Rising to the challenge of sleep problems in general practice – evidence for improving primary care for insomnia

This was an invited presentation at a national conference which aimed to:Place 'sleep quality' at the heart of the health, well-being and active ageing agenda.Disseminate research findings from the 4 year 'SomnIA: Sleep in Ageing project.Influence policy and practice in relation to sleep and night-time care in care homes.Raise awareness of the importance of the lighting environment for sleep and well-being.Improve policy and practice in relation to the management of insomnia in primary care.Demonstrate how a range of novel sensor devices can improve sleep at home and in care homes.</p

The Quality and Outcomes Framework: transparent, transferable, tenable?

This was an invited keynote presentation at The Primary Care Transparency Conference (Het Eesterlijns Transparantiecongres) in the Netherlands which aimed to explore the current state and future of primary care quality indicators in the Netherlands. I presented views and research on the UK Quality and Outcomes Framework, its benefits, unintended consequences and future.</p

EU 2020 Targets: the health 2020 targets and the role of primary care and occupational therapy

Invited keynote presentation at the 19 Annual Meeting of the European Network of Occupational Therapy in Higher Education which aimed to explore the role of primary care and occupational therapy in delivery of the EU Health 2020 targets. Health 2020, the European policy framework supporting action across government and society for health and wellbeing, was published in 2012 and led by the World Health Organization regional office in Europe. The policy sets out to enable people to achieve their full potential for health and well-being by improving governance and leadership, reducing inequalities and adding value through partnerships and cooperation. It addresses four interlinked, interdependent and mutually supportive priority areas: health throughout the life course, tackling major non-communicable and communicable disease, strengthening people centred health systems, public health and emergency preparedness and creating resilient and supportive environments.</p

Providing sexual health services in a rural GP setting: a case study example from England

Evaluation of Sexual Health Services in Lincolnshire.</p

Identifying barriers and facilitators to improving prehospital care of asthma: views of ambulance clinicians

Background: In 2008/09 there were nearly 80,000 emergency hospital admissions for asthma. Current UK guidelines emphasise the importance of evidence-based prehospital assessment and treatment of asthma for improving patient outcomes and reducing hospitalisation, morbidity and mortality. National benchmarking of ambulance clinical performance indicators for asthma has revealed important unexplained variations in care across ambulance services. Little research has been undertaken to understand the reasons for poor levels of care.Objective: The aim of this study was to gather data on ambulance clinicians’ perceptions and beliefs around prevailing and best practice for management of asthma. This was used to identify the factors which prevent or enable better asthma care in ambulance services. Methods: We used a phenomenological qualitative approach, which addresses how individuals use their experiences to make sense of their world, focusing on participants’ lived experiences of care delivery for asthma. We used focus groups of ambulance clinicians to gather data on barriers and facilitators to better asthma care. Recordings and notes were taken, transcribed and then analysed using QSR NVivo 8. A coding framework was developed based on a priori concepts but with emergent themes added during the analysis.Results: Two focus groups were conducted with eight and five participants respectively. A number of preliminary themes and subthemes were identified. The study identified issues relating to clarity of ambulance guidelines, conflicts between training and guidance, misconceptions about the importance of objective assessment and over reliance on non-objective assessment. Some practitioners believed that hospital staff were not interested in prehospital peak flow assessments.Conclusion: Our findings will inform improved systems of care for asthma and the effect on indicators will be measured using time series methods. This approach could be used more widely to improve management of specific clinical conditions where quality of care is demonstrated to be suboptimal.</p

Systematic scoping review of care navigation for older people with multimorbidity

The problem:The health and social care environment is being transformed by the needs of the aging population, higher levels of multimorbidity, and shifts in the care landscape, e.g., specialisation and fragmentation. Health and social care systems were not designed to appropriately support individuals with multimorbidities; evolving to cater for single diseases and acute events. There is now an urgent need to redesign care structures and delivery to ensure individuals can access the right care at the right time and in the right place. If users are unable to adequately navigate health, social and third sector care, there is likely to be an increase in expenditure (use of non-appropriate services) and reduction in patient satisfaction and well-being.Multimorbidity requires patients to seek care from different practitioners, within and beyond primary care. Little is known about how users interact with care systems, and particularly how this impacts on effective care navigation. This study aimed to scope the literature on how older people (aged 55 years and over) with multimorbidities effectively navigate the care system. The approach:A systematic scoping review addressed the research question: ‘What evidence is available in the literature regarding care system navigation in the setting of older people with multimorbidity?’ Papers were drawn from five databases and ten grey literature sources using the following inclusion criteria: literature published between 2003-2014 in English, Dutch, French or German and included key terms of navigat* AND multi*morbid*. The selection was refined through reading abstracts or full papers. Final papers were extracted into a data extraction table for analysis.Findings:From 3,171 papers in the initial search, 367 papers were identified through reviewing title and abstract. Further in-depth review of abstracts and full texts resulted in a final 12 papers. These studies demonstrated that patients perceived they were expected to find their own way, learning from experience, rather than being able to rely on a particular service that could support them to navigate their different care needs. Where care navigation programs were in place, demonstrable benefits were shown for patients with single diseases (e.g. cancer, chronic lung disease). Although promising results were seen for those patients with multimorbidities there was a lack of implementation. Consequences:Limited literature is available on experiences of older people with multimorbidities who face a daunting task navigating the care system. To maximise health and wellbeing, increase patient empowerment and satisfaction and limit costs due to inappropriate navigation, better systems are needed which provide patients with practical, information and social support to help them navigate the care system. There is clarity as to the type and extent of support patients perceive they need, there is little evidence around the most effective method of delivering such support.</p

Cast adrift in the care system? A systematic scoping review of care navigation for older people with multimorbidity

With an increase in the older population, higher levels of multimorbidity and changes in the care landscape (e.g. specialisation, fragmentation), there is a need for greater insight into how suffering from two or more major chronic conditions affects patient experience of, and navigation through, the health and social care system. This study aims to gain an understanding of what information is available in the literature regarding care system navigation in the setting of older people with multimorbidity. A scoping review through five electronic databases was conducted together with a review of the grey literature on this topic. This resulted in an in-depth analysis of 47 selected papers, from which 12 papers were of particular relevance. Limited literature is available on experiences of older people with multimorbidity navigating the care system. The few studies that we found revealed that patients were expected to find their own way, learning by experience, rather than having a system to help them navigate their care.</p

Exploring Service User and practitioner perspectives of QCancer use in primary care consultations

Trent Regional SAPC Spring MeetingTuesday 15 MarchCollege Court Conference Centre and Hotel, Knighton Road, Leicester, LE2 3UF Title of the abstract:Exploring Service User and practitioner perspectives of QCancer use in primary care consultationsAuthor(s): Akanuwe JN, Siriwardena AN, Black S and Owen SInstitution: Community and Health Research Unit, University of LincolnContact Details (email): [email protected]: QCancer is a novel cancer risk assessment tool that combines risk factors and symptoms to estimate an individual’s risk of developing cancer within two years. This study explored the perspectives of service users and primary care practitioners about using QCancer in the primary care consultation.Methods: We used qualitative methods to conduct individual and focus group interviews with service users recruited from the general public and primary care practitioners (GPs and nurses) recruited from general practices in Lincolnshire (a large rural county in England) until data saturation was achieved. The qualitative data were transcribed verbatim and analysed using the Framework approach.Results: Thirty-six participants, 19 service users and 17 practitioners, were interviewed. They expressed a range of views about the implications of quantifying cancer risk using QCancer including potential conflict with current cancer guidelines or that high risk symptoms would need referral for further investigation whatever the quantified risk.Participants, both service users and providers, agreed that QCancer was useful for consultations for cancer in: quantifying risk; supporting decision-making; identifying, raising awareness of and modifying health behaviours; improving processes and speed of assessment and treatment; and personalising care.Participants also raised the need to address communication issues related to use of QCancer such as tailoring visual representation of risk; openness and honesty; informing and involving patients in use of QCancer and providing time for listening, informing, explaining and reassuring in the context of a professional approach. Participants also identified potential challenges to uptake of QCancer in general practice including: additional time required, unnecessary worry generated by false positives, potential for over-referral, practitioner scepticism about using the new tool, and the need for evidence of effectiveness before introducing QCancer in patient consultations.Conclusion: Service users and primary care practitioners perceived that QCancer would support and individualise decision making, help identify and modify health behaviours, increase knowledge, improve the processes and speed of cancer assessments and treatments and facilitate personalised care of cancer. Communication needs of users and potential barriers for both users and practitioners will need to be considered in planning for QCancer use in general practice consultations.</p

Service user and practitioner perspectives of QCancer use in primary care consultations [workshop]

Workshop presentation for GP Educators conference- 14/01/16Workshop on service user and practitioner perspectives of QCancer use in primary care consultationsResearchers:Joseph Akanuwe, PhD Student, Community and Health Research Unit, University of Lincoln.Professor Niro Siriwardena, Professor of Primary and Pre Hospital Health Care and Director of the Community and Health Research Unit, University of Lincoln.Dr Sharon Black, Director of Nurse Education, University of LincolnProfessor Sarah Owen, Pro Vice Chancellor and Head of the College of Social Science, University of Lincoln.IntroductionQCancer is a novel cancer risk assessment tool that combines risk factors and symptoms to estimate an individual’s risk of developing cancer within two years. This study explored the perspectives of patients and primary care practitioners about using QCancer in the primary care consultation.MethodsWe used qualitative methods to conduct individual and focus group interviews with service users recruited from the general public and primary care practitioners (GPs and nurses) recruited from general practices in Lincolnshire (a large rural county in England) until data saturation was achieved. The qualitative data were transcribed verbatim and analysed using the Framework approach.Results Thirty-six participants, 19 service users (aged between 21-71 years) and 17 practitioners (aged between 33 and 55 years) were interviewed. They expressed a range of views:Implications of quantifying cancer risk using QCancer including:•Potential conflict with current cancer guidelines •High risk symptoms would need referral for further investigation whatever the quantified risk.QCancer is potentially useful for cancer consultations•Quantifying cancer risk•Supporting decision-making•Identifying, raising awareness of and modifying health behaviours•Improving processes and speed of assessment and treatment, and •Personalising care.Need to address communication issues related to use of QCancer•Tailoring visual representation of risk•Openness and honesty•Informing and involving patients in use of QCancer and •Providing time for listening, informing, explaining and reassuring in the context of a professional approachPotential challenges to uptake of QCancer in general practice •Additional time required•Unnecessary worry generated by false positives•Potential for over-referral and strain on resources•Practitioner scepticism about using the new tool, and •The need for evidence of effectiveness before introducing QCancer in patient consultations.ConclusionService users and primary care practitioners perceived that:•QCancer would support and individualise decision making•Help identify and modify health behaviours•Increase knowledge•Improve the processes and speed of cancer assessments and treatments and facilitate personalised care of cancer. •Communication needs of users and potential barriers for both users and practitioners will need to be considered in planning for QCancer use in general practice consultations.</p

Exploring service user and practitioner perspectives of QCancer use in primary care consultations

COLLEGE OF SOCIAL SCIENCESummer Research Conference 2016) Akanuwe JNA Siriwardena AN Black S, Owen SCommunity and Health Research Unit, School of Health and Social CareEXPLORING SERVICE USER AND PRACTITIONER PERSPECTIVES OF QCANCER USE IN PRIMARY CARE CONSULTATIONSIntroduction: This study explored perspectives of service users and primary care practitioners about using QCancer, a cancer risk assessment tool, in primary care consultations.Methods: Individual and focus group interviews with data analysed using the Framework approach.Results: 36 participants, 19 service users and 17 practitioners, were interviewed until data saturation was achieved. Participants expressed a range of views about the implications of quantifying cancer risk using QCancer including: potential conflict with current cancer guidelines and, high risk symptoms would need referral for further investigation whatever the quantified risk. Participants agreed that QCancer would be useful in a number of ways including: helping to identify and raise awareness for modifying health behaviours and personalising patient care. Participants discussed communication needs when using QCancer, which will add to knowledge in terms of how best to improve communication of cancer risk during the consultation. Potential challenges to uptake of QCancer were also identified.Conclusion: Participants perceived that QCancer would be potentially useful but communication needs of users and potential barriers for both users and practitioners need to be considered when planning QCancer use in general practice consultations.</p