Informal carers' health-related quality of life and patient experience in primary care: evidence from 195,364 carers in England responding to a national survey.

BACKGROUND: We aim to describe the health-related quality of life of informal carers and their experiences of primary care. METHODS: Responses from the 2011-12 English General Practice Patient Survey, including 195,364 informal carers, were analysed using mixed effect logistic regressions controlling for age, gender, ethnicity and social deprivation to describe carer health-related quality of life (mobility, self-care, usual activities, pain, and anxiety/depression, measured using EQ-5D) and primary care experience (access, continuity and communication). RESULTS: Informal carers reported poorer health-related quality of life than non-carers of similar age, gender, ethnicity and social deprivation. Increasing caring commitment was associated with worse EQ-5D scores, with carers of 50+ hours a week scoring 0.05 points lower than non-carers (95 % CI 0.05 to 0.04), equivalent to 18 fewer days of full health annually. Considering each domain of EQ-5D separately, carers of 50+ hours/week were more likely to report pain OR = 1.53 (1.50-1.57), p < 0.0001, and anxiety/depression OR = 1.69 (1.66-1.73), p < 0.0001, than non-carers. Younger carers scored lower on EQ-5D than non-carer peers but the converse was true among over-85s. In the most deprived areas carers reported the equivalent of 37 fewer days of full health annually than carers in the most affluent areas. On average, carers reported poorer patient experiences in all areas of primary care than non-carers (odds ratios 0.84-0.97), with this difference being most marked in the domain of access. CONCLUSIONS: Informal carers experience a double disadvantage of poorer health-related quality of life and poorer patient experience in primary care. We find no evidence for health benefits of caregiving. We recommend physicians identify and treat carer health problems, including pain and anxiety/depression, particularly among young, deprived and high time-commitment carers. Improving patient experience for carers, including access to primary care, should be a priority.This is the final version of the article. It first appeared from BioMed Central via http://dx.doi.org/10.1186/s12875-015-0277-

How do people with diabetes describe their experiences in primary care? Evidence from 85,760 patients with self-reported diabetes from the English General Practice Patient Survey.

OBJECTIVE: Developing primary care is an important current health policy goal in the U.S. and England. Information on patients' experience can help to improve the care of people with diabetes. We describe the experiences of people with diabetes in primary care and examine how these experiences vary with increasing comorbidity. RESEARCH DESIGN AND METHODS: Using data from 906,578 responders to the 2012 General Practice Patient Survey (England), including 85,760 with self-reported diabetes, we used logistic regressions controlling for age, sex, ethnicity, and socioeconomic status to analyze patient experience using seven items covering three domains of primary care: access, continuity, and communication. RESULTS: People with diabetes were significantly more likely to report better experience on six out of seven primary care items than people without diabetes after adjusting for age, sex, ethnicity, and socioeconomic status (adjusted differences 0.88-3.20%; odds ratios [ORs] 1.07-1.18; P < 0.001). Those with diabetes and additional comorbid long-term conditions were more likely to report worse experiences, particularly for access to primary care appointments (patients with diabetes alone compared with patients without diabetes: OR 1.22 [95% CI 1.17-1.28] and patients with diabetes plus three or more conditions compared with patients without diabetes: OR 0.87 [95% CI 0.83-0.91]). CONCLUSIONS: People with diabetes in England report primary care experiences that are at least as good as those without diabetes for most domains of care. However, improvements in primary care are needed for diabetes patients with comorbid long-term conditions, including better access to appointments and improved communication.Diabetes UKThis is the author accepted manuscript. The final version is available from the American Diabetes Association via http://dx.doi.org/10.2337/dc14-109

Inequalities in general practice remote consultations: a systematic review

Background: COVID-19 has led to rapid and widespread use of remote consultations in general practice, but the health inequalities impact remains unknown. Aim: To explore the impact of remote consultations in general practice compared to face-to-face consultations on utilisation and clinical outcomes across socio-economic and disadvantaged groups. Design &amp; setting: Systematic review Method: We undertook an electronic search of MEDLINE, EMBASE and Web of Science from inception to June 2020. We included studies which compared remote consultations to face-to-face consultations in primary care and reported outcomes by PROGRESS Plus criteria. Risk of bias was assessed using ROBINS-I. Data was synthesised narratively. Results: Based on 13 studies, exploring telephone and internet-based consultations, we found that telephone consultations were used by younger working age people, the very old and non-immigrants, with internet-based consultations more likely to be used by younger people. Women consistently used more remote forms of consulting than men. Socio-economic and ethnicity findings were mixed, with weak evidence that patients from more affluent areas were more likely to use internet-based communication. Remote consultations appeared to help patients with opioid dependence remain engaged with primary care. No studies reported on the impact on quality of care or clinical outcomes. Conclusion: Remote consultations in general practice are likely to be used more by younger working people, non-immigrants, the elderly and women, with internet-based consultations more by younger, affluent and educated groups. Wide-spread use of remote consultations should be treated with caution until the inequalities impact on clinical outcomes and quality of care is known

Testing a peer support intervention for people with type 2 diabetes: a pilot for a randomised controlled trial.

BACKGROUND: People with Type 2 diabetes face various psycho-social, self-management and clinical care issues and evidence is mixed whether support from others with diabetes, 'peer support', can help. We now describe a 2 month pilot study of different peer support interventions. METHODS: The intervention was informed by formative evaluation using semi-structured interviews with health professionals, community support groups and observation of diabetes education and support groups. Invitations to participate were mailed from 4 general practices and included a survey of barriers to care. Participants were randomized by practice to receive individual, group, combined (both individual and group) or no peer support. Evaluation included ethnographic observation, semi-structured interviews and questionnaires at baseline and post-intervention. RESULTS: Of 1,101 invited, 15% expressed an interest in participating in the pilot. Sufficient numbers volunteered to become peer supporters, although 50% of these (8/16) withdrew. Those in the pilot were similar to other patients, but were less likely to feel they knew enough about diabetes (60.8% vs 44.6% p = 0.035) and less likely to be happy with the diabetes education/care to date (75.4% vs 55.4% p = 0.013). Key issues identified were the need to recruit peer supporters directly rather than through clinicians, to address participant diabetes educational needs early and the potential for group sessions to have lower participation rates than 1:1 sessions. CONCLUSIONS: Recruitment to a full trial of peer support within the existing study design is feasible with some amendments. Attendance emerged as a key issue needing close monitoring and additional intervention during the trial.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Are people with negative diabetes screening tests falsely reassured? Parallel group cohort study embedded in the ADDITION (Cambridge) randomised controlled trial

Objective To assess whether receiving a negative test result at primary care based stepwise diabetes screening results in false reassurance

Rating Communication in GP Consultations: The Association Between Ratings Made by Patients and Trained Clinical Raters.

Patient evaluations of physician communication are widely used, but we know little about how these relate to professionally agreed norms of communication quality. We report an investigation into the association between patient assessments of communication quality and an observer-rated measure of communication competence. Consent was obtained to video record consultations with Family Practitioners in England, following which patients rated the physician's communication skills. A sample of consultation videos was subsequently evaluated by trained clinical raters using an instrument derived from the Calgary-Cambridge guide to the medical interview. Consultations scored highly for communication by clinical raters were also scored highly by patients. However, when clinical raters judged communication to be of lower quality, patient scores ranged from "poor" to "very good." Some patients may be inhibited from rating poor communication negatively. Patient evaluations can be useful for measuring relative performance of physicians' communication skills, but absolute scores should be interpreted with caution.The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was funded by a National Institute for Health Research Programme Grant for Applied Research (NIHR PGfAR) program (RP-PG-0608-10050).This is the final version of the article. It first appeared from SAGE via http://dx.doi.org/10.1177/107755871667121

What happens to patient experience when you want to see a doctor and you get to speak to a nurse? Observational study using data from the English General Practice Patient Survey.

OBJECTIVES: To examine patient consultation preferences for seeing or speaking to a general practitioner (GP) or nurse; to estimate associations between patient-reported experiences and the type of consultation patients actually received (phone or face-to-face, GP or nurse). DESIGN: Secondary analysis of data from the 2013 to 2014 General Practice Patient Survey. SETTING AND PARTICIPANTS: 870 085 patients from 8005 English general practices. OUTCOMES: Patient ratings of communication and 'trust and confidence' with the clinician they saw. RESULTS: 77.7% of patients reported wanting to see or speak to a GP, while 14.5% reported asking to see or speak to a nurse the last time they tried to make an appointment (weighted percentages). Being unable to see or speak to the practitioner type of the patients' choice was associated with lower ratings of trust and confidence and patient-rated communication. Smaller differences were found if patients wanted a face-to-face consultation and received a phone consultation instead. The greatest difference was for patients who asked to see a GP and instead spoke to a nurse for whom the adjusted mean difference in confidence and trust compared with those who wanted to see a nurse and did see a nurse was -15.8 points (95% CI -17.6 to -14.0) for confidence and trust in the practitioner and -10.5 points (95% CI -11.7 to -9.3) for net communication score, both on a 0-100 scale. CONCLUSIONS: Patients' evaluation of their care is worse if they do not receive the type of consultation they expect, especially if they prefer a doctor but are unable to see one. New models of care should consider the potential unintended consequences for patient experience of the widespread introduction of multidisciplinary teams in general practice

Type 2 diabetes : understanding the self-regulatory experience : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University, Palmerston North

This research investigates type 2 diabetes using a psychological approach grounded in self-regulatory theory. Diabetes mellitus is usually described as a long-term illness with serious physical consequences, and biomedical perspectives predominate in published diabetes research. Findings from the present study add to accumulating knowledge about diabetes by addressing an identifiable gap in the literature, namely, an understanding of the psychological processes involved in managing type 2 diabetes. The common sense model (CSM) of illness self-regulation was used as the conceptual framework for this study. The research sample (N = 1145) was identified from a medical database. A mailed questionnaire survey was used to obtain psychological and self-report data, and this was subsequently merged with clinical data from a review of the medical database. A response rate of 55% provided a total of 629 completed questionnaires. The age, gender, and cultural composition of the sample were a close match with those reported for the New Zealand type 2 diabetes population. Research findings contribute to self-regulatory theory by testing key relationships specified in the CSM. The identification of a relationship cluster connecting emotional illness responses with cyclical symptoms, serious consequences, strong illness identity, and low coherence, highlights an emotional pathway in diabetes self-regulation. Observed relationships support the interaction between cognition and affect proposed in the CSM. Results show significant relationships between treatment perceptions and diabetes self-management, and draw attention to the importance of family relationships in explaining diet and exercise patterns. Perceived consequences of diabetes play a pertinent role in explaining variance in quality of life, and diabetes-related distress. The CSM postulates coping responses mediate between representations and illness outcomes; current findings, showing that medication use mediates the relationship between treatment representations and HbA1c, support the predicted mediating relationship. It is concluded the common sense model provides a useful theoretical framework for research investigating self-care and wellbeing among people with type 2 diabetes. Potential implications for psychological theory and clinical practice are discussed, and three areas - examining the roles of appraisal, emotion, and culture in illness management - are identified as priority targets for further research and conceptual development

Satisfaction With Pharmacy Services Among Older Adults in New Zealand

Objectives: This study aimed to: (a) ascertain levels of satisfaction with pharmacy services, and (b) identify possible barriers to pharmacy services utilisation among older adults in New Zealand. Method: Data was collected using a mailed questionnaire. Participants were older adults randomly selected from the general electoral roll (N = 180). Results: While satisfaction with pharmacy services was found to be generally high among older adults, considerable dissatisfaction was evident in relation to the cost of medication. Conclusions: While dissatisfaction was expressed with the cost of prescriptions, at present this does not appear linked to a failure to uplift medication. Physical access to pharmacy services may be compromised by disabling health problems, particularly among those living alone