Attitudes toward hand hygiene among medical students on placement in primary care

Attitudes toward hand hygiene among medical students on placement in primary car

Smartphone apps for improving medication adherence in hypertension: patients’ perspectives

Purpose: Digital interventions, such as smartphone applications (apps), are becoming an increasingly common way to support medication adherence and self-management in chronic conditions. It is important to investigate how patients feel about and engage with these technologies. The aim of this study was to explore patients’ perspectives on smartphone apps to improve medication adherence in hypertension. Methods: This was a qualitative study based in the West of Ireland. Twenty-four patients with hypertension were purposively sampled and engaged in focus groups. Thematic analysis on the data was carried out. Results: Participants ranged in age from 50 to 83 years (M=65 years) with an equal split between men and women. Three major themes were identified in relation to patients’ perspectives on smartphone apps to improve medication adherence in hypertension: “development of digital competence,” “rules of engagement,” and “sustainability” of these technologies. Conclusion: These data showed that patients can identify the benefits of a medication reminder and recognize that self-monitoring their blood pressure could be empowering in terms of their understanding of the condition and interactions with their general practitioners. However, the data also revealed that there are concerns about increasing health-related anxiety and doubts about the sustainability of this technology over time. This suggests that the current patient perspective of smartphone apps might be best characterized by “ambivalence.

Patients' views and experiences of technology based self-management tools for the treatment of hypertension in the community: A qualitative study

Background: Patients with hypertension in the community frequently fail to meet treatment goals. The optimal way to organize and deliver care to hypertensive patients has not been clearly identified. The powerful on-board computing capacity of mobile devices, along with the unique relationship individuals have with newer technologies, suggests that they have the potential to influence behaviour. However, little is known regarding the views and experiences of patients using such technology to self-manage their hypertension and associated lifestyle behaviours. The aim of this study was to explore patients' views and experiences of using technology based self-management tools for the treatment of hypertension in the community. Methods: This focus group study was conducted with known hypertensive patients over 45 years of age who were recruited in a community setting in Ireland. Taped and transcribed semi-structured interviews with a purposeful sample involving 50 participants in six focus groups were used. Framework analysis was utilized to analyse the data. Results: Four key inter-related themes emerged from the analysis: individualisation; trust; motivation; and communication. The globalisation of newer technologies has triggered many substantial and widespread behaviour changes within society, yet users are unique in their use and interactions with such technologies. Trust is an ever present issue in terms of its potential impact on engagement with healthcare providers and motivation around self-management. The potential ability of technology to influence motivation through carefully selected and tailored messaging and to facilitate a personalised flow of communication between patient and healthcare provider was highlighted. Conclusions: Newer technologies such as mobile devices and the internet have been embraced across the globe despite technological challenges and concerns regarding privacy and security. In the design and development of technology based self-management tools for the treatment of hypertension, flexibility and security are vital to allow and encourage patients to customise, personalise and engage with their devices

Prognosis of patients with apparent treatment-resistant hypertension—a feasibility study

Background: Most cases of hypertension can be effectively treated with lifestyle changes together with medications, but within this population lies a group with more difficult to treat hypertension—those with apparent treatment-resistant hypertension (aTRH). The American Heart Association and the UK National Institute for Health and Care Excellence have both highlighted the need for further research into the prognosis of patients with resistant hypertension, both apparent and true. Methods: In 16 practices affiliated to a university research network, 646 patients had been identified with apparent treatment-resistant hypertension. To inform a planned full cohort study of these patients, we conducted a feasibility study within three practices to determine participation of practices and patients, availability of outcome measures and data collection times. Results: All three practices fully participated and 205/210 (98%) patients were followed up for a median of 23 months. Thirty-five outcome events of interest occurred—the most common was the new onset of retinopathy (9 cases). Eight percent (17/210) had the main composite outcome of death or serious incident cardiovascular event. Of the six patients who died, identification of cause of death was possible from practice records in five; the national General Register Office was successfully used for the final patient. There were 123 admissions, both day and overnight, recorded in 94 individual patients. Average manual systolic blood pressure measurements improved from baseline by 5 mmHg to 138 (SD 19) mmHg; diastolic remained the same at 75 (SD 12) mmHg. Average eGFR increased from 58.8 (SD17.4) to 66 (SD19.7) mls/min/1.73m2. The average time for data collection per patient was 12 mins. Conclusions: This study demonstrates that the proposed methodology for a full cohort study within general practice of patients with apparent treatment hypertension is both acceptable to practices and feasible. An adequately powered subsequent follow-up study of the entire cohort appears possible

Implementation of the SMART MOVE intervention in primary care: a qualitative study using normalisation process theory

Background: Problematic translational gaps continue to exist between demonstrating the positive impact of healthcare interventions in research settings and their implementation into routine daily practice. The aim of this qualitative evaluation of the SMART MOVE trial was to conduct a theoretically informed analysis, using normalisation process theory, of the potential barriers and levers to the implementation of a mhealth intervention to promote physical activity in primary care. Methods: The study took place in the West of Ireland with recruitment in the community from the Clare Primary Care Network. SMART MOVE trial participants and the staff from four primary care centres were invited to take part and all agreed to do so. A qualitative methodology with a combination of focus groups (general practitioners, practice nurses and non-clinical staff from four separate primary care centres, n = 14) and individual semi-structured interviews (intervention and control SMART MOVE trial participants, n = 4) with purposeful sampling utilising the principles of Framework Analysis was utilised. The Normalisation Process Theory was used to develop the topic guide for the interviews and also informed the data analysis process. Results: Four themes emerged from the analysis: personal and professional exercise strategies; roles and responsibilities to support active engagement; utilisation challenges; and evaluation, adoption and adherence. It was evident that introducing a new healthcare intervention demands a comprehensive evaluation of the intervention itself and also the environment in which it is to operate. Despite certain obstacles, the opportunity exists for the successful implementation of a novel healthcare intervention that addresses a hitherto unresolved healthcare need, provided that the intervention has strong usability attributes for both disseminators and target users and coheres strongly with the core objectives and culture of the health care environment in which it is to operate. Conclusion: We carried out a theoretical analysis of stakeholder informed barriers and levers to the implementation of a novel exercise promotion tool in the Irish primary care setting. We believe that this process amplifies the implementation potential of such an intervention in primary care. The SMART MOVE trial is registered at Current Controlled Trials (ISRCTN99944116; Date of registration: 1st August 2012)

How to improve recruitment, sustainability and scalability in physical activity programmes for adults aged 50 years and older: A qualitative study of key stakeholder perspectives

Physical inactivity among adults aged 50 years and over is a worldwide health concern. The objectives of the study were to investigate the perspectives of those involved with existing physical activity programmes on optimising recruitment, sustainability and scalability of physical activity programmes for adults aged 50 years and over. Methods The study was conducted in Ireland’s Midwest region, where community-based physical activity programmes are delivered to groups by state-funded Local Sports Partnerships. Programme attendees, physical activity professionals and community advocates were recruited. One-to-one interviews and focus groups were conducted in 2018, recorded, transcribed and analysed by an interdisciplinary team experienced in qualitative research. Over a series of meetings, a thematic approach was used to code and analyse the transcripts, categorising data into higher order codes, themes and overarching themes with the purpose of making meaning of the data. Twenty-nine people participated in four focus groups and 18 participated in one-to-one interviews. Findings Data analysis produced three overarching themes. “Age appropriate” explains how communication and the environment should be adapted to the needs of adults aged 50 years and older. “Culture and connection” refer to the interplay of individual and social factors that influence participation, including individual fears and insecurities, group cohesion and added value beyond the physical gains in these programmes. “Roles and partnerships” outlines how key collaborations may be identified and managed and how local ownership is key to success and scalability. Conclusion Successful recruitment, sustainability and scalability require an understanding that the target population has unique needs that must be catered for when planning interventions, communicating messages and choosing personnel. The findings of this study can inform the development of community-based programmes to increase physical activity in adults aged 50 years and older

Prevalence of treatment-resistant hypertension after considering pseudo-resistance and morbidity: a cross-sectional study in Irish primary care

Background To confirm treatment-resistant hypertension (TRH), ambulatory blood pressure measurement (ABPM) must exclude white-coat hypertension (WCH), three or more medications should be prescribed at the optimal doses tolerated, and non-adherence and lifestyle should be examined. Most previous studies have not adequately considered pseudo-resistance and merely provide an apparent TRH (aTRH) prevalence figure. Aim To conduct a cross-sectional study of the prevalence of aTRH in general practice, and then consider pseudo-resistance and morbidity. Design and setting With support, 16 practices ran an anatomical therapeutic chemical (ATC) drug search, identifying patients on any possible hypertensive medications, and then a search of individual patients' electronic records took place. Method ABPM was used to rule out WCH. The World Health Organization-defined daily dosing guidelines determined adequate dosing. Adherence was defined as whether patients requested nine or more repeat monthly prescriptions within the past year. Results Sixteen practices participated (n = 50 172), and 646 patients had aTRH. Dosing was adequate in 19% of patients, 84% were adherent to medications, as defined by prescription refill, and 43% had ever had an ABPM. Using a BP cut-off of 140/90 mmHg, the prevalence of aTRH was 9% (95% confidence interval [CI] = 9.0 to 10.0). Consideration of pseudo-resistance further reduced prevalence rates to 3% (95% CI = 3.0 to 4.0). Conclusion Reviewing individual patient records results in a lower estimate of prevalence of TRH than has been previously reported. Further consideration for individual patients of pseudo-resistance additionally lowers these estimates, and may be all that is required for management in the vast majority of cases

SMART MOVE - a smartphone-based intervention to promote physical activity in primary care: study protocol for a randomized controlled trial

Background: Sedentary lifestyles are now becoming a major concern for governments of developed and developing countries with physical inactivity related to increased all-cause mortality, lower quality of life, and increased risk of obesity, diabetes, hypertension and many other chronic diseases. The powerful onboard computing capacity of smartphones, along with the unique relationship individuals have with their mobile phones, suggests that mobile devices have the potential to influence behavior. However, no previous trials have been conducted using smartphone technology to promote physical activity. This project has the potential to provide robust evidence in this area of innovation. The aim of this study is to evaluate the effectiveness of a smartphone application as an intervention to promote physical activity in primary care. Methods/design: A two-group, parallel randomized controlled trial (RCT) with a main outcome measure of mean difference in daily step count between baseline and follow up over eight weeks. A minimum of 80 active android smartphone users over 16 years of age who are able to undertake moderate physical activity are randomly assigned to the intervention group (n = 40) or to a control group (n = 40) for an eight week period. After randomization, all participants will complete a baseline period of one week during which a baseline mean daily step count will be established. The intervention group will be instructed in the usability features of the smartphone application, will be encouraged to try to achieve 10,000 steps per day as an exercise goal and will be given an exercise promotion leaflet. The control group will be encouraged to try to walk an additional 30 minutes per day along with their normal activity (the equivalent of 10,000 steps) as an exercise goal and will be given an exercise promotion leaflet. The primary outcome is mean difference in daily step count between baseline and follow-up. Secondary outcomes are systolic and diastolic blood pressure, resting heart rate, mental health score using HADS and quality of life score using Euroqol. Randomization and allocation to the intervention and groups will be carried out by an independent researcher, ensuring the allocation sequence is concealed from the study researchers until the interventions are assigned. The primary analysis is based on mean daily step count, comparing the mean difference in daily step count between the baseline and the trial periods in the intervention and control groups at follow up. Trial registration: Current Controlled Trials ISRCTN9994411

Lessons learned from a pandemic: implications for a combined exercise and educational programme for medical students

Background: The ‘MED-WELL’ programme is a combined exercise and educational intervention designed to promote well-being among medical students and educate students about prescribing exercise as medicine in clinical practice. Due to COVID-19 public health restrictions of social distancing the ‘MED-WELL’ programme was ofered online instead  of in-person in 2021. The aim of this study is to compare the experiences of participants in the ‘MED-WELL’ programme  online to those that previously participated in the same programme in-person to understand the student experience  and optimize programme delivery. Methods: Purposive sampling was used to recruit 20 participants to a qualitative study using semi-structured interviews. Ten study participants took part in the ‘MED-WELL’ programme when it was ofered in-person, and the other ten  study participants took part in the programme when it was ofered online. All interviews were audio-recorded and  transcribed using Microsoft Teams. A combined inductive and deductive approach was used for analysis. An inductive  thematic analysis was utilized to categorize data into higher order codes, themes, and overarching themes. The theory  of online learning provided the theoretical framework for a deductive approach. Results: Analysis of the data produced fve overarching themes: ‘student-student’, ‘student-teacher’, ‘student-content’,  ‘student-environment’, and ‘efects of a pandemic’. The frst four themes detail distinct types of interaction that participants had with various entities of the 'MED-WELL’ programme and the efects that these interactions had on participant experiences. ‘Efects of a pandemic’ refers to the context of delivering the ‘MED-WELL’ programme online during  a pandemic and how this mode of delivery infuenced participants and the programme. Conclusions: Optimizing the ‘MED-WELL’ programme relies on an understanding of how participants interact with  diferent entities of the programme and are motivated to attend and engage. Participants tended to favour an in-person mode of delivery, however certain advantages of delivering the programme online were also identifed. The fndings from this study can be used to inform similar experiential and educational exercise interventions, and may  help plan for potential future restrictions on in-person educational and exercise-based programmes. </p

Implementing transnational telemedicine solutions: A connected health project in rural and remote areas of six Northern Periphery countries

This is the first article in a Series on collaborative projects between European countries, relevant for general practice/family medicine and primary healthcare. Telemedicine, in particular the use of the Internet, videoconferencing and handheld devices such as smartphones, holds the potential for further strides in the application of technology for the delivery of healthcare, particularly to communities in rural and remote areas within and without the European Union where this study is taking place. The Northern Periphery Programme has funded the 'Implementing Transnational Telemedicine Solutions' (ITTS) project from September 2011 to December 2013, led by the Centre for Rural Health in Inverness, Scotland. Ten sustainable projects based on videoconsultation (speech therapy, renal services, emergency psychiatry, diabetes), mobile patient self-management (physical activity, diabetes, inflammatory bowel disease) and home-based health services (medical and social care emergencies, rehabilitation, multi-morbidity) are being implemented by the six partner countries: Scotland, Finland, Ireland, Northern Ireland, Norway and Sweden. In addition, an International Telemedicine Advisory Service, created for the project, provides business expertise and advice. Community panels contribute feedback on the design and implementation of services and ensure 'user friendliness'. The project goals are to improve accessibility of healthcare in rural and remote communities, reducing unnecessary hospital visits and travel in a sustainable way. Opportunities will be provided for comparative research studies. This article provides an introduction to the ITTS project and how it aims to fulfil these needs. The ITTS team encourage all healthcare providers to at least explore possible technological solutions within their own context