bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rethinking continuity in primary care for people with mesothelioma
Authors: Couchman Emilie , Ejegi-Memeh Steph , Mitchell Sarah , Gardiner Clare 
Published: June 2024

BackgroundMesothelioma is a terminal disease that is linked to asbestos exposure. Continuity is difficult for GPs, and other healthcare professionals (HCPs), to provide within the current NHS primary care system, but is highly valued by people with mesothelioma.AimTo understand the experiences of continuity in primary care among people with mesothelioma, their close persons, and their HCPs; how they achieve this (or not); and how it affects their healthcare service use.MethodRealist case studies of patient journeys through the healthcare system (involving longitudinal interviews with people with mesothelioma, their close persons, and HCPs; and exploration of the organisational context). Data analysis allowed understanding of hidden mechanisms (resources and reasoning), triggered in certain contexts, leading to specific outcomes.ResultsForty-eight interviews (involving 9 patients, 8 close persons, and 12 HCPs) were undertaken (totalling 30.8 hours/1848 minutes). Context-Mechanism-Outcome configurations related to: challenges unique to mesothelioma; capacity of patients/close persons/HCPs to facilitate continuity; multidisciplinary (MDT) approach differs from the family doctor model; and ‘the NHS primary care system is broken’.ConclusionPatients perceive their continuity needs to be unmet by the inflexible primary care system, which needs to adapt to a society in which people receive increasingly novel treatments and live longer with complex healthcare needs. A societal perspective shift is required to understand that an MDT now shares responsibility for care, rather than an individual family doctor. Policy documents continue to focus on access, and still do not advocate strongly enough for continuity, despite unequivocal evidence demonstrating its worth.
Is pay for performance promoting inverse inequality in Irish general practice?
Authors: Linnane Sarah , Mullarkey Sarah , Kyne Eoin , Fallon John , O’Regan Andrew , Hannigan Ailish , Sharma Santosh , Healy Maeve , OConnor Raymond 
Published: June 2024

BackgroundIn 2020, the Chronic Disease Management (CDM) programme was introduced in Ireland. This programme resources GPs to review public (GMS) patients, diagnosed with eight named chronic diseases, twice yearly according to a structured protocol. This pay for performance initiative has been widely adopted by GPs. However, it is hypothesised that private patients (PPs) receive a poorer standard of care, as they may be reluctant to attend due to the cost involved.AimTo assess whether the management of eight chronic diseases named in the CDM programme is to the same standard among both PPs and GMS patients.MethodA retrospective audit of GP practices in the Midwest of Ireland. Data relating to 25 GMS patients and 25 PPs, matched by age, gender, and clinical condition, is collected from each practice. Patients have at least 1 of the eight named chronic diseases. Parameters include vaccination status (influenza, pneumococcal, COVID); body mass index; blood pressure; smoking status; renal function; HbA1c; lipid profile; brain natriuretic peptide (BNP) in patients with heart failure; and lung function tests in patients with COPD or asthma. COVID vaccination status acts as a control because it is freely available for both PPs and GMS patients.ResultsPreliminary results from 2 GP practices show large consistent disparities in management between PPs and GMS patients in most parameters.ConclusionLimiting Pay for Performance to the care of GMS patients only, based on age or income, promotes inverse inequality. We argue that CDM care should be offered to all patients.
How can we improve support for women with perinatal anxiety in primary care? A qualitative study
Authors: Silverwood Victoria , Fisher Tamsin , Proctor Janine , Kingstone Tom , Turner Katrina , Shivji Noreen , Chew-Graham Carolyn 
Published: June 2024

BackgroundPerinatal anxiety (PNA) occurs during pregnancy and up to 12 months post-partum. PNA affects more than 21% of women and can impact adversely on mothers, children and their families. National Institute for Health and Care Excellence (NICE) guidance identified evidence gaps around non-pharmacological interventions for PNA.AimThis qualitative study aimed to understand the perspectives of a variety of Perinatal Mental Health (PMH) stakeholders about non-pharmacological interventions for PNA.MethodEthics approval. Semi-structured interviews with women with lived experience of PNA, healthcare professionals (HCPs), voluntary community and social enterprise (VCSE) stakeholders and commissioners. Topic guide modified in response to emerging themes. Interviews digitally recorded with consent, transcribed, and analysed thematically. A patient advisory group was involved throughout the study.ResultsThere were 25 interviews conducted. Women with PNA expressed a wish to choose from a range of non-pharmacological interventions, which are often delivered by VSCE organisations or not commissioned within the NHS. HCPs described a hierarchy of interventions that can be offered to women, often related to severity of a woman’s PNA. PMH VCSE stakeholders emphasised that their services are flexible and accessible for women with PNA.ConclusionTension exists between what is currently recommended by NICE and thus commissioned, and the types of intervention that women want to access, including support from VCSE services. Clinicians should be aware of local VCSE organisations which provide care for women with PNA. There is an evidence gap around the effectiveness of various interventions delivered by VCSE organisations, which requires further exploration.
Effectiveness of post-COVID-19 primary care attendance in improving survival in very old patients with multimorbidity: a territory-wide target trial emulation
Authors: Wei Cuiling , Vincent  , Yan Ka Chun , Maringe Camille , Rachel  , Chu Yui Ki , Liu Wenlong , Liu Boyan , Hu Yuqi , Zhou Lingyue , Celine  , Chui Sze Ling , Li Xue , Eric  , Wan Yuk Fai , Cheung Ching Lung , Esther  , Chan Wai Yin , William  , Wong Chi Wai , Ian  , Wong Chi Kei , Lai Francisco 
Published: June 2024

BackgroundOlder adults with multimorbidity are at high risk of mortality following COVID-19 hospitalisation. However, the potential benefit of timely primary care follow-up on severe outcomes post-COVID-19 has not been well established.AimTo examine the effectiveness of attending general outpatient within 30 days after discharge from COVID-19 on 1-year survival among older adults aged ≥85 years, with multimorbidity.MethodWe emulated a target trial using a comprehensive public healthcare database in Hong Kong. The cloning-censoring-weighting technique was used to minimise immortal time bias and confounding bias by adjusting for demographics, hospitalisation duration and ICU admission, baseline chronic conditions, and medication history. The outcome included all-cause and cause-specific mortality.ResultsOf 6183 eligible COVID-19 survivors, the all-cause mortality rate following COVID-19 hospitalisation was lower in general out-patient clinics (GOPC) group compared to non-GOPC group (17.1 versus 42.8 deaths per 100 person-year). After adjustment, primary care consultations within 30 days after discharge were associated with a significantly greater 1-year survival (difference in 1-year survival: 11.2%, 95% CI = 8.1% to 14.4%). We also observed better survival from respiratory diseases in the GOPC group. In a sensitivity analysis for different grace period lengths, we found that the earlier participants had a GOPC visit after COVID-19 discharge, the better the survival.ConclusionTimely primary care consultations after discharge may improve survival following COVID-19 hospitalisation among older adults aged ≥85 years, with multimorbidity. Expanding primary care services and implementing follow-up mechanisms are crucial to support this vulnerable population’s recovery and well-being.
Moving beyond the ‘PPG’: co-production and inclusion health
Authors: McGeown Helen Rosemary , Potter Lucy , Stone Tracey , Swede Julie , Cramer Helen , Horwood Jeremy , Carvalho Maria , Connell Florrie , Feder Gene , Farr Michelle 
Published: June 2024

BackgroundWe frequently fail to meaningfully incorporate patient voice in the development of health services, in particular the voices of those who are most disadvantaged.AimTo share learning from a co-production project to improve primary care experience for those with multiple disadvantage and lived experience of trauma.MethodWe formed a collective of women (Bridging Gaps). Group members had lived experience of poverty, mental health challenges, addictions, homelessness, and sexual exploitation. Other members were researchers, GPs, and members of a third-sector organisation. We worked alongside local GPs to change how services were delivered. We collected interviews (n= 9), ethnographic data from group meetings (n= 3), and reflective notes from group members (n= 19). Data on our process were analysed using a framework approach drawn from the principles of trauma-informed care.ResultsWe highlight the challenges for those with multiple disadvantages and trauma experience to meaningfully and safely engage in traditional Patient Participation Group (PPG) models. True co-production of services requires adequate resources and close collaborative working with local community organisations. Groups must be facilitated by those with relevant experience and the ability to both notice and manage power dynamics within the room. With sufficient support, co-production models have potential to empower group participants and improve health services.ConclusionPartnership working between GPs, the third sector, and other organisations is vital. This can allow GPs to benefit from the expertise of those with relevant lived experience in tackling health inequalities.
Clustering by health and social care need in multple long-term conditions (MLTC): an exploratory qualitative study to understand the views of professionals and people living with MLTC about future interventions
Authors: Holt Sian , Santer Miriam , Everitt Hazel , Farmer Andrew , Dambha-Miller Hajira , Morrison Leanne 
Published: June 2024

BackgroundAround one in four people are living with multiple long-term conditions (MLTC). Integrated care to holistically manage both health and social needs could improve outcomes for people living with MLTC, including lower rates of hospitalisation and mortality. However, given the number of people with MLTC and increasing strain on health and social care, stratified approaches to identifying and addressing social care needs may be more efficient and cost-effective. We have developed data driven clusters that group people with similar health and social care needs, which could identify patients at the highest risk of poor outcomes related to social care need.AimTo explore views about a future intervention based on these clusters.MethodWe aim to plan a cluster-based intervention that engages people living with MLTC and health and social care professionals to consider social care needs (SCNs) when consulting in primary care. We have conducted 14 interviews with professionals to explore their priorities and concerns about care delivery by MLTC clusters and 19 remote interviews with people living with MLTC to find out how well they identify with the MLTC clusters we have defined. Data were analysed using reflexive thematic analysis.ResultsGPs are the ‘starting point’ for conversations about SCNs but need an efficient system to enable effective conversations. The cluster-based intervention could fill this gap.ConclusionThis research identifies key considerations needed for an intervention to engage people with MLTC and health and social care professionals to consider SCNs in primary care.
Engagement of culturally diverse communities in primary care research
Authors: Bedzo-Nutakor Judith , Islam Mohammed , Hyde Elliott , Radwan Tarek , L’Esperance Veline 
Published: June 2024

BackgroundThe underrepresentation of ethnic minorities and low-income groups in primary care (PC) research hinders the development of effective treatments for diverse populations.AimTo develop a framework that general practice staff and researchers can use to improve the participation of underserved groups in PC research.MethodThis study was undertaken across 10 GP practices in South London serving 150 658 patients. Practices are distributed across ethnically diverse and highly deprived communities. A mixed-methods approach was utilised. Retrospective data were collected on patient participation in research studies across the practices between July 2022 and July 2023. Professional and patient focus groups, and a patient questionnaire, were undertaken to understand awareness and knowledge of, enablers for, and barriers to research participation.ResultsOver the 12-month period, 627 patients participated in PC research studies across the 10 practices. Black African and Black Caribbean patients accounted for 26% of the practices’ patient population but were significantly underrepresented in research, comprising only 11% of participants. Patients of Asian backgrounds accounted for 11% of the practices’ population but made up 20% of research participants. Lack of awareness of research participation opportunities, fear of side effects, language barriers, and mistrust of researchers were some of the barriers to participation. Participants highlighted that trust in their GP, education, and transparency of research processes were key to building long-term engagement.ConclusionThis study provides insights into poor recruitment of specific ethnic minorities into primary care studies. The authors identified adaptations to research engagement activities, which are required to ensure that participation is improved.
Access to health services for people experiencing homelessness in Manchester, UK: a qualitative study
Authors: Howard Alya 
Published: June 2024

BackgroundHomelessness is a significant social issue in the UK. A GP practice (name redacted) based in Manchester has provided a primary Homeless Healthcare Service (HHS) to people experiencing homelessness (PEH) for 21 years.AimTo assess primary healthcare provision at this practice from the perspectives of PEH at homeless day facilities in the Greater Manchester area.MethodA qualitative multi-method study, including unstructured observations, was performed. Twenty semi-structured interviews were conducted with either staff or volunteers, and an additional 20 semi-structured interviews were held with PEH at four fixed sites. These sites were homeless day centres, which had previous or current outreach services with the practice. Participants were asked about their knowledge and opinions of the practice, experiences with the HHS, and recommendations for improvements.ResultsFive inductive themes were identified, consisting of PEH’s fears around communication, challenges navigating the health system, insufficient GP signposting, travel as a barrier to access, and the importance of outreach. Administrative, physical, and communication weaknesses were identified in the HHS.ConclusionRecommendations for future improvements were categorised as administrative, physical, service provision, and communication. The practice can further develop communication and advertising through Manchester, clarify pathways to care for PEH, and increase outreach services to ensure improved access to services.
Development and implementation of an online intervention and embedded decision aid to support self-management of acne vulgaris: qualitative interviews with healthcare professionals
Authors: Miah Fathema , Essery Rosie , Steele Mary , Le Feuvre Rebekah , Muller Ingrid , Santer Miriam 
Published: June 2024

BackgroundAcne is common and has a significant impact on quality of life. Topical treatments are first-line and effective, but non-adherence is common due to slow onset of action, or lack of advice on how to manage side effects.AimThe Acne Care Online programme is developing an online intervention to support acne self-management and help-seeking. This project aims to explore experiences and views of healthcare professionals (HCPs) treating acne to assess the acceptability and feasibility of implementing this intervention and embedded decision aid in practice.MethodThis qualitative study recruited HCPs working in general practice. Email invitations were sent to eight research-active practices in Southwest England, and snowball sampling was used. Purposive sampling was used to seek diverse participants. Semi-structured virtual interviews were conducted, audio-recorded, and transcribed. Data were explored using thematic analysis.ResultsNine interviews were conducted, including seven GPs, one nurse, and one pharmacist. Findings highlighted challenges faced by HCPs managing acne in time-limited consultations, particularly around patients’ limited understanding of effective treatments, frequent requests from patients for non-first-line treatments, treatment non-adherence, and addressing psychosocial impact. The intervention and embedded decision aid were perceived as beneficial in addressing these challenges, improving shared decision making, and providing a reliable resource for patients. Interviewees suggested integrating the intervention into electronic practice templates for effective implementation.ConclusionHCPs were positive about the potential for the intervention to be implemented as a useful tool in practice. Potential implementation barriers need to be considered, such as making the intervention quick to access in time-limited consultations.
Perimenopause management in defence primary healthcare: exploring GPs’ knowledge and confidence
Authors: Willman Antony 
Published: June 2024

BackgroundThe average age of the menopause in the United Kingdom is 52 but symptoms of the perimenopause (PMP) can start at 40 or earlier. The UK Armed Forces (UKAF) has a young demographic but women serving over the age of 40, potentially with PMP symptoms, has increased. Recent evidence suggested PMP management by Defence GPs was satisfactory but variable. Because of small numbers, Defence GPs have less exposure to the PMP than NHS GPs, a problem exacerbated for Uniformed GPs who have reduced clinical contact time due to military duties.AimThis study aimed to explore Defence GP knowledge and confidence in managing the PMP, identifying factors contributing to disparities.MethodThis study used a sequential mixed-methods approach. A survey with self-rating questions and vignettes was undertaken, followed by semi-structured interviews of selectively sampled respondents.Results164 out of 542 Defence GPs responded to a survey, which identified reasonable knowledge (91.3% managing cases per guidelines) but reduced confidence (54.3%). Regression analysis identified case exposure to the PMP, education, and gender as significant factors affecting confidence in PMP management. Themes identified from interviews which were felt to affect knowledge and confidence included: Characteristics of the GP (such as gender); lifelong learning and reflective practice; professional exposure to, and awareness of, the PMP; the changing demographic of Defence; an integrated PMP service to provide experiential learning. Case exposure and experiential learning emerged as the main drivers for confidence. For Uniformed GPs, this was affected by limited clinical time, but confidence returned once exposed to just a few PMP cases.ConclusionEstablishing an integrated PMP service in Defence was seen as crucial for improving care as well as providing educational opportunities through experiential learning for Defence GPs.
Exploratory study of frequent attenders in general practice to better understand why patients seek help
Authors: Nur Samira , Coultas James , Jones Louise , Oesterling Christine , Tookman Adrian , Walker Steven 
Published: June 2024

BackgroundFrequent attenders (defined as the top 10% of health care users or those making ≥10 visits per year) account for 30–50% of GP consultations. This has significant resource implications.AimTo understand the characteristics of frequent attenders (≥18-years) at an outer London general practice (list 5,876; deprivation index 5thdecile) and reasons for attending.MethodA retrospective case note review was conducted using SystmOne of people attending on ≥10 occasions to see a health professional between March 2022 and February 2023. Data were extracted by hand: age, gender, reason and type of consultation, diagnoses, referrals, Charlson Comorbidity Index (CCI), mortality at one year. Patient notes for ≥30 contacts were reviewed by a senior GP.Results544 people (9.3%) attended ≥10 appointments. Of these, five interacted with a GP ≥50 occasions (Group 1;mean age:74.6yrs/female: 4 /CCI:5.0), eight ≥40 occasions (Group 2; 69.6yrs/6.0/5.5) and 35 ≥30 occasions (Group 3;70yrs/27/4.7). Forty-eight people accounted for 882 appointments, 29% face to face and 71% by telephone. Frequency increased with age and CCI. Patients in group 3 underwent more investigations (6.0/6.0/10.0). There was no difference in mean numbers of clinicians seen (6.4/7.1/7.4) or referrals (5.0/4.0/5.0) between the three groups. Frequent attenders tended to fall into two groups: people with chronic diseases, typically associated with anxiety and complex needs, and people with ongoing mental health conditions. Coding was challenging due to complexity.ConclusionFrequent attenders presented due to their medical complexity or mental health disorders rather than medically unexplained symptoms. Most interactions with a GP are understandable.
Co-development of breast cancer health promotion educational materials for ethnically diverse women working with hairdressing and beauty salons: BELONG study
Authors: Adhav Sakshi , de Vale Marjorie Lima , Zaman Maham , Coultas Clare , Goff Louise , Mernagh-iles Ashlyn , L’Esperance Veline , Karamanos Alexis , Ayis Salma , Ćurčin Vasa , Durbaba Stevo , Molokhia Mariam , Harding Seeromanie 
Published: June 2024

BackgroundImproved screening uptake is essential for early breast cancer detection, women’s health and reducing health disparities. However, minority ethnic and deprived communities often face lower breast cancer screening rates and limited access to culturally tailored educational materials. A recent review found limited culturally tailored materials for breast cancer education.AimTo investigate the culturally appropriate interfaces and preferences of salon staff in educating their clients about breast cancerMethodWe used a two-stage approach, following the Double Diamond framework; discover and define phases. Relevant breast cancer materials (i.e., based on cultural appropriateness, English language presentation, and alignment with the UK context) were assessed using the Suitability Assessment of Materials (SAM) toolkit. Interviews with ethnically diverse salon staff provided insights into their needs and preferences for client education materials. Thematic analysis was applied to interview transcripts.ResultsCultural appropriateness was evident in 9/14 (64%) of the materials identified (e.g., targeting black ethnicities with positive representations). Of those, six of them demonstrated an overall SAM rating of 76% (“Superior”). Thematic analysis of interviews identified seven key themes, including the importance of engagement strategies, education and awareness for health promotion, salon staff’s role, preferred training methods, supportive materials, inclusivity, representation, and participant satisfaction.ConclusionThis study highlights the SAM toolkit’s role in selecting suitable educational materials for breast cancer prevention. The research offers prospects for improving breast cancer awareness in ethnically diverse communities and addressing healthcare access disparities, with salon hairdressers emerging as crucial advocates for health promotion.