Use of data from patient records for research : a model for best practice?

In the UK National Health Service (NHS), the registered list and the clinical records of patients are an invaluable resource for the quality assurance of clinical care in General Practice (e.g. audit) and for service development and quality initiatives. These records are also powerful instruments for the conduct of research in primary care. General practitioners are the "guardians" of these demographic and clinical data and, indeed, the use of patient data from these records for research in the past has given us many examples of excellent research which have had a direct impact on the care of our patients and the advice we give them.peer-reviewe

Influences of socioeconomic deprivation on GPs’ decisions to refer patients to cardiology: a qualitative study

Background Variation in GP referral practice may be a factor contributing to the lower uptake of cardiology specialist services for people living in socioeconomic deprivation. Cardiology referrals were chosen for this study due to higher rates of premature death and emergency admissions resulting from coronary heart disease for patients living in more deprived areas. Aim To find out how socioeconomic deprivation influences GP referral practice. Design and setting A qualitative study of GPs working in affluent and deprived areas of one large city in the UK. Method The authors used purposive and snowball sampling to recruit 17 GP participants to interviews and a focus group. Participants were asked to reflect on their own experience of making referrals. The authors used a framework approach to the analysis, with differences in themes for GPs working in least and most deprived areas being highlighted. Results The authors identified four main themes by which socioeconomic deprivation influenced GP referral practice: identifying problems; making decisions about referral; navigating the healthcare system; and external pressures. Using a published framework of consultation complexity, the authors then examined the data in relation to a fifth theme of complexity. Referrals from areas of high socioeconomic deprivation involved greater complexity in the majority of the domains of this framework. Conclusion Socioeconomic deprivation influences GP referral decisions and navigation of the healthcare system in multiple ways. Referral practice for GPs working in deprived areas is more complex than for their peers working in more affluent areas

Promoting Mental Health and Preventing Mental Illness in General Practice

This paper calls for the routine integration of mental health promotion and prevention into UK General Practice in order to reduce the burden of mental and physical disorders and the ensuing pressure on General Practice. The proposals & the resulting document (https://ethicscharity.files.wordpress.com/2015/09/rcgp_keymsg_150925_v5.pdf) arise from an expert ‘Think Tank’ convened by the London Journal of Primary Care, Educational Trust for Health Improvement through Cognitive Strategies (ETHICS Foundation) and the Royal College of General Practitioners. It makes 12 recommendations for General Practice: (1) Mental health promotion and prevention are too important to wait. (2) Work with your community to map risk factors, resources and assets. (3) Good health care, medicine and best practice are biopsychosocial rather than purely physical. (4) Integrate mental health promotion and prevention into your daily work. (5) Boost resilience in your community through approaches such as community development. (6) Identify people at increased risk of mental disorder for support and screening. (7) Support early intervention for people of all ages with signs of illness. (8) Maintain your biopsychosocial skills. (9) Ensure good communication, interdisciplinary team working and inter-sectoral working with other staff, teams and agencies. (10) Lead by example, taking action to promote the resilience of the general practice workforce. (11) Ensure mental health is appropriately included in the strategic agenda for your ‘cluster’ of General Practices, at the Clinical Commissioning Groups, and the Health and Wellbeing Board. (12) Be aware of national mental health strategies and localise them, including action to destigmatise mental illness within the context of community development

"I suddenly felt I'd aged": A qualitative study of patient experiences of polymyalgia rheumatica (PMR).

To explore patient experiences of living with, and receiving treatment for, PMR

A 'combined framework' approach to developing a patient decision aid: the PANDAs model

Background There is a lack of practical research frameworks to guide the development of patient decision aids [PtDAs]. This paper described how a PtDA was developed using the International Patient Decision Aids (IPDAS) guideline and UK Medical Research Council (UKMRC) frameworks to support patients when making treatment decisions in type 2 diabetes mellitus. Methods This study used mixed methods to develop a PtDA for use in a UK general practice setting. A 10-member expert panel was convened to guide development and patients and clinicians were also interviewed individually using semi-structured interview guides to identify their decisional needs. Current literature was reviewed systematically to determine the best available evidence. The Ottawa Decision Support Framework was used to guide the presentation of the information and value clarification exercise. An iterative draft-review-revise process by the research team and review panel was conducted until the PtDA reached content and format `saturation’. The PtDA was then pilot-tested by users in actual consultations to assess its acceptability and feasibility. The IPDAS and UKMRC frameworks were used throughout to inform the development process. Results The PANDAs PtDA was developed systematically and iteratively. Patients and clinicians highlighted the needs for information, decisional, emotional and social support, which were incorporated into the PtDA. The literature review identified gaps in high quality evidence and variations in patient outcome reporting. The PtDA comprised five components: background of the treatment options; pros and cons of each treatment option; value clarification exercise; support needs; and readiness to decide. Conclusions This study has demonstrated the feasibility of combining the IPDAS and the UKMRC frameworks for the development and evaluation of a PtDA. Future studies should test this model for developing PtDAs across different decisions and healthcare contexts

Pond ecology and conservation: research priorities and knowledge gaps

Ponds are among the most biodiverse and ecologically important freshwater habitats globally and may provide a significant opportunity to mitigate anthropogenic pressures and reverse the decline of aquatic biodiversity. Ponds also provide important contributions to society through the provision of ecosystem services. Despite the ecological and societal importance of ponds, freshwater research, policy, and conservation have historically focused on larger water bodies, with significant gaps remaining in our understanding and conservation of pond ecosystems. In May 2019, pond researchers and practitioners participated in a workshop to tackle several pond ecology, conservation, and management issues. Nine research themes and 30 research questions were identified during and following the workshop to address knowledge gaps around: (1) pond habitat definition; (2) global and long-term data availability; (3) anthropogenic stressors; (4) aquatic–terrestrial interactions; (5) succession and disturbance; (6) freshwater connectivity; (7) pond monitoring and technological advances; (8) socio-economic factors; and (9) conservation, management, and policy. Key areas for the future inclusion of ponds in environmental and conservation policy were also discussed. Addressing gaps in our fundamental understanding of pond ecosystems will facilitate more effective research-led conservation and management of pondscapes, their inclusion in environmental policy, support the sustainability of ecosystem services, and help address many of the global threats driving the decline in freshwater biodiversity

The language of sedation in end-of-life care: The ethical reasoning of care providers in three countries

The application of ethically controversial medical procedures may differ from one place to another. Drawing on a keyword and text-mining analysis of 156 interviews with doctors and nurses involved in end-of-life care ('care providers'), differences between countries in care providers' ethical rationales for the use of sedation are reported. In the United Kingdom, an emphasis on titrating doses proportionately against symptoms is more likely, maintaining consciousness where possible. The potential harms of sedation are perceived to be the potential hastening of social as well as biological death. In Belgium and the Netherlands, although there is concern to distinguish the practice from euthanasia, rapid inducement of deep unconsciousness is more acceptable to care providers. This is often perceived to be a proportionate response to unbearable suffering in a context where there is also greater pressure to hasten dying from relatives and others. This means that sedation is more likely to be organised like euthanasia, as the end 'moment' is reached, and family farewells are organised before the patient is made unconscious for ever. Medical and nursing practices are partly responses to factors outside the place of care, such as legislation and public sentiment. Dutch guidelines for sedation largely tally with the practices prevalent in the Netherlands and Belgium, in contrast with those produced by the more international European Association for Palliative Care whose authors describe an ethical framework closer to that reportedly used by UK care providers.This work was supported by the Economic and Social Research Council (UK) [grant no: RES-062-23-2078], the Research Foundation Flanders (BE), the Flemish Cancer Association (BE), the Research Council of Ghent University (BE), the Netherlands Organization for Scientific Research (NL and the Netherlands Organization for Health Research and Development (NL)

“Not in their front yard” The opportunities and challenges of introducing perennial urban meadows: A local authority stakeholder perspective

© 2017 The Authors The growing evidence base for the benefits for people and wildlife of nature-based solutions to managing urban green infrastructure lacks research investigating land manager perspectives on their implementation. To address this gap, we explored UK local authority manager perceptions of the challenges and opportunities of introducing perennial urban meadows to prioritise biodiversity and aesthetics. This was co-produced as an experiment in urban greenspaces with Luton Parks Service and Bedford Borough Council 2013–15. We conducted semi-structured interviews with the eight stakeholder managers involved to identify key factors impacting on the perceived feasibility of future urban meadow establishment in other areas. All managers identified three dominant factors (aesthetics and public reaction, locational context, and human resources and economic sustainability). Additional factors (local politics, communication, biodiversity and existing habitat and physical factors) varied in importance according to personal values and managerial role. Support for future meadow introduction and a desire to overcome the economic challenge of the disposal of meadow arisings were related to manager biocentricity. Managers were aware of changing public values leading to increasing acceptance of a messier urban aesthetic. They perceived perennial meadows as a realistic alternative to amenity mown grass that in specific contexts could increase local biodiversity and enhance aesthetics if implemented in consultation with the public and local councillors. Our findings have relevance for the wider implementation of such nature-based solutions to urban GI management: Changes in management practice such as the introduction of perennial meadows have significant political, strategic, economic and practical implications and cannot be viewed purely as a technical challenge