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 study includes a consortium of seven European countries led by TESAN (Italy), Restech and including Del Politcnico Di Milano (Italy), University of Liverpool (UK), Tallina Tehnikaulikool (Estonia), Universitat De Barcelona (Spain), Uppsala Universitet (Sweden), Universitetssykehuset Nord-Norge (Norway), Bolnisnica Sezana Zavod (Slovenia), University of Lincoln, Lincolnshire Community Health Services NHS Trust.
The CHROMED study has been investigating the effectiveness and cost-effectiveness of a telemonitoring system for people with multiple chronic disease, specifically Chronic Obstructive Pulmonary Disease (COPD) and heart disease. The trial in Lincoln involved a feasibility study of five patients and a randomisation cohort of 32 patients aged 65 years and above in Lincolnshire. The monitoring equipment included a novel device for measuring lung function (using a technique called forced oscillation) and a wrist clinic measuring pulse, blood pressure, oxygen saturation, and temperature.
The study has already shown evidence that monitoring can detect patients’ worsening condition, even before symptoms are apparent. The study data have now been collected and are being analysed to see whether the monitoring system has improved patients’ outcomes, quality of life and healthcare costs.
The latest edition of the CaHRU Newsletter (Winter 2015-16) was published in March 2016. 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 produced by Sue Bowler, CaHRU administrator.
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Joseph Akanuwe, doctoral student at CaHRU, was recently invited to present a workshop with Dr Sharon Black (both pictured below) at a regional primary educator’s conference organised by Health Education East Midlands at the Eastgate Hotel on 14 January 2016. Joseph who is a full time PhD student with CaHRU, continues to work as a nurse to support his studies which are supervised by Prof Niro Siriwardena, Dr Black and Prof Sara Owen.
The workshop entitled ‘Estimating and Communicating Cancer risk in the GP Consultation’ was based on his work reviewing the literature around use of cancer risk assessment tools and a series of interviews of primary care practitioners and service users on their perceptions of risk assessment using a novel risk tool (Qcancer) and how this might be used in the primary care consultation. Participants discussed the implications for GPs of using Qcancer to quantify cancer risk; the potential uses of QCancer in the consultation; what communication issues might arise when using Qcancer; and the potential challenges to using QCancer in routine general practice. The workshop raised issues about communicating risk in general practice participants found the discussion of potential advantages and disadvantages of using Qcancer.
Joseph also presented findings of a qualitative study involving semi-structured interviews and focus groups of 19 service users and 17 practitioners on cancer risk estimation and communication. The results of the workshop will contribute to validation of the research findings. Joseph has also been invited to present his most recent study, ‘Patient and practitioner perspectives of QCancer use in primary care consultations’ at the Trent Regional SAPC conference in Leicester in March 2016. His work was recently recognised through a bursary awarded by a member of the University Court to support his studies.
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.
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.