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Claassen AAOM, van den Ende CHM, Meesters JJL, Pellegrom S, Kaarls-Ohms BM, Vooijs J, Willemsen-de Mey GEMP, Vliet Vlieland TPM. How to best distribute written patient education materials among patients with rheumatoid arthritis: a randomized comparison of two strategies. BMC Health Serv Res 2018; 18:211. [PMID: 29580277 PMCID: PMC5870684 DOI: 10.1186/s12913-018-3039-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 03/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this randomized controlled trial was to evaluate the effect of a 'supply on demand'-distribution strategy, compared to an 'unsolicited supply'-distribution strategy, on the use of a care booklet and clinical outcomes among patients with rheumatoid arthritis (RA). In addition, differences in socio-demographic and clinical characteristics between users and non-users were explored. METHODS As part of regular care the care booklet was distributed among RA-patients of two hospitals in the Netherlands. 1000 patients received the care booklet by mail, whereas another 1000 received an information letter with the option to order the care booklet. Four months after distribution, a random sample of 810 patients (stratified by hospital and distribution method) received a questionnaire on the use of the booklet, social-demographic and clinical characteristics. To compare effects between the two distribution strategies and differences between users and non-users univariate and multilevel regression analyses were performed. Secondary analysis included a per-protocol analysis (excluding participants who did not order the care booklet). RESULTS One hundred ninety four patients in the 'unsolicited supply' and 176 patients in the 'supply on demand' group (46%) returned the questionnaire. In the 'supply on demand' group 106 (60.2%) participants ordered the care booklet. In total, no difference was found in use between the 'unsolicited supply'-group (23.2%) and the 'supply on demand'-group (21.6%) (OR 0.9 CI:0.6-1.5). However, the proportion of users among patients in the 'supply on demand'-group who ordered the booklet (35%) was significantly higher than in the 'unsolicited supply'-group (OR 1.9 CI:1.1-3.2). Regardless of distribution method, use of the care booklet was associated with being married (OR 2.4 CI:1.2-4.6), higher disease activity (mean difference 0.5 CI: 0.0-1.1), more activity limitations (mean difference 0.2 CI: 0.1-0.4), use of corticosteroids (OR 1.9 CI:1.0-3.5), perception of disease course as fluctuating (mean difference 1.4 CI:0.5-2.3) and higher educational needs (mean difference 9.7 CI: 2.9-16.6). CONCLUSIONS From an economic and environmental perspective a 'supply on demand'-distribution strategy could be recommended. Results of this study provide starting points to optimize further implementation strategies of a care-booklet in routine care. TRIAL REGISTRATION ISRCTN registry ( ISRCTN22703067 ). Retrospectively registered 27 March 2017.
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Affiliation(s)
- Aniek A O M Claassen
- Department of Rheumatology, Sint Maartenskliniek, 6500 GM, Nijmegen, The Netherlands
| | - Cornelia H M van den Ende
- Department of Rheumatology, Sint Maartenskliniek, 6500 GM, Nijmegen, The Netherlands. .,Department of Rheumatology, Radboud University Medical Center, 6525 GA, Nijmegen, The Netherlands.
| | - Jorit J L Meesters
- Department of Rheumatology, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
| | - Sanne Pellegrom
- Department of Rheumatology, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
| | | | | | | | - Thea P M Vliet Vlieland
- Department of Orthopedics, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
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Moore AJ, Richardson JC, Bernard M, Sim J. Interpreting intracorporeal landscapes: how patients visualize pathophysiology and utilize medical images in their understanding of chronic musculoskeletal illness. Disabil Rehabil 2018; 41:1647-1654. [PMID: 29482399 PMCID: PMC6532727 DOI: 10.1080/09638288.2018.1443162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Medical science and other sources, such as the media, increasingly inform the general public's understanding of disease. There is often discordance between this understanding and the diagnostic interpretations of health care practitioners (HCPs). In this paper - based on a supra-analysis of qualitative interview data from two studies of joint pain, including osteoarthritis - we investigate how people imagine and make sense of the pathophysiology of their illness, and how these understandings may affect self-management behavior. We then explore how HCPs' use of medical images and models can inform patients' understanding. In conceptualizing their illness to make sense of their experience of the disease, individuals often used visualizations of their inner body; these images may arise from their own lay understanding, or may be based on images provided by HCPs. When HCPs used anatomical models or medical images judiciously, patients' orientation to their illness changed. Including patients in a more collaborative diagnostic event that uses medical images and visual models to support explanations about their condition may help them to achieve a more meaningful understanding of their illness and to manage their condition more effectively. Implications for Rehabilitation Chronic musculoskeletal pain is a leading cause of pain and years lived with disability, and despite its being common, patients and healthcare professionals often have a different understanding of the underlying disease. An individual's understanding of his or her pathophysiology plays an important role in making sense of painful joint conditions and in decision-making about self-management and care. Including patients in a more collaborative diagnostic event using medical images and anatomical models to support explanations about their symptoms may help them to better understand their condition and manage it more effectively. Using visually informed explanations and anatomical models may also help to reassure patients about the safety and effectiveness of core treatments such as physical exercise and thereby help restore or improve patients' activity levels and return to social participation.
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Affiliation(s)
- Andrew J Moore
- a Musculoskeletal Research Unit , Bristol Medical School, University of Bristol , Bristol , UK
| | - Jane C Richardson
- b Arthritis Research UK Primary Care Centre , Research Institute for Primary Care and Health Sciences, Keele University , Staffordshire , UK
| | - Miriam Bernard
- c School of Social Science and Public Policy , Keele University , Staffordshire , UK
| | - Julius Sim
- b Arthritis Research UK Primary Care Centre , Research Institute for Primary Care and Health Sciences, Keele University , Staffordshire , UK
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Lalonde L, Choinière M, Martin E, Lévesque L, Hudon E, Bélanger D, Perreault S, Lacasse A, Laliberté MC. Priority interventions to improve the management of chronic non-cancer pain in primary care: a participatory research of the ACCORD program. J Pain Res 2015; 8:203-15. [PMID: 25995648 PMCID: PMC4425332 DOI: 10.2147/jpr.s78177] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE There is evidence that the management of chronic non-cancer pain (CNCP) in primary care is far from being optimal. A 1-day workshop was held to explore the perceptions of key actors regarding the challenges and priority interventions to improve CNCP management in primary care. METHODS Using the Chronic Care Model as a conceptual framework, physicians (n=6), pharmacists (n=6), nurses (n=6), physiotherapists (n=6), psychologists (n=6), pain specialists (n=6), patients (n=3), family members (n=3), decision makers and managers (n=4), and pain researchers (n=7) took part in seven focus groups and five nominal groups. RESULTS Challenges identified in focus group discussions were related to five dimensions: knowledge gap, "work in silos", lack of awareness that CNCP represents an important clinical problem, difficulties in access to health professionals and services, and patient empowerment needs. Based on the nominal group discussions, the following priority interventions were identified: interdisciplinary continuing education, interdisciplinary treatment approach, regional expert leadership, creation and definition of care paths, and patient education programs. CONCLUSION Barriers to optimal management of CNCP in primary care are numerous. Improving its management cannot be envisioned without considering multifaceted interventions targeting several dimensions of the Chronic Care Model and focusing on both clinicians and patients.
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Affiliation(s)
- Lyne Lalonde
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada ; Équipe de recherche en soins de première ligne, Centre de santé et de services sociaux de Laval, Laval, QC, Canada ; Centre de recherche, Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada ; Sanofi Aventis Endowment Chair in Ambulatory Pharmaceutical Care, Faculty of Pharmacy Université de Montréal and Centre de santé et de services sociaux de Laval, QC, Canada
| | - Manon Choinière
- Centre de recherche, Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada ; Department of Anesthesiology Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Elisabeth Martin
- Centre de recherche, Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Lise Lévesque
- Centre de recherche, Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Eveline Hudon
- Équipe de recherche en soins de première ligne, Centre de santé et de services sociaux de Laval, Laval, QC, Canada ; Centre de recherche, Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada ; Department of Family Medicine and Emergency, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Danielle Bélanger
- Équipe de recherche en soins de première ligne, Centre de santé et de services sociaux de Laval, Laval, QC, Canada
| | - Sylvie Perreault
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada ; Sanofi Aventis Endowment Chair in Drug Utilization, Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
| | - Anaïs Lacasse
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
| | - Marie-Claude Laliberté
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada ; AbbVie Corporation, St-Laurent, QC, Canada
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Morden A, Jinks C, Ong BN, Porcheret M, Dziedzic KS. Acceptability of a 'guidebook' for the management of Osteoarthritis: a qualitative study of patient and clinician's perspectives. BMC Musculoskelet Disord 2014; 15:427. [PMID: 25496765 PMCID: PMC4301067 DOI: 10.1186/1471-2474-15-427] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 12/08/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Written information can be of benefit to both practitioners and patients and the provision of quality information is emphasised as a core intervention by United Kingdom National Institute of Clinical Excellence (NICE) OA guidelines. Researchers, patients and HCPs developed an 'OA guidebook' to provide; a) a balanced source of information for patients; b) a resource to aid practitioners when discussing self-management. This study aimed to evaluate the acceptability and usefulness of the OA guidebook as part of complex intervention to deliver NICE OA guidelines in General Practice. METHODS The intervention comprises a series of consultations with GPs and practice nurses in which supported self-management is offered to patients. Eight practices in the West Midlands and North West of England were recruited to take part: four control practices and four intervention practices. Semi-structured interviews were undertaken with patients (n = 29), GPs (n = 9) and practice nurses (n = 4) from the intervention practices to explore experiences of the intervention and use of the guidebook. Data were analysed using thematic analysis and constant comparison of data within and across interviews. RESULTS GPs thought the guidebook helped provide patients with information about OA aetiology, prognosis and self-management. Thus, it backed up key messages they provided patients during consultations. GPs also found the guidebook helped them 'close off' consultations. Nurses also thought the guidebook helped them describe OA disease processes in consultations. Patients valued the explanations of disease onset, process and prognosis. The use of 'real' people and 'real life' situations contained within the guidebook made self-management strategies seem more tangible. A sense of inclusion and comfort was obtained from knowing other people encountered similar problems and feelings. CONCLUSION An OA specific written information guidebook was deemed acceptable and useful to practitioners and patients alike as part of the MOSAICS study. Findings reinforce the utility of this model of patient information as a resource to support patients living with chronic illnesses. An OA guidebook featuring a mixture of lay and professional information developed by professionals and lay people is useful and could effectively be used more widely in usual care.
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Affiliation(s)
- Andrew Morden
- Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Clare Jinks
- Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Bie Nio Ong
- Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Mark Porcheret
- Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Krysia S Dziedzic
- Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
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Salmasi V, Chaiban G, Eissa H, Tolba R, Lirette L, Guirguis MN. Application of cooled radiofrequency ablation in management of chronic joint pain. ACTA ACUST UNITED AC 2014. [DOI: 10.1053/j.trap.2015.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Roos EM, Juhl CB. Osteoarthritis 2012 year in review: rehabilitation and outcomes. Osteoarthritis Cartilage 2012; 20:1477-83. [PMID: 22960093 DOI: 10.1016/j.joca.2012.08.028] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 08/29/2012] [Accepted: 08/29/2012] [Indexed: 02/02/2023]
Abstract
UNLABELLED Recent scientific advances in the treatment of hip and knee osteoarthritis (OA) relating to education, exercise, weight control and passive non-pharmacological and non-surgical treatments such as manual therapy, orthoses/orthotics and other aids are described. METHODS A systematic literature search was performed in Medline from July 2011 to 10 April 2012 using the terms 'osteoarthritis, knee', 'osteoarthritis, hip' rehabilitation, physical therapy, exercise therapy and preoperative intervention; both as text words and as MeSH terms where possible. Trials evaluating rehabilitation interventions were included if they were randomized controlled trials (RCTs) or systematic reviews. Outcome papers were identified by combining the initial search with the terms 'outcome', 'measure*', 'valid*', 'reliabil*' or 'responsiveness'. Outcome studies were included if they contributed methodologically to advancing outcome measurement. RESULTS The literature search identified 550 potentially relevant papers. Seventeen RCTs on rehabilitation were selected and the results from these were supported by six systematic reviews. Sixteen outcomes papers were considered relevant, but did not add significantly to current knowledge about outcome measures in OA and so, were not included. CONCLUSION The current research focus on non-pharmacological and non-surgical treatments for hip and/or knee OA, when combined in systematic reviews, is improving the available evidence to identify best practice treatment. Education, exercise and weight loss are effective in the long term and supported as cost-effective first-line treatments.
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Affiliation(s)
- E M Roos
- Research Unit for Musculoskeletal Function, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark. [corrected]
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Activity Increase Despite Arthritis (AÏDA): phase II randomised controlled trial of an active management booklet for hip and knee osteoarthritis in primary care. Br J Gen Pract 2011; 61:e452-8. [PMID: 21801537 DOI: 10.3399/bjgp11x588411] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The Hip & Knee Book: Helping you cope with osteoarthritis was developed to change disadvantageous beliefs and encourage physical activity in people with hip or knee osteoarthritis. AIM To assess the feasibility of conducting a definitive randomised controlled trial (RCT) of this evidence-based booklet in people with hip or knee osteoarthritis. DESIGN Phase II feasibility randomised controlled trial (RCT). METHOD Computerised searches of patients' record databases identified people with osteoarthritis of the hip or knee, who were invited to participate in the RCT comparing the new booklet with a control booklet. Outcomes were measured at baseline, 1 month, and 3 months, and included: beliefs about hip and knee pain, exercise, and fear avoidance; level of physical activity; and health service use. RESULTS The trial methods were feasible in terms of recruitment, randomisation, and follow-up, but most participants recruited had longstanding established symptoms. After one and 3 months, there was a small relative improvement in illness, exercise, and fear-avoidance beliefs and physical activity level in The Hip & Knee Book group (n = 59) compared with the control group (n = 60), which provides some proof of principle for using these outcomes in future trials. CONCLUSION This feasibility study provided proof of principle for testing The Hip & Knee Book in a larger definitive RCT.
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Langworthy MJ, Saad A, Langworthy NM. Conservative treatment modalities and outcomes for osteoarthritis: the concomitant pyramid of treatment. PHYSICIAN SPORTSMED 2010; 38:133-45. [PMID: 20631473 DOI: 10.3810/psm.2010.06.1792] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This article reviews current treatment algorithms for the conservative treatment of hip and knee osteoarthritis. The available treatment options for osteoarthritis (physical therapy, medical therapeutics, steroid injections, nutraceuticals, hyaluronic acid injections, acupuncture, pulsed electrical stimulation, and topical ointments) are compared to determine efficacy in the treatment of pain and return of function in the osteoarthritic joint. A literature review was conducted to determine combinations of appropriate concomitant therapy. Based on the available literature, we conclude that an early transition to multimodal and concomitant therapy is the most efficacious approach to decrease pain and improve joint function in the osteoarthritic hip and knee.
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Affiliation(s)
- Michael J Langworthy
- , , Michael J. Langworthy MD 1 Amira Saad MD 2 Nadia M. Langworthy MD 3 1Battle Creek Orthopaedics and Sports Medicine Clinic Battle Creek MI 2Michigan State University East Lansing MI 3University of Michigan Ann Arbor MI Correspondence: Michael J. Langworthy MD Battle Creek Orthopaedics and Sports Medicine Clinic 6417 N. 39th St. Augusta MI 49012. Tel: 269-209-5066 Fax: 269-969-6283 E-mail: , ,
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Williams NH, Amoakwa E, Burton K, Hendry M, Belcher J, Lewis R, Hood K, Jones J, Bennett P, Edwards RT, Neal RD, Andrew G, Wilkinson C. Activity Increase Despite Arthritis (AIDA): design of a Phase II randomised controlled trial evaluating an active management booklet for hip and knee osteoarthritis [ISRCTN24554946]. BMC FAMILY PRACTICE 2009; 10:62. [PMID: 19732415 PMCID: PMC2744666 DOI: 10.1186/1471-2296-10-62] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Accepted: 09/04/2009] [Indexed: 11/10/2022]
Abstract
BACKGROUND Hip and knee osteoarthritis is a common cause of pain and disability, which can be improved by exercise interventions. However, regular exercise is uncommon in this group because the low physical activity level in the general population is probably reduced even further by pain related fear of movement. The best method of encouraging increased activity in this patient group is not known. A booklet has been developed for patients with hip or knee osteoarthritis. It focuses on changing disadvantageous beliefs and encouraging increased physical activity. METHODS/DESIGN This paper describes the design of a Phase II randomised controlled trial (RCT) to test the effectiveness of this new booklet for patients with hip and knee osteoarthritis in influencing illness and treatment beliefs, and to assess the feasibility of conducting a larger definitive RCT in terms of health status and exercise behaviour. A computerised search of four general medical practice patients' record databases will identify patients older than 50 years of age who have consulted with hip or knee pain in the previous twelve months. A random sample of 120 will be invited to participate in the RCT comparing the new booklet with a control booklet, and we expect 100 to return final questionnaires. This trial will assess the feasibility of recruitment and randomisation, the suitability of the control intervention and outcome measurement tools, and will provide an estimate of effect size. Outcomes will include beliefs about hip and knee pain, beliefs about exercise, fear avoidance, level of physical activity, health status and health service costs. They will be measured at baseline, one month and three months. DISCUSSION We discuss the merits of testing effectiveness in a phase II trial, in terms of intermediate outcome measures, whilst testing the processes for a larger definitive trial. We also discuss the advantages and disadvantages of testing the psychometric properties of the primary outcome measures concurrently with the trial. TRIAL REGISTRATION Current Controlled Trials ISRCTN24554946.
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Affiliation(s)
- Nefyn H Williams
- Department of Primary Care and Public Health, Cardiff University, School of Medicine, North Wales Clinical School, Gwenfro Units 6-7, Wrexham Technology Park, LL13 7YP, UK
| | - Elvis Amoakwa
- Department of Primary Care and Public Health, Cardiff University, School of Medicine, North Wales Clinical School, Gwenfro Units 6-7, Wrexham Technology Park, LL13 7YP, UK
| | - Kim Burton
- Centre for Health and Social Care Research, University of Huddersfield, UK
| | - Maggie Hendry
- Department of Primary Care and Public Health, Cardiff University, School of Medicine, North Wales Clinical School, Gwenfro Units 6-7, Wrexham Technology Park, LL13 7YP, UK
| | - John Belcher
- Arthritis Research Campaign National Primary Care Centre, Keele University, UK
| | - Ruth Lewis
- Department of Primary Care and Public Health, Cardiff University, School of Medicine, North Wales Clinical School, Gwenfro Units 6-7, Wrexham Technology Park, LL13 7YP, UK
| | - Kerenza Hood
- South East Wales Trials Unit, School of Medicine, Cardiff University, UK
| | - Jeremy Jones
- School of Sports Health and Exercise Science, Bangor University, UK
| | - Paul Bennett
- School of Nursing, Cardiff University, Cardiff, UK
| | | | - Richard D Neal
- Department of Primary Care and Public Health, Cardiff University, School of Medicine, North Wales Clinical School, Gwenfro Units 6-7, Wrexham Technology Park, LL13 7YP, UK
| | | | - Clare Wilkinson
- Department of Primary Care and Public Health, Cardiff University, School of Medicine, North Wales Clinical School, Gwenfro Units 6-7, Wrexham Technology Park, LL13 7YP, UK
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