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Verity A, Tzortziou Brown V. GP access for inclusion health groups: perspectives and recommendations. BJGP Open 2024:BJGPO.2024.0021. [PMID: 38448086 DOI: 10.3399/bjgpo.2024.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/29/2024] [Accepted: 02/29/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND General practice has seen the widespread adoption of remote consulting and triage systems. There is a lack of evidence exploring how inclusion health populations have been impacted by this transformation. AIM This study aimed to explore the post-pandemic GP access for inclusion health populations, through the lens of those with lived experience, and identify practical recommendations for improving access for this population. DESIGN & SETTING A mixed-methods study exploring the direct experience of people from inclusion health groups trying to access GP care in 13 practices in east London. METHOD A mystery shopper exercise involving 39 in-person practice visits and 13 phone calls were undertaken. The findings were reflected on by a multidisciplinary stakeholder group, which identified recommendations for improvements. RESULTS Only 31% of the mystery shopper visits (n = 8) resulted in registration and the offer of an appointment to see a GP for an urgent problem. None of the mystery shoppers was able to book an appointment over the phone but n = 10/13 felt that they would be able to register and make an appointment if they followed the receptionist's instructions. Most mystery shoppers felt respected, listened to, and understood the information provided to them. Just under half of the practices (46%, n = 6) received positive comments on how accessible and supportive their spaces felt. Practice- and system-level recommendations were identified by the stakeholder group. CONCLUSION Ongoing GP access issues persist for inclusion health populations. We identified practice- and system-level recommendations for improving access for this vulnerable population.
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Affiliation(s)
- Aaminah Verity
- Wolfson Institute of Population Health, Queen Mary University London, London, UK
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2
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Wilson S, Tolley C, Mc Ardle R, Lawson L, Beswick E, Hassan N, Slight R, Slight S. Recommendations to advance digital health equity: a systematic review of qualitative studies. NPJ Digit Med 2024; 7:173. [PMID: 38951666 PMCID: PMC11217442 DOI: 10.1038/s41746-024-01177-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 06/21/2024] [Indexed: 07/03/2024] Open
Abstract
The World Health Organisation advocates Digital Health Technologies (DHTs) for advancing population health, yet concerns about inequitable outcomes persist. Differences in access and use of DHTs across different demographic groups can contribute to inequities. Academics and policy makers have acknowledged this issue and called for inclusive digital health strategies. This systematic review synthesizes literature on these strategies and assesses facilitators and barriers to their implementation. We searched four large databases for qualitative studies using terms relevant to digital technology, health inequities, and socio-demographic factors associated with digital exclusion summarised by the CLEARS framework (Culture, Limiting conditions, Education, Age, Residence, Socioeconomic status). Following the PRISMA guidelines, 10,401 articles were screened independently by two reviewers, with ten articles meeting our inclusion criteria. Strategies were grouped into either outreach programmes or co-design approaches. Narrative synthesis of these strategies highlighted three key themes: firstly, using user-friendly designs, which included software and website interfaces that were easy to navigate and compatible with existing devices, culturally appropriate content, and engaging features. Secondly, providing supportive infrastructure to users, which included devices, free connectivity, and non-digital options to help access healthcare. Thirdly, providing educational support from family, friends, or professionals to help individuals develop their digital literacy skills to support the use of DHTs. Recommendations for advancing digital health equity include adopting a collaborative working approach to meet users' needs, and using effective advertising to raise awareness of the available support. Further research is needed to assess the feasibility and impact of these recommendations in practice.
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Affiliation(s)
- Sarah Wilson
- School of Pharmacy, Newcastle University, Newcastle Upon Tyne, UK
| | - Clare Tolley
- School of Pharmacy, Newcastle University, Newcastle Upon Tyne, UK
| | - Ríona Mc Ardle
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Lauren Lawson
- School of Pharmacy, Newcastle University, Newcastle Upon Tyne, UK
| | | | - Nehal Hassan
- School of Pharmacy, Newcastle University, Newcastle Upon Tyne, UK
| | - Robert Slight
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Sarah Slight
- School of Pharmacy, Newcastle University, Newcastle Upon Tyne, UK.
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.
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Potter LC, Stone T, Swede J, Connell F, Cramer H, McGeown H, Carvalho M, Horwood J, Feder G, Farr M, Gaps B. Improving access to general practice for and with people with severe and multiple disadvantage: a qualitative study. Br J Gen Pract 2024; 74:e330-e338. [PMID: 38575183 PMCID: PMC11005924 DOI: 10.3399/bjgp.2023.0244] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 11/01/2023] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND People with severe and multiple disadvantage (SMD) who experience combinations of homelessness, substance misuse, violence, abuse, and poor mental health have high health needs and poor access to primary care. AIM To improve access to general practice for people with SMD by facilitating collaborative service improvement meetings between healthcare staff, people with lived experience of SMD, and those who support them; participants were then interviewed about this work. DESIGN AND SETTING The Bridging Gaps group is a collaboration between healthcare staff, researchers, women with lived experience of SMD, and a charity that supports them in a UK city. A project was co-produced by the Bridging Gaps group to improve access to general practice for people with SMD, which was further developed with three inner-city general practices. METHOD Nine service improvement meetings were facilitated at three general practices, and six of these were formally observed. Nine practice staff and four women with lived experience of SMD were interviewed. Three women with lived experience of SMD and one staff member who supports them participated in a focus group. Data were analysed inductively and deductively using thematic analysis. RESULTS By providing time and funding opportunities to motivated general practice staff and involving participants with lived experience of SMD, service changes were made in an effort to improve access for people with SMD. These included prioritising patients on an inclusion patient list with more flexible access, providing continuity for patients via a care coordinator and micro-team of clinicians, and developing an information-sharing document. The process and outcomes improved connections within and between general practices, support organisations, and people with SMD. CONCLUSION The co-designed strategies described in this study could be adapted locally and evaluated in other areas. Investing in this focused way of working may improve accessibility to health care, health equity, and staff wellbeing.
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Affiliation(s)
- Lucy C Potter
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol
| | - Tracey Stone
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol; National Institute for Health and Care Research Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol
| | | | | | - Helen Cramer
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol
| | - Helen McGeown
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol
| | | | - Jeremy Horwood
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol; National Institute for Health and Care Research Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol
| | - Gene Feder
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol
| | - Michelle Farr
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol; National Institute for Health and Care Research Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol
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Dave M, Thakrar S, Bagnall H, Kumbang J. Real-time evaluation of a multi-agency TB-screening event for persons experiencing homelessness in a town with a low incidence of TB in England. Epidemiol Infect 2024; 152:e73. [PMID: 38557287 PMCID: PMC11094373 DOI: 10.1017/s0950268824000402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/28/2024] [Accepted: 02/22/2024] [Indexed: 04/04/2024] Open
Abstract
Real-time evaluation (RTE) supports populations (e.g., persons experiencing homelessness (PEH) to engage in evaluation of health interventions who may otherwise be overlooked. The aim of this RTE was to explore the understanding of TB amongst PEH, identify barriers/facilitators to attending screening for PEH alongside suggestions for improving TB-screening events targeting PEH, who have high and complex health needs. This RTE composed of free-text structured one-to-one interviews performed immediately after screening at a single tuberculosis (TB) screening event. Handwritten forms were transcribed for thematic analysis, with codes ascribed to answers that were developed into core themes. All RTE participants (n=15) learned about the screening event on the day it was held. Key concerns amongst screening attendees included: stigma around drug use, not understanding the purpose of TB screening, lack of trusted individuals/services present, too many partner organizations involved, and language barriers. Facilitators to screening included a positive welcome to the event, a satisfactory explanation of screening tests, and sharing of results. A need for improved event promotion alongside communication of the purpose of TB screening amongst PEH was also identified. A lack of trust identified by some participants suggests the range of services present should be reconsidered for future screening events.
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Affiliation(s)
- Mona Dave
- UK Field Epidemiology Training Program (UK FETP), UK Health Security Agency, London, United Kingdom
- Field Service Midlands Regions Directorate, UK Health Security Agency, Birmingham, UK
| | - Shivan Thakrar
- East Midlands Health Protection Team, UK Health Security Agency, Nottingham, UK
| | - Helen Bagnall
- Field Service Midlands Regions Directorate, UK Health Security Agency, Birmingham, UK
| | - Jharna Kumbang
- East Midlands Health Protection Team, UK Health Security Agency, Nottingham, UK
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5
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Voorhees J, Bailey S, Waterman H, Checkland K. A paradox of problems in accessing general practice: a qualitative participatory case study. Br J Gen Pract 2024; 74:e104-e112. [PMID: 38253550 PMCID: PMC10824332 DOI: 10.3399/bjgp.2023.0276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/10/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Despite longstanding problems of access to general practice, attempts to understand and address the issues do not adequately include perspectives of the people providing or using care, nor do they use established theories of access to understand complexity. AIM To understand problems of access to general practice from the multiple perspectives of service users and staff using an applied theory of access. DESIGN AND SETTING A qualitative participatory case study in an area of northwest England. METHOD A community-based participatory approach was used with qualitative interviews, focus groups, and observation to understand perspectives about accessing general practice. Data were collected between October 2015 and October 2016. Inductive and abductive analysis, informed by Levesque et al's theory of access, allowed the team to identify complexities and relationships between interrelated problems. RESULTS This study presents a paradox of problems in accessing general practice, in which the demand on general practice both creates and hides unmet need in the population. Data show how reactive rules to control demand have undermined important aspects of care, such as continuity. The layers of rules and decreased continuity create extra work for practice staff, clinicians, and patients. Complicated rules, combined with a lack of capacity to reach out or be flexible, leave many patients, including those with complex and/or unrecognised health needs, unable to navigate the system to access care. This relationship between demand and unmet need exacerbates existing health inequities. CONCLUSION Understanding the paradox of access problems allows for different targets for change and different solutions to free up capacity in general practice to address the unmet need in the population.
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Affiliation(s)
- Jennifer Voorhees
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester
| | - Simon Bailey
- Centre for Health Services Studies, University of Kent, Kent
| | - Heather Waterman
- Formerly School of Healthcare Sciences, Cardiff University, Cardiff
| | - Kath Checkland
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester
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Gibson H, Sanders C, Blakeman T, Ashcroft DM, Fudge N, Howells K. Providing care to marginalised communities: a qualitative study of community pharmacy teams. Br J Gen Pract 2024; 74:e49-e55. [PMID: 38154937 PMCID: PMC10755997 DOI: 10.3399/bjgp.2023.0267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/13/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND Health inequalities in the UK are widening, particularly since the COVID-19 pandemic. Community pharmacies are the most visited healthcare provider in England and are ideally placed to provide and facilitate access to care for those most disadvantaged. AIM To explore the experiences and needs of community pharmacy teams in providing care for marginalised groups and how this has changed since the COVID-19 pandemic. DESIGN AND SETTING A qualitative study in community pharmacy and across primary care. METHOD Semi-structured interviews were undertaken with members of community pharmacy teams, primary care network (PCN) pharmacists, GPs, and nurses in the North of England. RESULTS In total, 31 individuals participated in an interview (26 pharmacy staff, three GPs, and two nurses). Most participants acknowledged that their pharmacy had become busier since COVID-19 because of increased footfall compounded by patient difficulties in navigating remote digital systems. Few participants had received any formal training on working with marginalised communities; however, organisational barriers (such as lack of access to translation facilities) combined with interorganisational barriers (such as lack of integrated care) made it more difficult to provide care for some marginalised groups. Despite this, the continuity of care provided by many pharmacies was viewed as an important factor in enabling marginalised groups to access and receive care. CONCLUSION There are opportunities to better utilise the skills of community pharmacy teams. Resources, such as access to translation services, and interventions to enable better communication between community pharmacy teams and other primary care services, such as general practice, are essential.
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Affiliation(s)
- Helen Gibson
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester; NIHR Greater Manchester Patient Safety Research Collaboration, The University of Manchester, Manchester, UK
| | - Caroline Sanders
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester; NIHR Greater Manchester Patient Safety Research Collaboration, The University of Manchester, Manchester, UK
| | - Thomas Blakeman
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester; NIHR Greater Manchester Patient Safety Research Collaboration, The University of Manchester, Manchester, UK
| | - Darren M Ashcroft
- NIHR School for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester; NIHR Greater Manchester Patient Safety Research Collaboration, The University of Manchester; Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Nina Fudge
- Wolfson Institute of Population Health, Queen Mary University of London, London
| | - Kelly Howells
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester; NIHR Greater Manchester Patient Safety Research Collaboration, The University of Manchester, Manchester, UK
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7
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Alturkistani A, Greenfield G, Beaney T, Norton J, Costelloe CE. Cross-sectional analyses of online appointment booking and repeat prescription ordering user characteristics in general practices of England in the years 2018-2020. BMJ Open 2023; 13:e068627. [PMID: 37827735 PMCID: PMC10583059 DOI: 10.1136/bmjopen-2022-068627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 08/24/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVES To explore the characteristics of the General Practice Patient Survey (GPPS) respondents using the different functionalities of the online services in the context of England's National Health Service General Practices. We hypothesised that respondents who are older, with lower socioeconomic status and non-white ethnicity would be less likely to use online services, while long-term conditions might increase their usage. DESIGN Cross-sectional study using respondent-level data from the GPPS in England of the years 2018, 2019 and 2020. We assessed the association between online services use and respondent characteristics using two-level mixed-effects logistic regression. PARTICIPANTS Survey respondents of the GPPS 2018-2020. PRIMARY OUTCOME MEASURES Online appointment booking and online repeat prescription ordering. RESULTS 1 807 049 survey respondents were included in this study. 15% (n=263 938) used online appointment booking in the previous 12 months, and 19% (n=339 449) had ordered a repeat prescription in the previous 12 months. Respondents with a long-term condition, on regular multiple medications, who have deafness or hearing loss and who are from the lowest deprivation quintile were more likely to have used online services. Male respondents (compared with females) and respondents with black and other ethnicity compared with white ethnicity were less likely to use online services. Respondents over 85 years old were less likely to use online appointment booking and online repeat prescription ordering compared with the younger age groups. CONCLUSIONS Specific groups of respondents were more likely to use online services such as patients with long-term conditions or those with deafness or hearing loss. While online services could provide efficiency to patients and practices it is essential that alternatives continue to be provided to those that cannot use or choose not to use online services. Understanding the different patients' needs could inform solutions to increase the uptake and use of the services.
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Affiliation(s)
- Abrar Alturkistani
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Geva Greenfield
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Thomas Beaney
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - John Norton
- Applied Research Collaboration Northwest London, National Institute for Health Research, London, UK
| | - Ceire E Costelloe
- Department of Primary Care and Public Health, Imperial College London, London, UK
- Division of Clinical Studies, Institute of Cancer Research, London, UK
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Erku D, Khatri R, Endalamaw A, Wolka E, Nigatu F, Zewdie A, Assefa Y. Digital Health Interventions to Improve Access to and Quality of Primary Health Care Services: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6854. [PMID: 37835125 PMCID: PMC10572344 DOI: 10.3390/ijerph20196854] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/15/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023]
Abstract
Global digital technology advances offer the potential to enhance primary health care (PHC) quality, reach, and efficiency, driving toward universal health coverage (UHC). This scoping review explored how digital health solutions aid PHC delivery and UHC realization by examining the context, mechanisms, and outcomes of eHealth interventions. A comprehensive literature search was conducted, capturing qualitative and quantitative studies, process evaluations, and systematic or scoping reviews. Our analysis of 65 articles revealed that a well-functioning digital ecosystem-featuring adaptable, interoperable digital tools, robust Information and Communications Technology foundations, and enabling environments-is pivotal for eHealth interventions' success. Facilities with better digital literacy, motivated staff, and adequate funding demonstrated a higher adoption of eHealth technologies, leading to improved, coordinated service delivery and higher patient satisfaction. However, eHealth's potential is often restricted by existing socio-cultural norms, geographical inequities in technology access, and digital literacy disparities. Our review underscores the importance of considering the digital ecosystem's readiness, user behavior, broader health system requirements, and PHC capacity for adopting digital solutions while assessing digital health interventions' impact.
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Affiliation(s)
- Daniel Erku
- Centre for Applied Health Economics, School of Medicine, Griffith University, Nathan, QLD 4111, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, QLD 4111, Australia
- School of Public Health, The University of Queensland, Brisbane, QLD 4072, Australia; (R.K.); (A.E.); (Y.A.)
| | - Resham Khatri
- School of Public Health, The University of Queensland, Brisbane, QLD 4072, Australia; (R.K.); (A.E.); (Y.A.)
| | - Aklilu Endalamaw
- School of Public Health, The University of Queensland, Brisbane, QLD 4072, Australia; (R.K.); (A.E.); (Y.A.)
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Eskinder Wolka
- International Institute for Primary Health Care in Ethiopia, Addis Ababa, Ethiopia; (E.W.); (F.N.); (A.Z.)
| | - Frehiwot Nigatu
- International Institute for Primary Health Care in Ethiopia, Addis Ababa, Ethiopia; (E.W.); (F.N.); (A.Z.)
| | - Anteneh Zewdie
- International Institute for Primary Health Care in Ethiopia, Addis Ababa, Ethiopia; (E.W.); (F.N.); (A.Z.)
| | - Yibeltal Assefa
- School of Public Health, The University of Queensland, Brisbane, QLD 4072, Australia; (R.K.); (A.E.); (Y.A.)
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Vestesson EM, De Corte KLA, Crellin E, Ledger J, Bakhai M, Clarke GM. Consultation Rate and Mode by Deprivation in English General Practice From 2018 to 2022: Population-Based Study. JMIR Public Health Surveill 2023; 9:e44944. [PMID: 37129943 DOI: 10.2196/44944] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/03/2023] [Accepted: 03/14/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has had a significant impact on primary care service delivery with an increased use of remote consultations. With general practice delivering record numbers of appointments and rising concerns around access, funding, and staffing in the UK National Health Service, we assessed contemporary trends in consultation rate and modes (ie, face-to-face versus remote). OBJECTIVE This paper describes trends in consultation rates in general practice in England for key demographics before and during the COVID-19 pandemic. We explore the use of remote and face-to-face consultations with regard to socioeconomic deprivation to understand the possible effect of changes in consultation modes on health inequalities. METHODS We did a retrospective analysis of 9,429,919 consultations by general practitioners, nurses, or other health care professionals between March 2018 and February 2022 for patients registered at 397 general practices in England. We used routine electronic health records from Clinical Practice Research Datalink Aurum with linkage to national data sets. Negative binomial models were used to predict consultation rates and modes (ie, remote versus face-to-face) by age, sex, and socioeconomic deprivation over time. RESULTS Overall consultation rates increased by 15% from 4.92 in 2018-2019 to 5.66 in 2021-2022 with some fluctuation during the start of the COVID-19 pandemic. The breakdown into face-to-face and remote consultations shows that the pandemic precipitated a rapid increase in remote consultations across all groups, but the extent varies by age. Consultation rates increased with increasing levels of deprivation. Socioeconomic differences in consultation rates, adjusted for sex and age, halved during the pandemic (from 0.36 to 0.18, indicating more consultations in the most deprived), effectively narrowing relative differences between deprivation quintiles. This trend remains when stratified by sex, but the difference across deprivation quintiles is smaller for men. The most deprived saw a relatively larger increase in remote and decrease in face-to-face consultation rates compared to the least deprived. CONCLUSIONS The substantial increases in consultation rates observed in this study imply an increased pressure on general practice. The narrowing of consultation rates between deprivation quintiles is cause for concern, given ample evidence that health needs are greater in more deprived areas.
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Affiliation(s)
- Emma Maria Vestesson
- The Health Foundation, London, United Kingdom
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | | | | | - Jean Ledger
- National Health Service England, London, United Kingdom
| | - Minal Bakhai
- National Health Service England, London, United Kingdom
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Greenhalgh T, Shaw SE, Alvarez Nishio A, Byng R, Clarke A, Dakin F, Faulkner S, Hemmings N, Husain L, Kalin A, Ladds E, Moore L, Rosen R, Rybczynska-Bunt S, Wherton J, Wieringa S. Remote care in UK general practice: baseline data on 11 case studies. NIHR OPEN RESEARCH 2022; 2:47. [PMID: 36814638 PMCID: PMC7614213 DOI: 10.3310/nihropenres.13290.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 12/03/2022]
Abstract
Background Accessing and receiving care remotely (by telephone, video or online) became the default option during the coronavirus disease 2019 (COVID-19) pandemic, but in-person care has unique benefits in some circumstances. We are studying UK general practices as they try to balance remote and in-person care, with recurrent waves of COVID-19 and various post-pandemic backlogs. Methods Mixed-methods (mostly qualitative) case study across 11 general practices. Researchers-in-residence have built relationships with practices and become familiar with their contexts and activities; they are following their progress for two years via staff and patient interviews, documents and ethnography, and supporting improvement efforts through co-design. In this paper, we report baseline data. Results Reflecting our maximum-variety sampling strategy, the 11 practices vary in size, setting, ethos, staffing, population demographics and digital maturity, but share common contextual features-notably system-level stressors such as high workload and staff shortages, and UK's technical and regulatory infrastructure. We have identified both commonalities and differences between practices in terms of how they: 1] manage the 'digital front door' (access and triage) and balance demand and capacity; 2] strive for high standards of quality and safety; 3] ensure digital inclusion and mitigate wider inequalities; 4] support and train their staff (clinical and non-clinical), students and trainees; 5] select, install, pilot and use technologies and the digital infrastructure which support them; and 6] involve patients in their improvement efforts. Conclusions General practices' responses to pandemic-induced disruptive innovation appear unique and situated. We anticipate that by focusing on depth and detail, this longitudinal study will throw light on why a solution that works well in one practice does not work at all in another. As the study unfolds, we will explore how practices achieve timely diagnosis of urgent or serious illness and manage continuity of care, long-term conditions and complex needs.
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Sara E. Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | | | | | - Aileen Clarke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Francesca Dakin
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Stuart Faulkner
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | | | - Laiba Husain
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Asli Kalin
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Emma Ladds
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Lucy Moore
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | | | | | - Joseph Wherton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Sietse Wieringa
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
- Centre for Sustainable Health Education, University of Oslo, Oslo, NO-0316, Norway
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11
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Greenhalgh T, Shaw SE, Alvarez Nishio A, Byng R, Clarke A, Dakin F, Faulkner S, Hemmings N, Husain L, Kalin A, Ladds E, Moore L, Rosen R, Rybczynska-Bunt S, Wherton J, Wieringa S. Remote care in UK general practice: baseline data on 11 case studies. NIHR OPEN RESEARCH 2022; 2:47. [PMID: 36814638 PMCID: PMC7614213 DOI: 10.3310/nihropenres.13290.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 10/27/2023]
Abstract
BACKGROUND Accessing and receiving care remotely (by telephone, video or online) became the default option during the coronavirus disease 2019 (COVID-19) pandemic, but in-person care has unique benefits in some circumstances. We are studying UK general practices as they try to balance remote and in-person care, with recurrent waves of COVID-19 and various post-pandemic backlogs. METHODS Mixed-methods (mostly qualitative) case study across 11 general practices. Researchers-in-residence have built relationships with practices and become familiar with their contexts and activities; they are following their progress for two years via staff and patient interviews, documents and ethnography, and supporting improvement efforts through co-design. In this paper, we report baseline data. RESULTS Reflecting our maximum-variety sampling strategy, the 11 practices vary in size, setting, ethos, staffing, population demographics and digital maturity, but share common contextual features-notably system-level stressors such as high workload and staff shortages, and UK's technical and regulatory infrastructure. We have identified both commonalities and differences between practices in terms of how they: 1] manage the 'digital front door' (access and triage) and balance demand and capacity; 2] strive for high standards of quality and safety; 3] ensure digital inclusion and mitigate wider inequalities; 4] support and train their staff (clinical and non-clinical), students and trainees; 5] select, install, pilot and use technologies and the digital infrastructure which support them; and 6] involve patients in their improvement efforts. CONCLUSIONS General practices' responses to pandemic-induced disruptive innovation appear unique and situated. We anticipate that by focusing on depth and detail, this longitudinal study will throw light on why a solution that works well in one practice does not work at all in another. As the study unfolds, we will explore how practices achieve timely diagnosis of urgent or serious illness and manage continuity of care, long-term conditions and complex needs.
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Sara E. Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | | | | | - Aileen Clarke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Francesca Dakin
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Stuart Faulkner
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | | | - Laiba Husain
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Asli Kalin
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Emma Ladds
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Lucy Moore
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | | | | | - Joseph Wherton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Sietse Wieringa
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
- Centre for Sustainable Health Education, University of Oslo, Oslo, NO-0316, Norway
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Allen EM, Smither B, Barranco L, Reynolds J, Bursey K, Mattson K, Mosites E. Communicating Effectively With People Experiencing Homelessness to Prevent Infectious Diseases. J Infect Dis 2022; 226:S340-S345. [PMID: 36208164 PMCID: PMC9619659 DOI: 10.1093/infdis/jiac336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background People experiencing homelessness (PEH) are disproportionately affected by many infectious diseases, including coronavirus disease 2019 (COVID-19). However, communication efforts during public health emergencies like the COVID-19 pandemic often do not consider the unique needs of PEH. We examined how PEH seek and receive health information and how traditional health communication methods resonate with them. Methods We conducted in-person focus groups with PEH in 4 jurisdictions (Cincinnati, Ohio; Denver, Colorado; Sacramento, California; and the Bronx, New York) during July 2021. Results Findings from 15 focus groups with PEH (n = 53) revealed the need for trusted messengers and consistent messaging across local organizations, as PEH seek to verify information they receive from multiple sources. PEH overwhelmingly preferred to receive health information through face-to-face conversations, especially with healthcare providers with whom they had an established relationship, but they also cited news media, the internet, and social media as their main sources for obtaining health information. PEH reported that effective communication products pair a recommended action with instructions and resources about how to take that action within their community. Conclusions These findings support healthcare providers collaborating with public health agencies to ensure that infectious disease prevention messages for PEH are provided by trusted messengers, multimodal, paired with resources, and consistent.
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Affiliation(s)
- Elizabeth M Allen
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Betsy Smither
- Public Health and Healthcare Program, Oak Ridge Associated Universities, Oak Ridge, Tennessee, USA
| | - Lindsey Barranco
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer Reynolds
- Public Health and Healthcare Program, Oak Ridge Associated Universities, Oak Ridge, Tennessee, USA
| | - Kelli Bursey
- Public Health and Healthcare Program, Oak Ridge Associated Universities, Oak Ridge, Tennessee, USA
| | - Kristin Mattson
- Public Health and Healthcare Program, Oak Ridge Associated Universities, Oak Ridge, Tennessee, USA
| | - Emily Mosites
- Office of the Deputy Director for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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