop smoking. However, some risk factors such as sexual behaviour, cannot be easily assessed, are more difficult to measure and less likely to be recorded. Potentially risky sexual behaviour is sensitive information which is more difficult to classify as present or absent, but is still important in assessing a person’s overall health risk. Previous research indicates that although patients prefer to discuss sexual health issues with GPs compared to other healthcare workers, patients often wait for a sign from their GPs before discussing this intimate subject whereas GPs usually wait for a sign from the patient.
This was confirmed in a recently study, ‘Collecting and registering sexual health information in the context of HIV risk in the electronic medical record of general practitioners: a qualitative exploration of the preference of general practitioners in urban communities in Flanders (Belgium)‘, published in Primary Care Research and Development, with lead author Jolien Vos, who is a graduate research assistant at CaHRU. The study team interviewed 13 GPs in Flanders (Belgium) who had experience with HIV patients. The interviews explored what GPs considered to be ‘risk factors’ in terms of sexually risky behaviour as well as how they collected, discussed and registered this information.
The study revealed that although participating GPs said that they felt comfortable discussing sexual health with patients, they assumed that patients would not feel at ease with this. GPs felt that waiting for the patient to initiate the discussion would mean that it would only take place when a problem had already occurred. Sexual orientation was often seen as an indicator for GPs to be cautious when enquiring about sexual risk behaviour. The GPs emphasised the importance of discussing sexual health and the need for guidance on recording information sexual risky behaviour more systematically, to support continuity of care while maintaining privacy of sensitive patient data in a country where patients are free to move GP and general practices are becoming more multidisciplinary.
A new book, Coaching in Professional Contexts, edited by Christian van Niewerburgh, features a chapter on coaching patients authored by Rachel Hawley who is Project Manager for the HEI Challenge for Patient Supported Quality Improvement at the Community and Health Research Unit (CHRU), School of Health and Social Care.
The chapter, ‘Coaching Patients’, aims to encourage readers to reflect on their own experiences of health and health care and engage in a critical dialogue with the dominant discourses of coaching theory and practice. The idea of “making every conversation count” is a philosophy that underpins this chapter. In her coaching teaching and practice Rachel is committed to the view that through open and creative dialogue, coaching patients can open new opportunities for achieving improved health and wellbeing. In turn, this supports wider engagement in health care practice and learning.
For further information see: van Niewerburgh, C. (ed), Coaching in Professional Contexts. London: Sage (2015).
The NIHR commissioned rapid evidence review to assess the nature and quality of the existing evidence on delivery of emergency and urgent care services and to identify gaps for future research was published last week: Phung V-H (2015) Chapter 6 – Delivery of emergency department services in Turner J, Coster J, Chambers D, Cantrell A, Phung V-H, Knowles E, Bradbury D, Goyder (eds.). What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review. Health Serv Deliv Res 2015;3(43). The team, from the School of Health And Related Research (ScHARR) at the University of Sheffield with Viet-Hai Phung, research assistant and doctoral researcher at CaHRU, undertook five separate literature reviews linked to themes in the NHS England review in 2013, which latter drove the need for this rapid evidence review. The review, which took six months to complete, incorporated findings from 45 systematic reviews and 102 primary research studies across all five reviews
Viet-Hai Phung wrote the review in Chapter 6 on the Delivery of Emergency Department (ED) services. This review included literature from 2009 to 2015. Nine papers were included in the review: two systematic reviews, which included 28 individual papers, and seven additional papers. Of the 35 included studies, there were only five randomised control trials and many uncontrolled before-and-after studies, which cannot control for other system effects.
There were three themes to this part of the review: Managing ED flow; Workforce; and managing the frail and the elderly in EDs. In the first review, interventions that aimed to increase access to primary care and ED cost-sharing were found to be effective in reducing ED use. For the Workforce review, the evidence suggested that supplementing existing ED staff with NPs can help to manage demand more effectively, especially in high-volume EDs. For the final review, there was mixed evidence about the effectiveness of Comprehensive Geriatric Assessment (CGA): CGA did not have a significant impact on outcomes nor mortality, while other studies suggested that use of CGA to inform interventions could reduce functional decline.