bluuebunny/crossref_metadata_2025_split huggingface dataset:
Active participation of ‘real-time’ patients in undergraduate medical education: a qualitative study
Authors: Alao Adedoyin , Burford Bryan , Hrisos Susan , Alberti Hugh , Kennedy David , Barton Roger , Vance Gillian 
Published: June 2019

BackgroundThe ‘patient’s voice’ is increasingly emphasised in educational strategies. However, much of this has focused on patients who have been recruited to have a primary educational role. Students also benefit from interaction with ‘real-time’ patients who attend the clinical settings with diverse health problems. The involvement of these patients does not usually extend to having an active part in the learning encounter, where the patient completes a potential triadic relationship with the clinical teacher and student.AimTo identify ways to enhance the active participation of ‘real-time’ patients in medical students’ training.MethodFocus groups were conducted with patients, who were selected purposively from an earlier questionnaire survey. The discussions were audiorecorded, transcribed, and analysed using thematic analysis.ResultsA total of twenty-three participants attended four focus groups in general practices across the North East of England. Patient involvement in medical education may be described using Communities of Practice theory. Patients’ role within the educational Community of Practice is mainly peripheral. Factors affecting their active involvement may operate at the micro level (individual teaching consultation), organisational level, or within the NHS. Issues identified include patients’ awareness about medical education, ambiguity about their role, attitude of the doctor, and processes for consent and feedback.ConclusionThis research has provided insights into patients’ perspectives towards their involvement in medical education. The data may provide evidence for a practical framework to encourage and prepare patients to play an active role in educational processes.
Routine health monitoring and preventative care for people with dementia in UK primary care
Authors: Bhanu Cini , Jones Mary Elizabeth , Walters Kate , Petersen Irene , Cooper Claudia 
Published: June 2019

BackgroundUK National Dementia Strategies prioritise fair access to dementia treatment for all. It has been shown that people from black and minority ethnic (BME) groups are diagnosed later and those are less likely to receive anti-dementia medication.AimIt is hypothesised that access to primary care services post diagnosis is also reduced in ethnic minority groups.MethodThe Health Improvement Network (THIN) database of UK primary care records was analysed between 2015 and 2016, all patients with dementia were identified, and health service use was compared. Annual GP consultations, blood pressure (BP), weight/body mass index (BMI), Quality and Outcomes Framework (QOF) dementia review, and flu vaccination recordings were compared between ethnic groups.ResultsOver 20 000 individuals with a dementia diagnosis aged 50–105 years were included. There was no significant difference between white, black, and Asian groups across all outcomes. Overall 80% received an annual BP check, 86% received at least one annual GP consultation, 68% received an annual dementia review, and 48% had a weight/BMI recorded. People with dementia who did not have cardiovascular risk factors were less likely to have their BP checked (59%) and be seen by a GP.ConclusionThere do not appear to be ethnic inequalities in primary care service use post-dementia diagnosis. The overall proportion receiving an annual dementia review and weight check was low, despite recommendations that a care plan should be reviewed annually (including nutrition as a key priority). Post-diagnosis support and preventative care should be prioritised in general practice for all people living with dementia.
Implementation of social prescribing to reduce frequent attender consultation rates in primary care
Authors: Jeyes Adam , Pugh Laura 
Published: June 2019

BackgroundThe impact of social determinants on health has been established. Evidence shows that addressing social needs through link workers can improve wellbeing and consultation rates. This is of importance since demand on primary care appointments is high and access to primary care is pivotal to the NHS as a whole.AimTo evaluate whether frequently-attending patients who might benefit from social prescribing, can be recognised through a computer search of risks for isolation, loneliness, or social pressures and whether a social intervention has an effect on wellbeing and consultation rate.MethodPatients highlighted as frequent attenders (≥20 GP/nurse practitioner [NP] appointments in past 12 months) were screened for appropriateness of referral to link worker. A social risk tool was applied to select patients most at risk of social isolation. Patients who agreed had a pre- and post-intervention wellness score calculated. Number of appointments pre- and post-intervention were also recorded and matched by month. Post-intervention questionnaires allowed collation of qualitative data analysing patient opinions of the scheme.ResultsThere was an average increase in wellbeing score post-intervention of 0.8/5. The average reduction in appointments for GPs and NPs combined was 5.1 appointment/patient (37% reduction) at 6 months and 12.9 appointments/patient at 1 year (53% reduction).ConclusionThe numbers in this project are small, but it supports the growing evidence that social prescribing can improve patient well-being and sustained reduced demand for GP and NP appointments. It supports the suggestion that computer searches can delineate a high-risk population.
Variation in tests for people with type 2 diabetes, hypertension, or chronic kidney disease in UK primary care
Authors: Patel Rita , Elwenspoek Martha , Watson Jessica , Mann Ed , Alsop Katharine , Whiting Penny 
Published: June 2019

BackgroundRates of pathology testing are rising in the UK, with significant geographical variability. Around 50% of overall GP laboratory testing represents monitoring for chronic conditions such as high blood pressure, type 2 diabetes, and chronic kidney disease (CKD). Overuse of tests for monitoring chronic conditions may be a potential source of harm; causing patient anxiety, downstream tests/referrals, overdiagnosis, increase GP workload and increase health service costs. On the other hand, failure to test may lead to missed diagnoses, complications, patient harm and litigation.AimThis study aims to use an open cohort to examine current variation in the use of tests for individuals with type 2 diabetes, hypertension, and CKD>2 across the UK.MethodClinical Practice Research Datalink (CPRD) data will be used to consider what tests have been ordered for people with these conditions and look at variation over time, and by region, age, sex, ethnicity, and socioeconomic position using age–sex-standardised utilisation rates, descriptive statistics, and multilevel Poisson regression.ResultsAn estimated 1.2 million patients within the CPRD database have previously been diagnosed with any of the chronic conditions with over 11 million tests. Some 1 029 496 patients have hypertension, 344 613 with diabetes, and 271 897 with CKD>2, with much overlap. The results from this study will help to find what tests are currently used among patients with these conditions and to quantify variation in testing.ConclusionThis work will be used to inform the development of testing algorithms for patients with these conditions in primary care.
The incidence, prevalence, and management of plantar heel pain in Dutch general practice
Authors: Rasenberg Nadine , Bierma-Zeinstra Sita MA , Bindels Patrick , van der Lei Johan , Van Middelkoop Marienke 
Published: June 2019

BackgroundPlantar heel pain (PHP) is a common cause of foot complaints, but information on the occurrence in primary care is scarce.AimThe objective of this study was to determine the incidence and prevalence of PHP and to gain insight in types of treatments provided to patients with PHP in primary care.MethodA cohort study was conducted in a healthcare database containing the electronic general practice medical records of approximately 1.9 million patients throughout the Netherlands. A search algorithm was defined and used to identify cases of PHP in the years 2013–2016. Descriptive statistics were used to obtain the incidence and prevalence of PHP. Data on the management of PHP was extracted in a random sample of 1000 patients.ResultsThe overall incidence of PHP was 3.81 (95% confidence [CI] = 3.75 to 3.87) per 1000 patient years and the overall prevalence of PHP was 0.4374% (95% CI = 0.4369 to 0.4378). Incidence of PHP peaked in the last quarter of every calendar year. The GP applied a wait-and-see policy at the first consultation for PHP in 18.0% of patients. The most commonly applied interventions included prescription for NSAID (19.9%), referral to a paramedical podiatric specialist (19.7%), and advice to wear insoles (16.4%): 34.0% of patients received multiple interventions (range 2–11) and 30.9% had multiple consultations for PHP (range 2–8).ConclusionPHP appears to be common in primary care. Despite a lack of evidence for most treatments, multiple interventions are applied. This urges the need for future research on effectiveness of treatments.
A qualitative evaluation of a Clinical Effectiveness Scheme in London
Authors: Shefer Guy , Kordowicz Maria 
Published: June 2019

BackgroundClinical Effectiveness Southwark (CES) is a London-based primary care Quality Improvement (QI) scheme with the aim of improving clinical quality across local general practice. In order to improve patient outcomes in selected long-term conditions, a team of four GPs, working with other professionals, developed condition-based short guides, clinical templates, and other educational interventions.AimA mixed methods evaluation of the processes and impact of CES in its implementation and operation phases.MethodIn the first year, qualitative methods were used which included 18 interviews, one focus group and observation of 53 meetings, educational events and teleconferences. The data were analysed thematically using NVivo software. The result of surveys with local clinicians about their use of CES guides are reported.ResultsIn the first year since formation, CES produced seven clinical guides and three templates. Six months after the launch of the first three guides, 57% of the survey responders reported using at least one guide in their practice. Electronic templates took longer than expected to develop. The existence of other (typically online) guidelines and a wish for even shorter, more concise, guides were among the reasons reported by those who did not use the guides on a regular basis.ConclusionThere is a demand from GPs and nurses for high quality, well-written, short, easy to use, local guides for various conditions.
Gout in primary care: can we improve patient outcomes?
Authors: Blakey Georgina , Callear Jacqueline 
Published: June 2019

BackgroundGout is a red flag indicator for cardiovascular disease and comorbidity. Despite this, there are no incentivised treatment protocols and suboptimal management in the primary care setting is common.AimImprovement cycles aimed to educate patients, improve uric acid monitoring, and support medication compliance. It was ultimately hoped that these measures would reduce gout flares and GP practice attendance.MethodA computer-based retrospective search at a large inner-city GP practice between January 2014–December 2014 identified 115 patients with gout. Baseline measurements revealed multiple gout related consultations, poor medication compliance, high uric acid levels, and deficiencies in uric acid monitoring. All patients in the cohort received a telephone consultation regarding their gout followed by a diet, lifestyle, and advice sheet in the post. A new gout phlebotomy order set was devised to include full blood count, urea and electrolytes, cholesterol, urate, random blood sugar, and HbA1c. Letters were sent out to arrange for these blood tests in patients who had not received them during the previous 12 months.ResultsThe improvement cycles contributed towards reduction in uric acid levels from 0.37 to 0.3 (P = 0.14), 20% reduction in patients experiencing one or more gout flares, and 77% reduction in GP related consultations between March 2015 and March 2016 compared to baseline. The proportion of patients fully compliant with taking their urate lowering therapies improved from 63% to 91% (P = 0.0001).ConclusionThe improvement and Plan, Do, Study, Act cycles have demonstrated that simple interventions can be a sustainable way of improving disease control and patient outcomes.
Potentially inappropriate medications in older patients based on Beers criteria at a large family medicine clinic in Saudi Arabia
Authors: Alturki Atheer 
Published: June 2019

BackgroundThe use of potentially inappropriate medications (PIMs) is an issue especially among older patients who have medical comorbidities. They are more at risk to drug adverse effects compared to younger patients.AimTo determine the prevalence of PIMs use according to Beers criteria among the older population in a large family medicine setting in Saudi Arabia and to identify the associated risk.MethodThis was a prospective cross-sectional study conducted from June 2017 to June 2018. All patients aged ≥65 years who were followed-up at the family medicine clinics were included. The American Geriatrics Society 2015 Updated Beers Criteria were used to determine the PIMs use.ResultsA total of 270 older patients aged 72.41 ± 6.23 years were included in the study. The prevalence of PIMs was 60.7%. Multivariate analyses identified three independent variables associated with PIMs: incremental age per 5 years (odds ratio [OR] = 1.47; 95% confidence interval [CI] = 1.15 to 1.88; P = 0.002), female sex (OR 1.95; 95% CI = 1.10 to 3.42; P = 0.021), and polypharmacy (OR 8.21; 95% CI = 4.58 to 14.7; P<0.001). The most common PIMs used were 39.4% related to proton pump inhibitors (PPIs), 25.2% to diuretics (other than spironolactone), 10.6% to non-steroidal anti-inflammatory drugs (NSAIDs), and 8.7% to aspirin use.ConclusionThis study showed high prevalence of PIMs. Increasing age, female sex, and polypharmacy were found to be significant risk factors for PIMs use. The present study reinforces the importance of comprehensive medication management and reviews. Future research should evaluate interventions aimed at improving primary care follow-up and reducing the prevalence of PIMs.
Trends in reported incidence of erectile dysfunction, hypogonadism, PDE5i prescriptions and TRT in patients with type 2 diabetes in primary care
Authors: Schartau Patricia , Horsfall Laura , Nazareth Irwin , Molokhia Mariam , Kirby Michael , Sharma Manuj 
Published: June 2019

BackgroundErectile dysfunction (ED) and testosterone deficiency (TD) are complications of type 2 diabetes mellitus (T2DM), and predictors of cardiovascular disease. Guidelines recommend that men with T2DM are assessed and treated for ED/TD, which was included into the Quality and Outcomes Framework (QOF) from 2013–2014 only.AimExplore the effects of QOF on ED/TD diagnoses and management in T2DM patients.MethodThe study population included males (≥18 years) with T2DM and contributing to UK GP electronic health records from 1999–2016. Adjusted incidence rate ratios (IRRs) were estimated using multivariable Poisson regression.ResultsIn total 135 342 adult males (mean age 60 years) with T2DM were included. During follow-up, 60 819 (45%) had a recorded ED assessment, 23 834 (18%) an ED diagnosis and of these 73% received a phosophodiesterase-5 inhibitor (PDE5i). ED assessments increased from 7.6 per 1000 PYAR in 2012 (95% confidence interval [CI] = 7.0 to 8.3) to 620 in 2013 (95% CI = 614 to 626) when included into QOF but dropped to 59.4 (95% CI = 56 to 63) in 2016. Compared with 2012, the adjusted incidence of recorded ED diagnoses and PDE5i prescriptions doubled in 2013 (incidence rate ratio [IRR] 2.0; 95% CI = 1.8 to 2.1) before falling to below pre-QOF levels in 2016 (IRR 0.89; 95% CI = 0.82 to 0.97). Of 1187 diabetic men diagnosed with ED or receiving a PDE5i in 2015, 213 (18%) had minimum one testosterone measurement, of which 45 (21%) met criteria for hypogonadism (testosterone ≤8nmol/l). Nine (20%) subsequently received testosterone replacement therapy (TRT).ConclusionTo improve diagnosis and management of ED/TD in T2DM patients and thereby (cardiovascular) health and quality of life, incorporation of guidelines into a GP framework and/or financial incentives may be required alongside GP education.
Transforming community nursing services in the UK: lessons from a participatory evaluation of the implementation of a new model of community nursing in East London
Authors: Lalani Mirza , Fernandes Jane , Fradgley Richard , Ogunsola Caroline , Marshall Martin 
Published: June 2019

BackgroundBuurtzorg, a model of community nursing conceived in the Netherlands, is widely cited as a promising and evidence-based approach to improving the delivery of integrated nursing and social care in community settings.AimThis study aimed to examine the transferability of some of the principles of the Buurtzorg model to community nursing in the UK NHS.MethodA community nursing model based on the Buurtzorg approach was piloted between June 2017 and August 2018 with a team of nurses co-located in a single general practice in the Borough of Tower Hamlets, East London. The initiative was evaluated using a qualitative approach within the participatory Researcher-in-Residence model. Participant observation of meetings and semi-structured interviews with team members, patients/carers, and other local stakeholders were undertaken. A thematic framework analysis of the data was carried out.ResultsPatient experience of the service was positive, in particular because of the better access, improved continuity of care and longer appointment times in comparison with traditional district nursing provision. However, certain aspects of the Buurtzorg model were difficult to put into practice in the NHS because of significant cultural, human resource, and regulatory differences between The Netherlands and the UK.ConclusionWhile many of the principles of the Buurtzorg model are applicable and transferable to the UK, in particular promoting independence among patients, improving patient experience, and empowering frontline staff, the successful embedding of these aims as normalised ways of working will require a significant cultural shift at all levels of the NHS.
Routine consultations for dermatology problems in adults in general practice: cross-sectional study
Authors: Le Roux Emma , Edwards Peter , Sanderson Emily , Barnes Rebecca , Ridd Matthew 
Published: June 2019

BackgroundDermatological conditions present frequently in general practice, and treatment failure is common due to low adherence with treatments. There has been little research exploring GP consultations for skin problems.AimTo describe consultations for skin problems in adults including shared decision making (SDM) around treatment decisions, delivery of self-management advice, and follow-up.MethodData were extracted from the One in a Million Study, an archive of 327 videorecorded routine GP adult consultations and linked data. A coding instrument was developed and refined, which was applied to all consultations where a skin problem was identified as having been discussed. SDM was assessed using OPTION. Twenty per cent of the consultations were double coded and inter-rater reliability assessed. Data were analysed using Stata, with descriptive statistics reported.ResultsIn total 45 consultations (13.8%) were examined, featuring a mean of 2.2 problems. Of the 100 problem types, 51 were dermatological. Mean time spent on skin problems was 4:16 minutes (29.6% of total duration of consultations with ≥2 problems). SDM for skin problems was low, with mean OPTION score of 10.7 (range 0–35). Self-management advice was given for 47.1% of skin problems (verbal only). Most skin problems (84.3%) were not referred to secondary care; 32.6% of skin problems not referred were seen again in primary care within 12 weeks of the index consultation, of which 35.6% were unplanned.ConclusionSkin problems commonly present alongside other complaints. SDM and self-management advice are uncommon. While most dermatological problems are not referred, patients often re-consult for the same problem.
Opportunities and challenges of a novel cardiac output response to stress (CORS) test to enhance diagnosis of heart failure in primary care: a qualitative study
Authors: Charman Sarah , Okwose Nduka , Maniatopoulos Gregory , Graziadio Sara , Vale Luke , Metzler Tamara , Seferovic Petar , Fuat Ahmet , Deaton Christi , Mant Jonathan , Hobbs FD Richard , Jakovljevic Djordje 
Published: June 2019

BackgroundPrimary care physicians lack access to an objective cardiac function test during diagnostic testing for suspected heart failure.AimTo determine the role of the novel Cardiac Output Response to Stress (CORS) test in the current diagnostic pathway for heart failure and the opportunities and challenges to potential implementation in primary care.MethodQualitative study using semi-structured in-depth interviews which were audiorecorded and transcribed verbatim. Data from the interviews were analysed thematically using an inductive approach. Fourteen healthcare professionals (six males, eight females) from primary (GPs, nurses, healthcare assistants, and practice managers) and secondary care (consultant cardiologists) participated.ResultsFour themes relating to opportunities and challenges surrounding the implementation of the new diagnostic technology were identified. These reflected that adoption of CORS test would be an advantage to primary care but the test had barriers to implementation which include establishment of clinical utility, suitability for immobile patients, and cost implication to GP practices.ConclusionThe development of a simple non-invasive clinical test to accelerate the diagnosis of heart failure in primary care maybe helpful to reduce unnecessary referrals to secondary care. The CORS test has the potential to serve this purpose however, factors such as cost-effectiveness, diagnostic accuracy, and seamless implementation in primary care have to be fully explored.