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Cowap L, Riley V, Grogan S, Ellis NJ, Crone D, Cottrell E, Chambers R, Clark-Carter D, Gidlow CJ. "They are saying it's high, but I think it's quite low": exploring cardiovascular disease risk communication in NHS health checks through video-stimulated recall interviews with patients - a qualitative study. BMC Prim Care 2024; 25:126. [PMID: 38654245 PMCID: PMC11036616 DOI: 10.1186/s12875-024-02357-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/28/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND NHS Health Check (NHSHC) is a national cardiovascular disease (CVD) risk identification and management programme. However, evidence suggests a limited understanding of the most used metric to communicate CVD risk with patients (10-year percentage risk). This study used novel application of video-stimulated recall interviews to understand patient perceptions and understanding of CVD risk following an NHSHC that used one of two different CVD risk calculators. METHODS Qualitative, semi-structured video-stimulated recall interviews were conducted with patients (n = 40) who had attended an NHSHC using either the QRISK2 10-year risk calculator (n = 19) or JBS3 lifetime CVD risk calculator (n = 21). Interviews were transcribed and analysed using reflexive thematic analysis. RESULTS Analysis resulted in the development of four themes: variability in understanding, relief about personal risk, perceived changeability of CVD risk, and positive impact of visual displays. The first three themes were evident across the two patient groups, regardless of risk calculator; the latter related to JBS3 only. Patients felt relieved about their CVD risk, yet there were differences in understanding between calculators. Heart age within JBS3 prompted more accessible risk appraisal, yet mixed understanding was evident for both calculators. Event-free survival age also resulted in misunderstanding. QRISK2 patients tended to question the ability for CVD risk to change, while risk manipulation through JBS3 facilitated this understanding. Displaying information visually also appeared to enhance understanding. CONCLUSIONS Effective communication of CVD risk within NHSHC remains challenging, and lifetime risk metrics still lead to mixed levels of understanding in patients. However, visual presentation of information, alongside risk manipulation during NHSHCs can help to increase understanding and prompt risk-reducing lifestyle changes. TRIAL REGISTRATION ISRCTN10443908. Registered 7th February 2017.
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Affiliation(s)
- Lisa Cowap
- Staffordshire University, Stoke-on-Trent, UK
| | | | - Sarah Grogan
- Manchester Metropolitan University, Manchester, UK
| | | | - Diane Crone
- Cardiff Metropolitan University, Cardiff, UK
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Simkins J, Holden MA, Babatunde O, White S, Nicholls E, Long A, Dziedzic K, Chudyk A, Todd A, Walker C, Stanford C, Cottrell E, Edwards J, Healey EL, Cork T, Mallen C, O'Brien N. Exploring the potential extended role of community pharmacy in the management of osteoarthritis: A multi-methods study with pharmacy staff and other healthcare professionals. Musculoskeletal Care 2024; 22:e1873. [PMID: 38453169 DOI: 10.1002/msc.1873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/13/2024] [Accepted: 02/16/2024] [Indexed: 03/09/2024]
Abstract
INTRODUCTION Osteoarthritis is the commonest form of chronic joint pain, which patients often self-manage before seeking healthcare advice. Patients frequently seek advice from community pharmacies, and a recent policy has recommended integrating community pharmacies into long-term condition pathways. This study explored community pharmacy teams' (CPs) and other healthcare professionals' (HCPs) views on community pharmacies providing an extended role for osteoarthritis management, identifying potential barriers and facilitators to this. METHODS A multi-methods study comprising surveys of CPs and other HCPs, followed by qualitative interviews. Descriptive statistics were used in an exploratory analysis of the survey data. Qualitative data were analysed using reflexive thematic analysis and the identified barriers and facilitators were mapped to the Theoretical Domains Framework. RESULT CPs and other HCPs in the surveys and interviews reported that an extended role for osteoarthritis management could include: a subjective assessment, explaining the joint problem and its treatment, medication management and support for self-care. There was less consensus on diagnosing the problem as OA and completing an objective assessment. A key facilitator was training to deliver the role, whilst barriers were high workload and lack of access to General Practitioner medical records. DISCUSSION Acceptable elements of an extended community pharmacy role for osteoarthritis centre around the provision of information, advice on medication and supported self-management. CONCLUSION CPs are well placed to contribute towards evidenced-based osteoarthritis management. Feasibility testing of delivering the extended role is needed and future implementation requires training for CPs and raising public awareness of the extended role.
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Affiliation(s)
- Joanna Simkins
- Keele University, Primary Care Centre Versus Arthritis, School of Medicine, Keele, Staffordshire, UK
| | - Melanie A Holden
- Keele University, Primary Care Centre Versus Arthritis, School of Medicine, Keele, Staffordshire, UK
| | - Opeyemi Babatunde
- Keele University, Primary Care Centre Versus Arthritis, School of Medicine, Keele, Staffordshire, UK
| | - Simon White
- Keele University, School of Pharmacy and Bioengineering, Keele, Staffordshire, UK
| | - Elaine Nicholls
- Keele University, Primary Care Centre Versus Arthritis, School of Medicine, Keele, Staffordshire, UK
- Keele Clinical Trials Unit, Keele University, Keele, Staffordshire, UK
| | - Angela Long
- Department of Psychology, Northumbria University, Newcastle-Upon-Tyne, Tyne and Wear, UK
| | - Krysia Dziedzic
- Impact Accelerator Unit, Keele University, Keele, Staffordshire, UK
| | - Adrian Chudyk
- Impact Accelerator Unit, Keele University, Keele, Staffordshire, UK
| | - Adam Todd
- Newcastle University, School of Pharmacy, Newcastle Upon Tyne, Tyne and Wear, UK
| | - Christine Walker
- Impact Accelerator Unit, Keele University, Keele, Staffordshire, UK
| | - Colin Stanford
- NHS Shropshire Clinical Commissioning Group, Shropshire, UK
| | | | - John Edwards
- Wolstanton Medical Centre, Newcastle-under-Lyme, Staffordshire, UK
| | - Emma L Healey
- Keele University, Primary Care Centre Versus Arthritis, School of Medicine, Keele, Staffordshire, UK
| | - Tania Cork
- Community Pharmacy Staffordshire & Stoke-on-Trent, Staffordshire, UK
| | - Christian Mallen
- Keele University, Primary Care Centre Versus Arthritis, School of Medicine, Keele, Staffordshire, UK
| | - Nicola O'Brien
- Department of Psychology, Northumbria University, Newcastle-Upon-Tyne, Tyne and Wear, UK
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Babatunde OO, Cottrell E, White S, Chudyk A, Healey EL, Edwards J, Nicholls E, O'Brien N, Todd A, Walker C, Stanford C, Cork T, Long A, Simkins J, Mallen CD, Dziedzic K, Holden MA. Co-development and testing of an extended community pharmacy model of service delivery for managing osteoarthritis: protocol for a sequential, multi-methods study (PharmOA). BMC Musculoskelet Disord 2024; 25:54. [PMID: 38216895 PMCID: PMC10785546 DOI: 10.1186/s12891-023-07105-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 12/08/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Osteoarthritis is a common, painful and disabling long-term condition. Delivery of high-quality guideline-informed osteoarthritis care that successfully promotes and maintains supported self-management is imperative. However, osteoarthritis care remains inconsistent, including under use of core non-pharmacological approaches of education, exercise and weight loss. Community pharmacies are an accessible healthcare provider. United Kingdom government initiatives are promoting their involvement in a range of long-term conditions, including musculoskeletal conditions. It is not known what an enhanced community pharmacy role for osteoarthritis care should include, what support is needed to deliver such a role, and whether it would be feasible and acceptable to community pharmacy teams. In this (PharmOA) study, we aim to address these gaps, and co-design and test an evidence-based extended community pharmacy model of service delivery for managing osteoarthritis. METHODS Informed by the Theoretical Domains Framework, Normalisation Process Theory, and the Medical Research Council (MRC) framework for developing complex interventions, we will undertake a multi-methods study involving five phases: 1. Systematic review to summarise currently available evidence on community pharmacy roles in supporting adults with osteoarthritis and other chronic (non-cancer) pain. 2. Cross-sectional surveys and one-to-one qualitative interviews with patients, healthcare professionals and pharmacy staff to explore experiences of current, and potential extended community pharmacy roles, in delivering osteoarthritis care. 3. Stakeholder co-design to: a) agree on the extended role of community pharmacies in osteoarthritis care; b) develop a model of osteoarthritis care within which the extended roles could be delivered (PharmOA model of service delivery); and c) refine existing tools to support community pharmacies to deliver extended osteoarthritis care roles (PharmOA tools). 4. Feasibility study to explore the acceptability and feasibility of the PharmOA model of service delivery and PharmOA tools to community pharmacy teams. 5. Final stakeholder workshop to: a) finalise the PharmOA model of service delivery and PharmOA tools, and b) if applicable, prioritise recommendations for its wider future implementation. DISCUSSION This novel study paves the way to improving access to and availability of high-quality guideline-informed, consistent care for people with osteoarthritis from within community pharmacies.
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Affiliation(s)
- Opeyemi O Babatunde
- Keele University, Primary Care Centre Versus Arthritis, School of Medicine, Keele, Staffordshire, ST5 5BG, UK.
- Impact Accelerator Unit, Keele University, Keele, Staffordshire, ST5 5BG, UK.
| | - Elizabeth Cottrell
- Wolstanton Medical Centre Newcastle-Under-Lyme, Newcastle-under-Lyme, ST5 8BN, UK
| | - Simon White
- Keele University, School of Pharmacy and Bioengineering, Keele, Staffordshire, UK
| | - Adrian Chudyk
- Keele University, Primary Care Centre Versus Arthritis, School of Medicine, Keele, Staffordshire, ST5 5BG, UK
- Impact Accelerator Unit, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Emma L Healey
- Keele University, Primary Care Centre Versus Arthritis, School of Medicine, Keele, Staffordshire, ST5 5BG, UK
| | - John Edwards
- Wolstanton Medical Centre Newcastle-Under-Lyme, Newcastle-under-Lyme, ST5 8BN, UK
| | - Elaine Nicholls
- Keele University, Primary Care Centre Versus Arthritis, School of Medicine, Keele, Staffordshire, ST5 5BG, UK
- Keele Clinical Trials Unit, Keele University, Keele, Staffordshire, UK
| | - Nicola O'Brien
- Department of Psychology, Northumbria University, Newcastle-Upon-Tyne, Tyne and Wear, UK
| | - Adam Todd
- Newcastle University, School of Pharmacy, Newcastle-Upon-Tyne, Tyne and Wear, UK
| | - Christine Walker
- Impact Accelerator Unit, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Colin Stanford
- NHS Shropshire Clinical Commissioning Group, Shrewsbury, Shropshire, UK
| | - Tania Cork
- North Staffs and Stoke Local Pharmaceutical Committee, Stoke-On-Trent, Staffordshire, UK
| | - Angela Long
- Department of Psychology, Northumbria University, Newcastle-Upon-Tyne, Tyne and Wear, UK
| | - Joanna Simkins
- Keele University, Primary Care Centre Versus Arthritis, School of Medicine, Keele, Staffordshire, ST5 5BG, UK
| | - Christian D Mallen
- Keele University, Primary Care Centre Versus Arthritis, School of Medicine, Keele, Staffordshire, ST5 5BG, UK
| | - Krysia Dziedzic
- Keele University, Primary Care Centre Versus Arthritis, School of Medicine, Keele, Staffordshire, ST5 5BG, UK
- Impact Accelerator Unit, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Melanie A Holden
- Keele University, Primary Care Centre Versus Arthritis, School of Medicine, Keele, Staffordshire, ST5 5BG, UK
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Cunningham J, Doyle F, Ryan JM, Clyne B, Cadogan C, Cottrell E, Murphy P, Smith SM, French HP. Primary care-based models of care for osteoarthritis; a scoping review. Semin Arthritis Rheum 2023; 61:152221. [PMID: 37327762 DOI: 10.1016/j.semarthrit.2023.152221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/21/2023] [Accepted: 05/02/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To identify and describe the extent, nature, characteristics, and impact of primary care-based models of care (MoCs) for osteoarthritis (OA) that have been developed and/or evaluated. DESIGN Six electronic databases were searched from 2010 to May 2022. Relevant data were extracted and collated for narrative synthesis. RESULTS Sixty-three studies pertaining to 37 discrete MoCs from 13 countries were included, of which 23 (62%) could be classified as OA management programmes (OAMPs) comprising a self-management intervention to be delivered as a discrete package. Four models (11%) focussed on enhancing the initial consultation between a patient presenting with OA at the first point of contact into a local health system and the clinician. Emphasis was placed on educational training for general practitioners (GPs) and allied healthcare professionals delivering this initial consultation. The remaining 10 MoCs (27%) detailed integrated care pathways of onward referral to specialist secondary orthopaedic and rheumatology care within local healthcare systems. The majority (35/37; 95%) were developed in high-income countries and 32/37 (87%) targeted hip/and or knee OA. Frequently identified model components included GP-led care, referral to primary care services and multidisciplinary care. The models were predominantly 'one-size fits all' and lacked individualised care approaches. A minority of MoCs, 5/37 (14%) were developed using underlying frameworks, three (8%) of which incorporated behaviour change theories, while 13/37 (35%) incorporated provider training. Thirty-four of the 37 models (92%) were evaluated. Outcome domains most frequently reported included clinical outcomes, followed by system- and provider-level outcomes. While there was evidence of improved quality of OA care associated with the models, effects on clinical outcomes were mixed. CONCLUSION There are emerging efforts internationally to develop evidence-based models focused on non-surgical primary care OA management. Notwithstanding variations in healthcare systems and resources, future research should focus on model development alignment with implementation science frameworks and theories, key stakeholder involvement including patient and public representation, provision of training and education for providers, treatment individualisation, integration and coordination of services across the care continuum and incorporation of behaviour change strategies to foster long-term adherence and self-management.
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Affiliation(s)
- Joice Cunningham
- School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland.
| | - Frank Doyle
- Department of Health Psychology, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Jennifer M Ryan
- Public Health and Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Barbara Clyne
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Cathal Cadogan
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | | | - Paul Murphy
- RCSI Library, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Susan M Smith
- School of Medicine, Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | - Helen P French
- School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
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Lopez T, Fischer TP, Plank T, Malinverno A, Rizzo AL, Rasmussen DJ, Cottrell E, Werner C, Kern C, Bergfeld D, Ilanko T, Andrys JL, Kelley KA. Tracking carbon from subduction to outgassing along the Aleutian-Alaska Volcanic Arc. Sci Adv 2023; 9:eadf3024. [PMID: 37379389 DOI: 10.1126/sciadv.adf3024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 05/25/2023] [Indexed: 06/30/2023]
Abstract
Subduction transports volatiles between Earth's mantle, crust, and atmosphere, ultimately creating a habitable Earth. We use isotopes to track carbon from subduction to outgassing along the Aleutian-Alaska Arc. We find substantial along-strike variations in the isotopic composition of volcanic gases, explained by different recycling efficiencies of subducting carbon to the atmosphere via arc volcanism and modulated by subduction character. Fast and cool subduction facilitates recycling of ~43 to 61% sediment-derived organic carbon to the atmosphere through degassing of central Aleutian volcanoes, while slow and warm subduction favors forearc sediment removal, leading to recycling of ~6 to 9% altered oceanic crust carbon to the atmosphere through degassing of western Aleutian volcanoes. These results indicate that less carbon is returned to the deep mantle than previously thought and that subducting organic carbon is not a reliable atmospheric carbon sink over subduction time scales.
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Affiliation(s)
- Taryn Lopez
- Geophysical Institute, University of Alaska Fairbanks, Fairbanks, AK, USA
- Alaska Volcano Observatory, UAF Geophysical Institute, Fairbanks, AK, USA
| | | | - Terry Plank
- Lamont Doherty Earth Observatory, Columbia University, Palisades, NY, USA
| | - Alberto Malinverno
- Lamont Doherty Earth Observatory, Columbia University, Palisades, NY, USA
| | - Andrea L Rizzo
- Istituto Nazionale di Geofisica e Vulcanologia, Sezione di Milano, Milano, Italy
- Department of Earth and Environmental Sciences, University of Milano-Bicocca, Milano, Italy
| | - Daniel J Rasmussen
- Lamont Doherty Earth Observatory, Columbia University, Palisades, NY, USA
- Department of Mineral Sciences, National Museum of Natural History Smithsonian Institution, Washington, DC, USA
| | - Elizabeth Cottrell
- Department of Mineral Sciences, National Museum of Natural History Smithsonian Institution, Washington, DC, USA
| | - Cynthia Werner
- U.S. Geological Survey Contractor, New Plymouth, New Zealand
| | - Christoph Kern
- Cascades Volcano Observatory, U.S. Geological Survey, Vancouver, WA, USA
| | - Deborah Bergfeld
- California Volcano Observatory, U.S. Geological Survey, Moffett Field, CA, USA
| | | | - Janine L Andrys
- U.S. Geological Survey Contractor, New Plymouth, New Zealand
- Graduate School of Oceanography, University of Rhode Island, Narragansett, RI, USA
| | - Katherine A Kelley
- Graduate School of Oceanography, University of Rhode Island, Narragansett, RI, USA
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Holycross M, Cottrell E. Garnet crystallization does not drive oxidation at arcs. Science 2023; 380:506-509. [PMID: 37141374 DOI: 10.1126/science.ade3418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Arc magmas, the building blocks of continental crust, are depleted in total iron (Fe), have higher ratios of oxidized Fe to total Fe (Fe3+/∑Fe), and record higher oxygen fugacities (fO2's) compared with magmas erupted at mid-ocean ridges. Garnet crystallization could explain these observations if garnet removes substantial amounts of Fe2+, but not Fe3+, from magma, yet this model for continental crust generation has never been tested experimentally. Analysis of garnets and melts in laboratory experiments show that the compatibilities of Fe2+ and Fe3+ in garnet are of similar magnitudes. Our results indicate that fractional crystallization of garnet-bearing cumulates will remove 20% of total Fe from primary arc basalts but negligibly alter the Fe3+/∑Fe ratio and fO2 of the melt. Garnet crystallization is unlikely to be responsible for the relatively oxidized nature of basaltic arc magmas or the Fe-depletion trend observed in continental crust.
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Affiliation(s)
- Megan Holycross
- Cornell University, Ithaca, NY 14853, USA
- National Museum of Natural History, Smithsonian Institution, Washington, DC 20560, USA
| | - Elizabeth Cottrell
- National Museum of Natural History, Smithsonian Institution, Washington, DC 20560, USA
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Holden MA, Metcalf B, Lawford BJ, Hinman RS, Boyd M, Button K, Collins NJ, Cottrell E, Henrotin Y, Larsen JB, Master H, Skou ST, Thoma LM, Rydz R, Wellsandt E, White DK, Bennell K. Recommendations for the delivery of therapeutic exercise for people with knee and/or hip osteoarthritis. An international consensus study from the OARSI Rehabilitation Discussion Group. Osteoarthritis Cartilage 2023; 31:386-396. [PMID: 36367486 DOI: 10.1016/j.joca.2022.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/27/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To develop evidence-informed recommendations to support the delivery of best practice therapeutic exercise for people with knee and/or hip osteoarthritis (OA). DESIGN A multi-stage, evidence-informed, international multi-disciplinary consensus process that included: 1) a narrative literature review to synthesise existing evidence; 2) generation of evidence-informed proposition statements about delivery of exercise for people with knee and/or hip OA by an international multi-disciplinary expert panel, with statements refined and analysed thematically; 3) an e-Delphi survey with the expert panel to gain consensus on the most important statements; 4) a final round of statement refinement and thematic analysis to group remaining statements into domains. RESULTS The expert panel included 318 members (academics, health care professionals and exercise providers, patient representatives) from 43 countries. Final recommendations comprised 54 specific proposition statements across 11 broad domains: 1) use an evidence-based approach; 2) consider exercise in the context of living with OA and pain; 3) undertake a comprehensive baseline assessment with follow-up; 4) set goals; 5) consider the type of exercise; 6) consider the dose of exercise; 7) modify and progress exercise; 8) individualise exercise; 9) optimise the delivery of exercise; 10) focus on exercise adherence; and 11) provide education about OA and the role of exercise. CONCLUSION The breadth of issues identified as important by the international diverse expert panel highlights that delivering therapeutic exercise for OA is multi-dimensional and complex.
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Affiliation(s)
- M A Holden
- Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Staffordshire, ST5 5BG, UK.
| | - B Metcalf
- Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia.
| | - B J Lawford
- Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia.
| | - R S Hinman
- Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia.
| | - M Boyd
- Patient Representative, Australia
| | - K Button
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, UK.
| | - N J Collins
- School of Health and Rehabilitation Sciences: Physiotherapy, The University of Queensland, Australia.
| | - E Cottrell
- Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Staffordshire, ST5 5BG, UK.
| | - Y Henrotin
- Department of Physical Therapy and Rehabilitation, Princess Paola Hospital, Belgium; musculoSKeletal Innovative research Lab (mSKIL), Motricity Sciences Department, Institute of Pathology, University of Liège, Belgium; Center for Interdisciplinary Research on Medicines (CIRM), Institute of Pharmacy, University of Liège, Belgium; The Osteoarthritis Foundation, Boncelles, Belgium.
| | - J B Larsen
- Musculoskeletal Health and Implementation, Department of Health Science and Technology, Aalborg University, Denmark.
| | - H Master
- Vanderbilt Institute of Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - S T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark; The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Denmark.
| | - L M Thoma
- Division of Physical Therapy, Department of Allied Health Sciences, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - R Rydz
- Patient Representative, Australia.
| | - E Wellsandt
- Division of Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA.
| | - D K White
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE, USA.
| | - K Bennell
- Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia.
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Affiliation(s)
- George Wood
- National Institute for Health and Care Excellence, Manchester, UK
| | - Julie Neilson
- National Institute for Health and Care Excellence, Manchester, UK
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Lawford BJ, Master H, Larsen JB, Bartholdy C, Corrigan P, Ginnerup-Nielsen E, Le C, Teoli A, Bennell KL, Metcalf B, Hinman RS, Button K, Collins NJ, Cottrell E, Henrotin Y, Skou ST, Thoma LM, Wellsandt E, White DK, Holden MA. What should a toolkit to aid the delivery of therapeutic exercise for hip and knee osteoarthritis look like? Qualitative analysis of an international survey of 318 researchers, clinicians, and consumers by the OARSI Rehabilitation Discussion Group. Musculoskeletal Care 2023. [PMID: 36631968 DOI: 10.1002/msc.1732] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 12/24/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND We aimed to identify important components of, and practical resources relevant for inclusion in, a toolkit to aid exercise delivery for people with hip/knee osteoarthritis. METHOD An online international multi-disciplinary survey was conducted across 43 countries (139 clinicians, 44 people with hip/knee osteoarthritis and 135 osteoarthritis researchers). Participants were presented with the seeding statement 'Practical resources to aid the implementation of exercise for people with hip/knee osteoarthritis should…' and asked to provide up to 10 open text responses. Responses underwent refinement and qualitative content analysis to create domains and categories. RESULTS Refinement of 551 open text responses yielded 72 unique statements relevant for analysis. Statements were organised into nine broad domains, suggesting that resources to aid exercise delivery should: (1) be easily accessible; (2) be of high quality; (3) be developed by, and for, stakeholders; (4) include different ways of delivering information; (5) include different types of resources to support exercise and non-exercise components of self-management; (6) include resources on recommended exercises and how to perform/progress them; (7) include tools to support motivation and track progress; (8) include resources to enable tailoring of the programme to the individual and; (9) facilitate access to professional and peer support. CONCLUSION Our findings identified important components of, and practical resources to include within, a toolkit to aid delivery of exercise for people with hip/knee osteoarthritis. These findings have implications for exercise providers and lay the foundation for the development of a toolkit to help ensure exercise provision aligns with current international recommendations.
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Affiliation(s)
- Belinda J Lawford
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, School of Health Sciences, The University of Melbourne, Melbourne, Parkville, Australia
| | - Hiral Master
- Vanderbilt Institute of Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jesper B Larsen
- Department of Health Science and Technology, Musculoskeletal Health and Implementation, Aalborg University, Aalborg, Denmark
| | - Cecilie Bartholdy
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Patrick Corrigan
- Department of Physical Therapy and Athletic Training, Doisy College of Health Sciences, Saint Louis University, St. Louis, Missouri, USA
| | | | - Christina Le
- University of Alberta in Edmonton, Edmonton, Alberta, Canada
| | - Anthony Teoli
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.,Centre for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, Quebec, Canada
| | - Kim L Bennell
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, School of Health Sciences, The University of Melbourne, Melbourne, Parkville, Australia
| | - Ben Metcalf
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, School of Health Sciences, The University of Melbourne, Melbourne, Parkville, Australia
| | - Rana S Hinman
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, School of Health Sciences, The University of Melbourne, Melbourne, Parkville, Australia
| | - Kate Button
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Natalie J Collins
- School of Health and Rehabilitation Sciences: Physiotherapy, The University of Queensland, Brisbane, Queensland, Australia
| | - Elizabeth Cottrell
- Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Staffordshire, UK
| | - Yves Henrotin
- Department of Physical Therapy and Rehabilitation, Princess Paola Hospital, Marche-en-Famenne, Belgium.,Motricity Sciences Department, musculoSKeletal Innovative Research Lab (mSKIL), Institute of Pathology, University of Liège, Liège, Belgium.,Center for Interdisciplinary Research on Medicines (CIRM), Institute of Pharmacy, University of Liège, Liège, Belgium.,The Osteoarthritis Foundation, Boncelles, Belgium
| | - Søren T Skou
- Department of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, The Research Unit PROgrez, Naestved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Louise M Thoma
- Division of Physical Therapy, Department of Health Sciences, School of Medicine, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Elizabeth Wellsandt
- Department of Health and Rehabilitation Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Daniel K White
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, Delaware, USA
| | - Melanie A Holden
- Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Staffordshire, UK
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Fedorowicz S, Riley V, Cowap L, Ellis NJ, Chambers R, Grogan S, Crone D, Cottrell E, Clark-Carter D, Roberts L, Gidlow CJ. Using social media for patient and public involvement and engagement in health research: The process and impact of a closed Facebook group. Health Expect 2022; 25:2786-2795. [PMID: 36134468 DOI: 10.1111/hex.13515] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 03/10/2022] [Accepted: 04/11/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND As part of a multifaceted approach to patient and public involvement and engagement (PPIE), alongside traditional methods, a closed Facebook group was established to facilitate PPIE feedback on various aspects of a project that used video-recording to examine risk communication in NHS Health Checks between June 2017 and July 2019. OBJECTIVE To explore the process and impact of conducting PPIE through a closed Facebook group and to identify the associated benefits and challenges. METHODS Supported by reflections and information from project meetings used to document how this engagement informed the project, we describe the creation and maintenance of the Facebook Group and how feedback from the group members was obtained. Facebook data were used to investigate levels and types of engagement in the closed Facebook group. We reflect on the challenges of using this method of engaging the public in health research. RESULTS A total of 289 people joined the 'Risk Communication of Cardiovascular disease in NHS Health Checks' PPIE closed Facebook group. They provided feedback, which was used to inform aspects of the study, including participant-facing documents, recruitment, camera position and how the methodology being used (video-recorded Health Checks and follow-up interviews) would be received by the public. DISCUSSION Using a closed Facebook group to facilitate PPIE offered a flexible approach for both researchers and participants, enabled a more inclusive method to PPIE (compared with traditional methods) and allowed rapid feedback. Challenges included maintaining the group, which was more labour intensive than anticipated and managing members' expectations. Suggestions for best practice include clear communication about the purpose of the group, assigning a group co-ordinator to be the main point of contact for the group, and a research team who can dedicate the time necessary to maintain the group. CONCLUSION The use of a closed Facebook group can facilitate effective PPIE. Its flexibility can be beneficial for researchers, patients and public who wish to engage in the research process. Dedicated time for sustained group engagement is important. PATIENT OR PUBLIC CONTRIBUTION Patient representatives were engaged with the development of the research described in this paper and a patient representative reviewed the manuscript.
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Affiliation(s)
- Sophia Fedorowicz
- The Centre for Health and Development, Staffordshire University, Stoke-on-Trent, UK
| | - Victoria Riley
- The Centre for Health and Development, Staffordshire University, Stoke-on-Trent, UK
| | - Lisa Cowap
- The Centre for Health and Development, Staffordshire University, Stoke-on-Trent, UK
| | - Naomi J Ellis
- The Centre for Health and Development, Staffordshire University, Stoke-on-Trent, UK
| | - Ruth Chambers
- Technology Enabled Care Programme, Staffordshire Sustainability and Transformation Partnership's Digital Workstream, Stoke-on-Trent Clinical Commissioning Group, Stoke-on-Trent, UK
| | - Sarah Grogan
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Diane Crone
- School of Sport and Health Sciences, Cardiff Metropolitan University, Cyncoed Campus, Cardiff, UK
| | | | - David Clark-Carter
- The Centre for Health and Development, Staffordshire University, Stoke-on-Trent, UK
| | - Lesley Roberts
- Member Governor of Midlands Partnership NHS Foundation Trust, Patient Representative, Stoke-on-Trent, UK
| | - Christopher J Gidlow
- The Centre for Health and Development, Staffordshire University, Stoke-on-Trent, UK
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Ormesher L, Higson S, Luckie M, Roberts SA, Glossop H, Trafford A, Cottrell E, Johnstone ED, Myers JE. Postnatal cardiovascular morbidity following preterm pre-eclampsia: An observational study. Pregnancy Hypertens 2022; 30:68-81. [PMID: 36029727 DOI: 10.1016/j.preghy.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore the nature of postnatal cardiovascular morbidity following pregnancies complicated by preterm pre-eclampsia and investigate associations between pregnancy characteristics and maternal postnatal cardiovascular function. STUDY DESIGN This was an observational sub-study of a single-centre feasibility randomised double-blind placebo-controlled trial (https://www. CLINICALTRIALS gov; NCT03466333), involving women with preterm pre-eclampsia, delivering before 37 weeks. Eligible women underwent echocardiography, arteriography and blood pressure monitoring within three days of birth, six weeks and six months postpartum. Correlations between pregnancy and cardiovascular characteristics were assessed using Spearman's correlation. MAIN OUTCOME MEASURES The prevalence of cardiovascular dysfunction and remodelling six months following preterm pre-eclampsia. RESULTS Forty-four women completed the study. At six months, 27 (61 %) had diastolic dysfunction, 33 (75 %) had raised total vascular resistance (TVR) and 18 (41 %) had left ventricular remodelling. Sixteen (46 %) women had de novo hypertension by six months and only two (5 %) women had a completely normal echocardiogram. Echocardiography did not change significantly from six weeks to six months. Earlier gestation at delivery and lower birthweight centile were associated with worse six-month diastolic dysfunction (E/E': rho = -0.39, p = 0.001 & rho = -0.42, p = 0.005) and TVR (rho = -0.34, p = 0.02 & rho = -0.37, p = 0.01). CONCLUSIONS Preterm pre-eclampsia is associated with persistent cardiovascular morbidity-six months postpartum in the majority of women. These cardiovascular changes have significant implications for long-term cardiovascular health. The graded severity of diastolic dysfunction and TVR with worsening pre-eclampsia phenotype suggests a dose-effect. However, the mechanistic link remains uncertain.
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Affiliation(s)
- Laura Ormesher
- Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, University of Manchester, UK; Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
| | - Suzanne Higson
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Matthew Luckie
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Heather Glossop
- Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Andrew Trafford
- Division of Cardiovascular Sciences, University of Manchester, UK
| | - Elizabeth Cottrell
- Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, University of Manchester, UK
| | - Edward D Johnstone
- Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, University of Manchester, UK; Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jenny E Myers
- Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, University of Manchester, UK; Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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Paskins Z, Nicholls E, Grossmann H, McRobert C, Peat G, Shivji N, Bartlam B, Croft P, Jinks C, Maddison J, Main C, Quicke J, Porcheret M, Protheroe J, Cottrell E. P077 Developing a better explanation of osteoarthritis: results from a conjoint analysis of patient preferences. Rheumatology (Oxford) 2022. [DOI: 10.1093/rheumatology/keac133.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Aims
Despite the negative impact of osteoarthritis (OA) and existence of evidence-based guidelines, many patients and professionals lack clarity about the nature of OA and effective treatment strategies. This project aims to improve OA explanations in consultations and investigate the extent to which different explanation statements impact on intention to self-manage OA.
Methods
Participants registered at four general practices, aged ≥45 years, with a recorded consultation for OA in the previous two years were mailed a survey. The survey included eight pairs of potential OA explanation statements for participants to select the explanation that would most help them to self-manage their OA, alongside questions on socio-demographics, OA symptoms, comorbidity and health literacy. The OA explanations were designed using a partial-profile choice-based conjoint analysis (profile strength 4, comparison depth 3) from a set of 11 theoretically informed key attributes (Table 1). Each attribute contained two statements: one representing current information sources, and one a newly designed statement from our previous co-design work with patients and stakeholders.
Results
The survey response rate was 22% (428/1980) (average age = 65 years [SD = 10]; 66% female). The newer statement was preferred to the existing statement for 10 of the 11 statements (indicated by a positive regression coefficient) and 8 of these differences were statistically significant (p < 0.05) (Table 1). Sensitivity analyses (e.g. to adjust the model to allow for within person correlation of response, and to test for 2-way interactions between model attributes) did not change the findings from the primary model.
Conclusion
Patients with OA preferred the newer statements, with one exception (causes). The preferred statements have been discussed with the project’s Patient Advisory Group and the statements combined into a written leaflet and animation, and further assessed using Flesch reading ease and Flesch Grade level. Our conjoint analysis has provided evidence about what explanation statements patients with OA prefer and improve likelihood of self-management. The next step is to evaluate the leaflet and written animation in think-aloud qualitative interviews before refining the OA explanation and widespread dissemination.
Disclosure
Z. Paskins: None. E. Nicholls: None. H. Grossmann: None. C. McRobert: None. G. Peat: None. N. Shivji: None. B. Bartlam: None. P. Croft: None. C. Jinks: None. J. Maddison: None. C. Main: None. J. Quicke: None. M. Porcheret: None. J. Protheroe: None. E. Cottrell: None.
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Affiliation(s)
- Zoe Paskins
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
| | - Elaine Nicholls
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
| | - Heiko Grossmann
- Faculty of Mathematics, OVGU University of Mageburg, Magdeburg, GERMANY
| | - Cliona McRobert
- School of Health Sciences, University of Liverpool, Liverpool, UNITED KINGDOM
| | - George Peat
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
| | - Noureen Shivji
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
| | - Bernadette Bartlam
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
| | - Peter Croft
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
| | - Clare Jinks
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
| | - John Maddison
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
| | - Chris Main
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
| | - Jonathan Quicke
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
| | - Mark Porcheret
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
| | - Joanne Protheroe
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
| | - Elizabeth Cottrell
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
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Paskins Z, Bullock L, Manning F, Bishop S, Campbell P, Cottrell E, Jinks C, Narayanasamy M, Scott I, Sahota O, Ryan S. P059 Acceptability of remote consulting during COVID-19 among patients with two common long-term musculoskeletal conditions: findings from three qualitative studies and recommendations for practice. Rheumatology (Oxford) 2022. [DOI: 10.1093/rheumatology/keac133.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background/Aims
The COVID-19 pandemic led to the widespread adoption of remote consultations. Whilst remote consultations offer many potential advantages to patients and healthcare services, they are unlikely to be suitable for all. Guidance encourages clinicians to consider patient preferences when choosing face-to-face vs remote consultations. However, little is known about acceptability of, and preferences for remote consultations, particularly amongst patients with musculoskeletal conditions. This study aimed to explore the acceptability of, and preferences for, remote consultations among patients with osteoporosis and rheumatoid arthritis.
Methods
Data for this study derived from three UK qualitative studies: iFraP (improving fracture prevention study), Blast Off (BO; Bisphosphonate aLternAtive regimenS for the prevenTion of Osteoporotic Fragility Fractures), and ERA (Exploring people with Rheumatoid Arthritis’ experience of the pandemic). Each study explored patient experiences of accessing and receiving healthcare during the pandemic year. Transcripts from each data set relating to remote consulting were extracted. A minimum of two study team members worked independently, following a consistent approach, to conduct a rapid deductive analysis using the Theoretical Framework of Acceptability (TFA). The TFA consists of 7 constructs to understand acceptability of, in this context, remote consultations, including: affective attitudes; intervention coherence; perceived effectiveness; burden; self-efficacy; opportunity-costs; and ethicality. Following coding, the findings of all three studies were pooled. Analysis was facilitated by group meetings to discuss interpretations.
Results
Findings from 1 focus group and 64 interviews with 35 people, who had mostly experienced telephone consultations, were included the analysis. Participants’ emotional attitudes to remote consultations, views on fairness (ethicality) and sense making (intervention coherence) varied according to their specific needs for the consultation and values, relative to the pandemic context; participants perceived remote consultations as making more sense and being ‘fairer’ earlier in the pandemic. Some participants valued the reduced burden associated with remote consultations, while others highly valued, and did not want to give up, non-verbal communication or physical examination associated with face-to-face consults (opportunity costs); although perceived need for physical examination in participants with RA was associated with strong preference for face-to-face consultations, asymptomatic participants with RA and osteoporosis also expressed similar strong preferences. Some participants described low confidence (self-efficacy) in being able to communicate in remote consultations and others perceived remote consultations as ineffective, in part due to suboptimal communication.
Conclusion
Acceptability of, and preferences for remote consultation appear to be influenced by a range of societal, healthcare provider and personal factors and in this study, were not fixed, or condition-dependent. Remote care by default has the potential to exacerbate health inequalities and needs nuanced implementation. The findings have supported the development of patient-centred recommendations for practice that should be considered alongside clinician-focused recommendations when deciding whether remote consultations are appropriate.
Disclosure
Z. Paskins: Grants/research support; NIHR, Clinician Scientist Award (CS-2018-18-ST2-010)/NIHR Academy. L. Bullock: None. F. Manning: Grants/research support; part funded NIHR Clinical Research Network Scholar Programme. S. Bishop: None. P. Campbell: None. E. Cottrell: None. C. Jinks: Grants/research support; part funded by the NIHR Applied Research Collaboration (ARC) West Midlands. M. Narayanasamy: None. I. Scott: Grants/research support; funded by an NIHR Advanced Research Fellowship Award (NIHR300826). O. Sahota: None. S. Ryan: None.
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Affiliation(s)
- Zoe Paskins
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke on Trent, UNITED KINGDOM
| | - Laurna Bullock
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
| | - Fay Manning
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
- University of Exeter Medical School, University of Exeter, Exeter, UNITED KINGDOM
| | - Simon Bishop
- Centre for Health Innovation, Leadership and Learning, University of Nottingham, Nottingham, UNITED KINGDOM
| | - Paul Campbell
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke on Trent, UNITED KINGDOM
| | - Elizabeth Cottrell
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
| | - Clare Jinks
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
| | - Melanie Narayanasamy
- Nottingham University Business School, University of Nottingham, Nottingham, UNITED KINGDOM
| | - Ian Scott
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke on Trent, UNITED KINGDOM
| | - Opinder Sahota
- Department of Health Care of Older People, Nottingham University Hospitals NHS Trust, Nottingham, UNITED KINGDOM
| | - Sarah Ryan
- School of Nursing, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke on Trent, UNITED KINGDOM
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14
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Paskins Z, Bullock L, Manning F, Bishop S, Campbell P, Cottrell E, Partner GP, Jinks C, Narayanasamy M, Scott IC, Sahota O, Ryan S. Acceptability of, and preferences for, remote consulting during COVID-19 among older patients with two common long-term musculoskeletal conditions: findings from three qualitative studies and recommendations for practice. BMC Musculoskelet Disord 2022; 23:312. [PMID: 35366845 PMCID: PMC8976169 DOI: 10.1186/s12891-022-05273-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/23/2022] [Indexed: 11/23/2022] Open
Abstract
Background Guidance for choosing face-to-face vs remote consultations (RCs) encourages clinicians to consider patient preferences, however, little is known about acceptability of, and preferences for RCs, particularly amongst patients with musculoskeletal conditions. This study aimed to explore the acceptability of, and preferences for, RC among patients with osteoporosis and rheumatoid arthritis. Methods Three UK qualitative studies, exploring patient experiences of accessing and receiving healthcare, undertaken during the pandemic, with people with osteoporosis and rheumatoid arthritis. Study team members agreed a consistent approach to conduct rapid deductive analysis using the Theoretical Framework of Acceptability (TFA) on transcripts from each data set relating to RC, facilitated by group meetings to discuss interpretations. Findings from the three studies were pooled. Results Findings from 1 focus group and 64 interviews with 35 people were included in the analysis. Participants’ attitudes to RC, views on fairness (ethicality) and sense-making (intervention coherence) varied according to their needs within the consultation and views of the pandemic. Some participants valued the reduced burden associated with RC, while others highly valued non-verbal communication and physical examination associated with face-to-face consults (opportunity costs). Some participants described low confidence (self-efficacy) in being able to communicate in RCs and others perceived RCs as ineffective, in part due to suboptimal communication. Conclusions Acceptability of, and preferences for RC appear to be influenced by societal, healthcare provider and personal factors and in this study, were not condition-dependant. Remote care by default has the potential to exacerbate health inequalities and needs nuanced implementation. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05273-1.
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15
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Cottrell E, Silverwood V, Strivens-Joyce A, Minshull L, Edwards JJ, Lawton S, Aiello M, Turner S. Acceptability of physician associate interns in primary care: results from a service evaluation. BMC Fam Pract 2021; 22:250. [PMID: 34930126 PMCID: PMC8691079 DOI: 10.1186/s12875-021-01372-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/12/2021] [Indexed: 11/30/2022]
Abstract
Background Physician associates (PA) form part of the policy-driven response to increased primary care demand and a general practitioner (GP) recruitment and retention crisis. However, they are novel to the primary care workforce and have limitations, for example, they cannot prescribe. The novel 1 year Staffordshire PA Internship (SPAI) scheme, introduced in 2017, was established to support the integration of PAs into primary care. PA interns concurrently worked in primary and secondary care posts, with protected weekly primary care focussed education sessions. This evaluation established the acceptability of PA interns within primary care. Methods All ten PAs from the first two SPAI cohorts, the nine host practices (supervising GPs and practice managers) and host practice patients were invited to participate in the evaluation. A conceptual framework for implementing interventions in primary care informed data collection and analysis. Data were gathered at three time points over the internship from practices, through discussions with the supervising GP and/or practice manager, and from the PAs via discussion groups. To enrich discussion data, PA and practices were sent brief surveys requesting information on PA/practice characteristics and PA primary care roles. Patient acceptability data were collected by the host practices. Participation at every stage was optional. Results By evaluation end, eight PAs had completed the internship. Seven PAs and six practices provided data at every time point. Five practices provided patient acceptability data. Overall PA interns were acceptable to practices and patients, however ambiguity about the PA role and how best to communicate and operationalise PA roles was revealed. An expectation-preparedness gap resulted in PAs needing high levels of supervision early within the internship. SPAI facilitated closure of the expectation-preparedness gap and its funding arrangements made the high supervision requirements more acceptable to practices. Conclusions The test-of-concept SPAI successfully integrated new PAs into primary care. However, the identified challenges risk undermining PAs roles in primary care before they have attained their full potential. Nationally, workforce leaders should develop approaches to support new PAs into primary care, including commitments to longer-term, sustainable, cohesive and appropriately funded schemes, including structured and standardised education and supervision.
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Affiliation(s)
- Elizabeth Cottrell
- Keele University, Newcastle, UK. .,Wolstanton Medical Centre, Newcastle-under-Lyme, UK. .,Wolstanton Medical Centre, Palmerston Street, Wolstanton, Newcastle-under-Lyme, Staffordshire, ST5 8BN, UK.
| | - Victoria Silverwood
- Keele University, Newcastle, UK.,Honeywall Medical Practice, Stoke-on-Trent, UK
| | | | - Lucy Minshull
- North Staffordshire GP Federation, Stoke-on-Trent, UK
| | | | - Sarah Lawton
- Keele Clinical Trials Unit, Keele University, Newcastle-under-Lyme, UK
| | - Matt Aiello
- Urgent and Emergency Care, Health Education England, London, UK
| | - Sharon Turner
- North Staffordshire GP Federation, Stoke-on-Trent, UK
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16
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Stynes S, Jordan K, Hill J, Wynne-Jones G, Cottrell E, Foster N, Goodwin R, Bishop A. Evaluation of the First Contact Physiotherapy (FCP) model of primary care: Patient characteristics and outcomes. Physiotherapy 2021. [DOI: 10.1016/j.physio.2021.10.258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Baumbach L, Roos EM, Ankerst D, Nyberg LA, Cottrell E, Lykkegaard J. Changes in received quality of care for knee osteoarthritis after a multicomponent intervention in a general practice in Denmark. Health Sci Rep 2021; 4:e402. [PMID: 34632100 PMCID: PMC8493241 DOI: 10.1002/hsr2.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 08/09/2021] [Accepted: 09/08/2021] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE First-line treatment for patients with knee osteoarthritis should ideally prescribe patient education, exercise, and if needed, weight loss. In practice, however, adjunctive treatments, including painkillers and referrals to specialists, are typically introduced before these measures. This study evaluated interventions to sustainably improve general practitioner delivered care for patients with knee osteoarthritis. DESIGN Comparison of impacts of knee osteoarthritis care during four half-year periods: before, 6, 12, and 18 months after primary intervention based on electronic medical records (EMR) and patient questionnaires. SETTING Danish general practitioners (GPs) treating 6240 patients. PARTICIPANTS Four GPs, two GP trainees, and six staff members. INTERVENTIONS Six pre-planned primary interventions: patient leaflet, GP and staff educational session, knee osteoarthritis consultation, two functional tests monitoring patient function, EMR phrase aiding consultation, and waiting room advertisement and three supportive follow-up interventions. MAIN OUTCOME MEASURES Usage of first-line and adjunctive treatment elements, the functional tests, and the EMR phrase. RESULTS Approximately 50 knee osteoarthritis cases participated in each of the four half-year periods. Primary interventions had only transient effects lasting <12 months on the knee osteoarthritis care. Functional tests and EMR phrases were used predominantly during the first 6 months, where a transient drop in the referral rate to orthopedics was observed. Use of educational elements was moderate and without significant change during follow-up. CONCLUSION More routine use of the primary or inclusion of novel increased-adherence interventions is needed to sustainably improve care for knee osteoarthritis patients in Danish general practice.
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Affiliation(s)
- Linda Baumbach
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical BiomechanicsUniversity of Southern DenmarkOdenseDenmark
- Department of Health Economics and Health Services ResearchUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Ewa M. Roos
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical BiomechanicsUniversity of Southern DenmarkOdenseDenmark
| | - Donna Ankerst
- Department of Mathematics and Life Science SystemsTechnical University of MunichMunichGermany
| | - Lillemor A. Nyberg
- Department of Medical Sciences, Faculty of Medicine and HealthÖrebro UniversityÖrebroSweden
| | | | - Jesper Lykkegaard
- Research Unit for General PracticeInstitute of Public Health, University of Southern DenmarkOdenseDenmark
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18
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Cunningham J, Doyle F, Ryan JM, Clyne B, Cadogan C, Cottrell E, Smith SM, French HP. Primary care-based models of care for osteoarthritis: a scoping review protocol. HRB Open Res 2021; 4:48. [PMID: 34291185 PMCID: PMC8264805 DOI: 10.12688/hrbopenres.13260.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 12/14/2022] Open
Abstract
Background: The burden of osteoarthritis (OA) to individuals and health systems is substantial and is expected to increase due to population ageing and rising prevalence of obesity and multimorbidity. Primary care-based models of care (MoCs) are being increasingly developed in response to this growing burden. However, these MoCs have yet to be formally reviewed. A MoC can be defined as an ‘evidence-informed strategy, framework or pathway that outlines the optimal manner in which condition-specific care should be delivered to consumers within a local health system’. Objective: To identify and describe the available research regarding the extent, nature and characteristics of MoCs for OA that have been developed or evaluated in primary care. Methods: A scoping review will be conducted in accordance with the Arksey and O’Malley scoping review framework and the PRISMA-ScR guidelines. Systematic literature searches of MEDLINE, EMBASE, CINAHL, PsychINFO, Web of Science and LILACs will be conducted from 2010 to present, aligning with publication dates of recent clinical guidelines.
A structured iterative search of grey literature will be conducted. Full-text original quantitative or mixed method studies which describe the development or evaluation of MoCs for OA in primary care will be considered. Data will be charted and synthesised and a narrative synthesis will be conducted. Conclusions: This scoping review will provide a broad overview regarding the extent, nature and characteristics of the available literature on primary care based MoCs for OA. Findings will be used to identify gaps in the current evidence to identify areas for future research.
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Affiliation(s)
- Joice Cunningham
- School of Physiotherapy, Royal College of Surgeons in Ireland, RCSI, University of Medicine and Health Sciences, Dublin, Ireland
| | - Frank Doyle
- Department of Health Psychology, RCSI, University of Medicine and Health Sciences, Dublin, Ireland
| | - Jennifer M Ryan
- Public Health and Epidemiology, RCSI, University of Medicine and Health Sciences, Dublin, Ireland
| | - Barbara Clyne
- HRB Centre for Primary Care Research, Department of General Practice, RCSI, University of Medicine and Health Sciences, Dublin, Ireland
| | - Cathal Cadogan
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | | | - Susan M Smith
- HRB Centre for Primary Care Research, Department of General Practice, RCSI, University of Medicine and Health Sciences, Dublin, Ireland
| | - Helen P French
- School of Physiotherapy, Royal College of Surgeons in Ireland, RCSI, University of Medicine and Health Sciences, Dublin, Ireland
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Stynes S, Jordan KP, Hill JC, Wynne-Jones G, Cottrell E, Foster NE, Goodwin R, Bishop A. Evaluation of the First Contact Physiotherapy (FCP) model of primary care: patient characteristics and outcomes. Physiotherapy 2021; 113:199-208. [PMID: 34656297 DOI: 10.1016/j.physio.2021.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 06/16/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE First Contact Physiotherapy (FCP) is a primary care model where expert musculoskeletal (MSK) physiotherapists undertake the first patient consultation, to enhance MSK-patient care and free-up GP capacity. The authors report the quantitative findings from the FCP National Evaluation (Phase 3) which evaluated the FCP model against success criteria. DESIGN AND SETTING A mixed-methods 24-month service evaluation involving 40 FCP sites and 240 FCPs across England. METHODS An online platform collected patient-reported experience and outcomes following the FCP consultation and at 1, 2 and 3-months follow-up. These included the Keele STarT MSK Tool, pain intensity (0-10 NRS scale), Musculoskeletal Health Questionnaire (MSK-HQ, range 0-56), and Friends-and-Family Test. RESULTS Over 13 months, 2825 patients were invited by email and 24% (n=680) completed their initial questionnaire. Their mean age was 56.2 (SD 14.9), 61% were female, ethnicity was 97% white, mean pain intensity was 6.1 (SD 2.13) and mean MSK-HQ score was 33.8 (SD 9.5). At 3-months follow-up (n=370) there was a 2.8 (CI 2.5 to 3.1) mean pain intensity reduction from baseline, a mean 7.1 (6.0 to 8.2) score improvement in MSK-HQ and 64% reporting overall improvement (much better/better) since seeing the FCP. One of the six success criteria was not met; 29% of those in employment reported receiving specific work advice from the FCP (target ≥75%). CONCLUSION Ahead of the planned scale-up of the FCP primary care model across the UK, this evaluation provides useful data on patients who access this service, their short-term clinical outcomes and whether key success criteria are being met.
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Affiliation(s)
- S Stynes
- Keele University, School of Medicine, Primary Care Centre Versus Arthritis, Keele, United Kingdom; Midlands Partnership Foundation NHS Trust, Haywood Hospital Spinal Interface Service, Staffordshire, United Kingdom.
| | - K P Jordan
- Keele University, School of Medicine, Primary Care Centre Versus Arthritis, Keele, United Kingdom.
| | - J C Hill
- Keele University, School of Medicine, Primary Care Centre Versus Arthritis, Keele, United Kingdom.
| | - G Wynne-Jones
- Keele University, School of Medicine, Primary Care Centre Versus Arthritis, Keele, United Kingdom.
| | - E Cottrell
- Keele University, School of Medicine, Primary Care Centre Versus Arthritis, Keele, United Kingdom.
| | - N E Foster
- Keele University, School of Medicine, Primary Care Centre Versus Arthritis, Keele, United Kingdom; Faculty of Health and Behavioural Sciences, University of Queensland, Australia.
| | - R Goodwin
- Division of Rehabilitation, Ageing and Wellbeing, Faculty of Medicine & Health Sciences, University of Nottingham, United Kingdom.
| | - A Bishop
- Keele University, School of Medicine, Primary Care Centre Versus Arthritis, Keele, United Kingdom.
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20
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Gidlow CJ, Ellis NJ, Riley V, Cowap L, Crone D, Cottrell E, Grogan S, Chambers R, Calvert S, Clark-Carter D. Cardiovascular disease risk communication in NHS Health Checks: a qualitative video-stimulated recall interview study with practitioners. BJGP Open 2021; 5:BJGPO.2021.0049. [PMID: 34172476 PMCID: PMC8596312 DOI: 10.3399/bjgpo.2021.0049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/24/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND NHS Health Check (NHSHC) is a national programme to identify and manage cardiovascular disease (CVD) risk. Practitioners delivering the programme should be competent in discussing CVD risk, but there is evidence of limited understanding of the recommended 10-year percentage CVD risk scores. Lifetime CVD risk calculators might improve understanding and communication of risk. AIM To explore practitioner understanding, perceptions, and experiences of CVD risk communication in NHSHCs when using two different CVD risk calculators. DESIGN & SETTING Qualitative video-stimulated recall (VSR) study with NHSHC practitioners in the West Midlands. METHOD VSR interviews were conducted with practitioners who delivered NHSHCs using either the QRISK2 10-year risk calculator (n = 7) or JBS3 lifetime CVD risk calculator (n = 8). Data were analysed using reflexive thematic analysis. RESULTS In total, nine healthcare assistants (HCAs) and six general practice nurses (GPNs) were interviewed. There was limited understanding and confidence of 10-year risk, which was used to guide clinical decisions through determining low-, medium-, or high-risk thresholds, rather than as a risk communication tool. Potential benefits of some JBS3 functions were evident, particularly heart age, risk manipulation, and visual presentation of risk. CONCLUSION There is a gap between the expectation and reality of practitioners' understanding, competencies, and training in CVD risk communication for NHSHCs. Practitioners would welcome heart age and risk manipulation functions of JBS3 to promote patient understanding of CVD risk, but there is a more fundamental need for practitioner training in CVD risk communication.
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Affiliation(s)
- Christopher J Gidlow
- Centre for Health and Development, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
| | - Naomi J Ellis
- Centre for Health and Development, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
| | - Victoria Riley
- Centre for Health and Development, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
| | - Lisa Cowap
- Centre for Health and Development, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
| | - Diane Crone
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Elizabeth Cottrell
- School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Sarah Grogan
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Ruth Chambers
- Stoke-on-Trent Clinical Commissioning Group, Stoke-on-Trent, UK
| | - Sian Calvert
- Centre for Health and Development, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
| | - David Clark-Carter
- Centre for Health and Development, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
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21
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Cunningham J, M. Briggs A, Cottrell E, Doyle F, Dziedzic K, Finney A, Murphy P, Paskins Z, Sheridan E, Swaithes L, P. French H. Barriers and facilitators to the implementation of osteoarthritis management programmes in primary or community care settings: a systematic review and qualitative framework synthesis protocol. HRB Open Res 2021; 4:102. [PMID: 34746643 PMCID: PMC8543168 DOI: 10.12688/hrbopenres.13377.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 12/29/2022] Open
Abstract
Despite consistent international guidelines for osteoarthritis (OA) management, evidence-based treatments are underutilised. OA management programmes (OAMPs) are being implemented internationally to address this evidence-practice gap. An OAMP is defined as a 'model of evidence-based, non-surgical OA care that has been implemented in a real-world setting'. Our objective is to identify, synthesise and appraise qualitative research identifying anticipated or experienced micro (individual/behavioural), meso (organisational) or macro (context/system) level barriers or facilitators to the implementation of primary or community care-based OAMPs. Five electronic databases will be searched for papers published between 2010 and 2021. Qualitative or mixed-methods studies that include qualitative data on the anticipated or experienced barriers or facilitators to the implementation of primary or community care-based OAMPs, from the perspective of service users or service providers, will be included. The review will be reported using the PRISMA and ENTREQ guidelines. A data extraction form will be used to provide details of the included studies. Data will be analysed and identified barriers and facilitators will be mapped onto an appropriate implementation framework, such as the Theoretical Domains Framework. The appropriate JBI critical appraisal tools will be used to assess methodological quality, while the GRADE-CERQual approach will be used to assess confidence in the findings. Translation of evidence-based guidelines into practice is challenging and reliant on the quality of implementation. By comparing and contrasting anticipated and experienced barriers, this review will determine the extent of congruence between the two, and provide valuable insights into the views and experiences of key stakeholders involved in the implementation of OAMPs. The mapping of identified barriers and facilitators to behaviour change theory will enhance the applicability and construct validity of our findings and will offer significant utility for future development and implementation of OAMPs. Registration: This protocol was registered with PROSPERO (CRD42021255698) on 15/07/21.
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Affiliation(s)
- Joice Cunningham
- School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
| | - Andrew M. Briggs
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Elizabeth Cottrell
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
| | - Frank Doyle
- Department of Health Psychology, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Krysia Dziedzic
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
| | - Andrew Finney
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
| | - Paul Murphy
- RCSI Library, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Zoe Paskins
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
- Haywood Academic Rheumatology Centre, Midland Partnership NHS Foundation Trust, Stoke-on-Trent, ST6 7AG, UK
| | - Eoin Sheridan
- School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
| | - Laura Swaithes
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
| | - Helen P. French
- School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
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Tropea T, Cottrell E, Myers J, Johnstone E, Brownbill P. Intra- and inter-placental variability of human chorionic plate artery responsiveness. Placenta 2021. [DOI: 10.1016/j.placenta.2021.07.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Vincent K, Higgins L, Myers J, Cottrell E, Desforges M. Low maternal circulating PlGF is not an indicator of altered placental vascularity or placental nutrient transfer capacity. Placenta 2021. [DOI: 10.1016/j.placenta.2021.07.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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24
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Willmott T, Cottrell E, McBain AJ, Humphreys G, Myers J. Y-004. Investigating nitrate metabolism and the oral microbiome in hypertensive pregnancies. Pregnancy Hypertens 2021. [DOI: 10.1016/j.preghy.2021.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Tropea T, Cottrell E, Myers J, Johnstone E, Brownbill P. Vascular reactivity of chorionic plate arteries is altered by maternal antihypertensive medications. Placenta 2021. [DOI: 10.1016/j.placenta.2021.07.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Tropea T, Nihlen C, Weitzberg E, Lundberg J, David A, Tsatsaris V, Greenwood S, Sibley C, Cottrell E. Assessment of umbilical blood flow parameters in pregnant eNOS-/- mice supplemented with beetroot juice using high-frequency ultrasound. Placenta 2021. [DOI: 10.1016/j.placenta.2021.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Vincent KM, Dooley M, Desforges M, Myers JE, Cottrell E, Higgins LE. P-025. Comparison of methods for determining PlGF and sFlt-1 levels in maternal circulation in pregnancies complicated by placental dysfunction. Pregnancy Hypertens 2021. [DOI: 10.1016/j.preghy.2021.07.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gidlow CJ, Ellis NJ, Cowap L, Riley V, Crone D, Cottrell E, Grogan S, Chambers R, Clark-Carter D. Cardiovascular disease risk communication in NHS Health Checks using QRISK®2 and JBS3 risk calculators: the RICO qualitative and quantitative study. Health Technol Assess 2021; 25:1-124. [PMID: 34427556 DOI: 10.3310/hta25500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The NHS Health Check is a national cardiovascular disease prevention programme. There is a lack of evidence on how health checks are conducted, how cardiovascular disease risk is communicated to foster risk-reducing intentions or behaviour, and the impact on communication of using different cardiovascular disease risk calculators. OBJECTIVES RIsk COmmunication in Health Check (RICO) study aimed to explore practitioner and patient understanding of cardiovascular disease risk, the associated advice or treatment offered by the practitioner, and the response of the patients in health checks supported by either the QRISK®2 or the JBS3 lifetime risk calculator. DESIGN This was a qualitative study with quantitative process evaluation. SETTING Twelve general practices in the West Midlands of England, stratified on deprivation of the local area (bottom 50% vs. top 50%), and with matched pairs randomly allocated to use QRISK2 or JBS3 during health checks. PARTICIPANTS A total of 173 patients eligible for NHS Health Check and 15 practitioners. INTERVENTIONS The health check was delivered using either the QRISK2 10-year risk calculator (usual practice) or the JBS3 lifetime risk calculator, with heart age, event-free survival age and risk score manipulation (intervention). RESULTS Video-recorded health checks were analysed quantitatively (n = 173; JBS3, n = 100; QRISK2, n = 73) and qualitatively (n = 128; n = 64 per group), and video-stimulated recall interviews were undertaken with 40 patients and 15 practitioners, with 10 in-depth case studies. The duration of the health check varied (6.8-38 minutes), but most health checks were short (60% lasting < 20 minutes), with little cardiovascular disease risk discussion (average < 2 minutes). The use of JBS3 was associated with more cardiovascular disease risk discussion and fewer practitioner-dominated consultations than the use of QRISK2. Heart age and visual representations of risk, as used in JBS3, appeared to be better understood by patients than 10-year risk (QRISK2) and, as a result, the use of JBS3 was more likely to lead to discussion of risk factors and their management. Event-free survival age was not well understood by practitioners or patients. However, a lack of effective cardiovascular disease risk discussion in both groups increased the likelihood of a maladaptive coping response (i.e. no risk-reducing behaviour change). In both groups, practitioners often missed opportunities to check patient understanding and to tailor information on cardiovascular disease risk and its management during health checks, confirming apparent practitioner verbal dominance. LIMITATIONS The main limitations were under-recruitment in some general practices and the resulting imbalance between groups. CONCLUSIONS Communication of cardiovascular disease risk during health checks was brief, particularly when using QRISK2. Patient understanding of and responses to cardiovascular disease risk information were limited. Practitioners need to better engage patients in discussion of and action-planning for their cardiovascular disease risk to reduce misunderstandings. The use of heart age, visual representation of risk and risk score manipulation was generally seen to be a useful way of doing this. Future work could focus on more fundamental issues of practitioner training and time allocation within health check consultations. TRIAL REGISTRATION Current Controlled Trials ISRCTN10443908. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 50. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Christopher J Gidlow
- Centre for Health and Development, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
| | - Naomi J Ellis
- Centre for Health and Development, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
| | - Lisa Cowap
- Centre for Psychological Research, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
| | - Victoria Riley
- Centre for Health and Development, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
| | - Diane Crone
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Elizabeth Cottrell
- School of Primary, Community and Social Care, Keele University, Keele, Newcastle-under-Lyme, UK
| | - Sarah Grogan
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Ruth Chambers
- Stoke-on-Trent Clinical Commissioning Group, Stoke-on-Trent, UK
| | - David Clark-Carter
- Centre for Psychological Research, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
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Paskins Z, Bullock L, Crawford-Manning F, Cottrell E, Fleming J, Leyland S, Edwards JJ, Clark E, Thomas S, Chapman SR, Ryan S, Lefroy JE, Gidlow CJ, Iglesias C, Protheroe J, Horne R, O'Neill TW, Mallen C, Jinks C. Improving uptake of Fracture Prevention drug treatments: a protocol for Development of a consultation intervention (iFraP-D). BMJ Open 2021; 11:e048811. [PMID: 34408051 PMCID: PMC8375717 DOI: 10.1136/bmjopen-2021-048811] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Prevention of fragility fractures, a source of significant economic and personal burden, is hindered by poor uptake of fracture prevention medicines. Enhancing communication of scientific evidence and elicitation of patient medication-related beliefs has the potential to increase patient commitment to treatment. The Improving uptake of Fracture Prevention drug treatments (iFraP) programme aims to develop and evaluate a theoretically informed, complex intervention consisting of a computerised web-based decision support tool, training package and information resources, to facilitate informed decision-making about fracture prevention treatment, with a long-term aim of improving informed treatment adherence. This protocol focuses on the iFraP Development (iFraP-D) work. METHODS AND ANALYSIS The approach to iFraP-D is informed by the Medical Research Council complex intervention development and evaluation framework and the three-step implementation of change model. The context for the study is UK fracture liaison services (FLS), which enact secondary fracture prevention. An evidence synthesis of clinical guidelines and Delphi exercise will be conducted to identify content for the intervention. Focus groups with patients, FLS clinicians and general practitioners and a usual care survey will facilitate understanding of current practice, and investigate barriers and facilitators to change. Design of the iFraP intervention will be informed by decision aid development standards and theories of implementation, behaviour change, acceptability and medicines adherence. The principles of co-design will underpin all elements of the study through a dedicated iFraP community of practice including key stakeholders and patient advisory groups. In-practice testing of the prototype intervention will inform revisions ready for further testing in a subsequent pilot and feasibility randomised trial. ETHICS AND DISSEMINATION Ethical approval was obtained from North West-Greater Manchester West Research Ethics Committee (19/NW/0559). Dissemination and knowledge mobilisation will be facilitated through national bodies and networks, publications and presentations. TRIAL REGISTRATION NUMBER researchregistry5041.
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Affiliation(s)
- Zoe Paskins
- School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK
| | | | - Fay Crawford-Manning
- School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK
| | | | - Jane Fleming
- Cambridge Public Health, University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS Trust, Addenbrooke's Hospital, Cambridge, UK
| | | | | | - Emma Clark
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Simon Thomas
- School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, UK
| | | | - Sarah Ryan
- Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK
- School of Medicine & School of Nursing and Midwifery, Keele University, Stoke-on-Trent, UK
| | - J E Lefroy
- School of Medicine, Keele University, Keele, UK
| | | | - C Iglesias
- Department of Health Sciences, University of York, York, UK
- Danish Centre for Healthcare Improvements, Aalborg Universitet, Aalborg, Denmark
| | | | - Robert Horne
- Centre for Behavioural Medicine, UCL School of Pharmacy, University College London, London, UK
| | - Terence W O'Neill
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Clare Jinks
- School of Medicine, Keele University, Keele, UK
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Cottrell E, Ladha T, Borysewicz-Sańczyk H, Sawicka B, Savage MO, Bossowski AT, Storr HL. The value of whole exome sequencing for genetic diagnosis in a patient with Bloom syndrome. J Endocrinol Invest 2021; 44:1331-1334. [PMID: 32996068 DOI: 10.1007/s40618-020-01433-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/23/2020] [Indexed: 12/01/2022]
Affiliation(s)
- E Cottrell
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - T Ladha
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - H Borysewicz-Sańczyk
- Department of Paediatrics, Endocrinology and Diabetes with a Cardiology Division, Medical University of Bialystok, ul. Waszyngtona 17, 15-274, Białystok, Poland
| | - B Sawicka
- Department of Paediatrics, Endocrinology and Diabetes with a Cardiology Division, Medical University of Bialystok, ul. Waszyngtona 17, 15-274, Białystok, Poland
| | - M O Savage
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - A T Bossowski
- Department of Paediatrics, Endocrinology and Diabetes with a Cardiology Division, Medical University of Bialystok, ul. Waszyngtona 17, 15-274, Białystok, Poland.
| | - H L Storr
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary University of London, London, UK
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Baumbach L, Ankerst D, Roos EM, Nyberg LA, Cottrell E, Lykkegaard J. Association between received treatment elements and satisfaction with care for patients with knee osteoarthritis seen in general practice in Denmark. Scand J Prim Health Care 2021; 39:257-264. [PMID: 34218731 PMCID: PMC8293968 DOI: 10.1080/02813432.2021.1922835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 04/11/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE While education, exercise, and weight reduction when indicated, are recommended first-line treatments for knee osteoarthritis patients, they remain poorly implemented in favour of pain killer treatment, imaging and referral to surgery. A reason could be that patients are more satisfied with receiving these adjunctive treatment elements. This study aimed to investigate the associations between the received elements of care and the patient's satisfaction with the care for knee osteoarthritis in general practice. DESIGN Cross-sectional study. SETTING A Danish general practice. SUBJECTS All consecutive patients ≥30 years of age who consulted the general practitioner (GP) with chronic knee complaints during 18 months and who replied to a mailed questionnaire (n = 136). MAIN OUTCOME MEASURES The questionnaire addressed patient's knee-related quality of life, and overall satisfaction with care, as well as reception of seven types of information, which are known quality indicators. Information on reception of adjunctive treatment elements was obtained from electronic medical records. RESULTS Patient satisfaction (versus neutrality/dissatisfaction) was positively associated with reception of information on: physical activity and exercise (relative risks [RR] 1.38, 95% bootstrap percentile interval [BPI] 1.02-4.33), and the relationship between weight and osteoarthritis (1.38, 1.01-4.41). No significant associations were found for the five remaining types of information and all the adjunctive treatment elements. CONCLUSION Providing information as education to patients with knee osteoarthritis as part of the treatment is positively associated with satisfaction with care.KEY POINTSGeneral practitioners worry about the doctor-patient relationship when addressing recommended lifestyle changes. However, this study revealed:•Patients in general practice with knee osteoarthritis are satisfied with care after having received information on lifestyle changes, such as exercise and the relationship between weight and osteoarthritis.•Patient satisfaction was not associated with the reception of adjunctive treatment elements for osteoarthritis.
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Affiliation(s)
- Linda Baumbach
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Donna Ankerst
- Department of Mathematics and School of Life Sciences, Technical University of Munich, Munich, Germany
| | - Ewa M. Roos
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Lillemor A. Nyberg
- Faculty of Medicine and Health, Department of Medical Sciences, Örebro University, Örebro, Sweden
| | | | - Jesper Lykkegaard
- Department of Public Health, Research Unit for General Practice, University of Southern Denmark, Odense, Denmark
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Cunningham J, Doyle F, Ryan JM, Clyne B, Cadogan C, Cottrell E, Smith SM, French HP. Primary care-based models of care for osteoarthritis: a scoping review protocol. HRB Open Res 2021; 4:48. [PMID: 34291185 DOI: 10.12688/hrbopenres.13260.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2021] [Indexed: 11/20/2022] Open
Abstract
Background: The burden of osteoarthritis (OA) to individuals and health systems is substantial and is expected to increase due to population ageing and rising prevalence of obesity and multimorbidity. Primary care-based models of care (MoCs) are being increasingly developed in response to this growing burden. However, these MoCs have yet to be formally reviewed. A MoC can be defined as an 'evidence-informed strategy, framework or pathway that outlines the optimal manner in which condition-specific care should be delivered to consumers within a local health system'. Objective: To identify and describe the available research regarding the extent, nature and characteristics of MoCs for OA that have been developed or evaluated in primary care. Methods: A scoping review will be conducted in accordance with the Arksey and O'Malley scoping review framework and the PRISMA-ScR guidelines. Systematic literature searches of MEDLINE, EMBASE, CINAHL, PsychINFO, Web of Science and LILACs will be conducted from 2010 to present, aligning with publication dates of recent clinical guidelines. A structured iterative search of grey literature will be conducted. Full-text original quantitative or mixed method studies which describe the development or evaluation of MoCs for OA in primary care will be considered. Data will be charted and synthesised and a narrative synthesis will be conducted. Conclusions: This scoping review will provide a broad overview regarding the extent, nature and characteristics of the available literature on primary care based MoCs for OA. Findings will be used to identify gaps in the current evidence to identify areas for future research.
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Affiliation(s)
- Joice Cunningham
- School of Physiotherapy, Royal College of Surgeons in Ireland, RCSI, University of Medicine and Health Sciences, Dublin, Ireland
| | - Frank Doyle
- Department of Health Psychology, RCSI, University of Medicine and Health Sciences, Dublin, Ireland
| | - Jennifer M Ryan
- Public Health and Epidemiology, RCSI, University of Medicine and Health Sciences, Dublin, Ireland
| | - Barbara Clyne
- HRB Centre for Primary Care Research, Department of General Practice, RCSI, University of Medicine and Health Sciences, Dublin, Ireland
| | - Cathal Cadogan
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | | | - Susan M Smith
- HRB Centre for Primary Care Research, Department of General Practice, RCSI, University of Medicine and Health Sciences, Dublin, Ireland
| | - Helen P French
- School of Physiotherapy, Royal College of Surgeons in Ireland, RCSI, University of Medicine and Health Sciences, Dublin, Ireland
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Bullock L, Jinks C, Hawarden A, Crawford-Manning F, Leyland S, Fleming J, Clark EM, Cottrell E, Edwards J, Paskins Z. P117 Exploring experiences of Fracture Liaison Services and perceptions of a new decision tool to support patient and clinician decisions: a focus group study. Rheumatology (Oxford) 2021. [DOI: 10.1093/rheumatology/keab247.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Aims
The iFraP study (Improving uptake of Fracture Prevention Treatments) is developing a computerised decision-support tool to support clinician decision-making, risk communication and informed patient decision-making in Fracture Liaison Service (FLS) consultations. To inform iFraP intervention development, this study explored 1) patient and clinician experiences of FLSs and 2) perspectives towards the new iFraP tool.
Methods
Four focus groups and supplementary interviews included 9 FLS clinicians, 7 General Practitioners (GPs), and 8 patients who recently attended an FLS consultation. Theoretically-informed thematic analysis was conducted to facilitate understanding of current FLS practice, potential intervention acceptability and possible barriers to, and facilitators of, implementation.
Results
FLS clinicians and GPs suggested that FLSs worked well to identify patients at high risk of future fracture and to recommend medication. FLS clinicians were confident in their role and felt their consultations were person-centred and addressed information needs. However, some FLS clinicians described communicating risk as difficult and gave examples of when they are uncertain whether medication should be recommended (e.g. patient with osteopenic bone mineral density). FLS clinicians had varying perceptions of their roles in discussing medications, with some not viewing this as their responsibility; whereas GPs reported that medication discussions were an important aspect of the FLS clinician role. When medication recommendations (and discussion) were delivered, the setting varied across services including face-to-face in clinic or at the patient’s home, by letter, or by telephone. On the whole, patients reflected positively on their FLS appointment. However, some patients described unmet information needs, such as risk of future fractures, potential benefits and risks of medications, and information about follow-up.Many FLS clinicians and GPs reflected upon the potential value of the tool, including the inclusion of visual images to facilitate understanding of fracture risk, and to promote consistent messages across FLSs and between primary and secondary care. Barriers to intervention implementation were also identified. Clinicians expressed concern that evidence-based Cates plots to support explanations of medication effectiveness may make patients believe medications are not ‘worthwhile’. This suggests that clinicians prioritised promotion of medication adherence over informed decision-making, highlighting that the goal of FLS clinicians and iFraP may not align. Furthermore, concern was expressed that use of a computerised tool may detract from the clinician-patient relationship.
Conclusion
These novel findings illustrate the experience of FLS consultations from three perspectives. They highlight FLS clinicians’ clinical decision-support needs and patients’ unmet need for clear information that addresses their medication concerns. Overall, the iFraP intervention was viewed as acceptable, with the potential to support clinicians’ decision-making and to facilitate informed decision-making. Differences in FLS configuration and a move to more remote consulting may mean the intervention needs to be adaptable to different settings to address barriers to implementation.
Disclosure
L. Bullock: None. C. Jinks: Grants/research support; CJ is part funded by the NIHR Applied Research Collaboration (ARC) West Midlands. A. Hawarden: Grants/research support; AH is a NIHR funded Academic Clinical Fellow. F. Crawford-Manning: Grants/research support; FCM is part funded by the NIHR Clinical Research Network Scholar Programme. S. Leyland: None. J. Fleming: None. E.M. Clark: None. E. Cottrell: None. J. Edwards: Grants/research support; JE is an NIHR Academic Clinical Lecturer in Primary Care (CL-2016-10-003). Z. Paskins: Grants/research support; ZP is funded by the NIHR, Clinician Scientist Award (CS-2018-18-ST2-010)/NIHR Academy.
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Affiliation(s)
- Laurna Bullock
- Keele University, School of Medicine, Newcastle-under-Lyme, UNITED KINGDOM
| | - Clare Jinks
- Keele University, School of Medicine, Newcastle-under-Lyme, UNITED KINGDOM
| | - Ashley Hawarden
- Keele University, School of Medicine, Newcastle-under-Lyme, UNITED KINGDOM
| | | | - Sarah Leyland
- Royal Osteoporosis Society, Royal Osteoporosis Society, Bath, UNITED KINGDOM
| | - Jane Fleming
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, UNITED KINGDOM
| | - Emma M Clark
- Bristol Medical School, University of Bristol, Bristol, UNITED KINGDOM
| | - Elizabeth Cottrell
- Keele University, School of Medicine, Newcastle-under-Lyme, UNITED KINGDOM
| | - John Edwards
- Keele University, School of Medicine, Newcastle-under-Lyme, UNITED KINGDOM
| | - Zoe Paskins
- Keele University, School of Medicine, Newcastle-under-Lyme, UNITED KINGDOM
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Bullock L, Jinks C, Crawford-Manning F, Leyland S, Fleming J, Clark EM, Cottrell E, Edwards J, Paskins Z. P118 Co-design of a model Fracture Liaison Service consultation: a Delphi survey with patients and clinicians. Rheumatology (Oxford) 2021. [DOI: 10.1093/rheumatology/keab247.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Aims
Fracture Liaison Services (FLSs) are recommended to deliver best practice in secondary fracture prevention. As part of the iFraP (Improving uptake of Fracture Prevention drug Treatments) research programme this study aimed to 1) co-design content for a ‘model FLS consultation’ and 2) gain consensus on the appropriateness of osteoporosis clinical guidelines in the context of FLSs.
Methods
Three rounds of modified Delphi survey were sent to patients with osteoporosis and/or fragility fractures, carers, and clinicians. Participants were presented with potential consultation content derived from an evidence synthesis of current guidelines, frameworks and theories of shared decision-making, communication and medicine adherence, and stakeholder consultation. Participants were asked to rate their perception of the importance of each statement on a 5-point Likert scale and elaborate using free-text boxes. In Round 2, participants were shown mean scores of importance from Round 1. Statements identified as of ‘low importance’ at the end of Rounds 1 and 2 were discussed by the study team, including patient contributors, and were removed or amended. In Round 3, participants were asked whether the statement was ‘essential’ or ‘optional’ in a time-limited FLS consultation. Percentage agreement with each statement was ranked. The threshold for ‘essential’ versus ‘optional’ was determined by the study team.
Results
391 invitations to participate were sent, with 72, 49, and 52 responders to Rounds 1, 2 and 3 respectively. Throughout Rounds 1-3 participants considered 122 statements. By Round 3, 81 statements were deemed essential, with an additional 14 optional statements. Essential statements were distilled into 18 recommendations constituting the ‘model FLS consultation’. Statements related to stages of the consultation, including: introductions; gather information; consider therapeutic options; elicit patient perceptions; establish shared decision-making preferences; share information about condition and treatment; check understanding; and signpost next steps. There was consensus that FLS clinicians should discuss the benefits and risks of oral and intravenous bisphosphonates and denosumab. Optional consultation content included a statement suggesting clinicians should observe the patient to look for signs of fractures in their spine, with free-text responses suggesting that FLS clinicians may not ‘be best qualified’ to perform physical examinations. Removed statements included those relating to the discussion of Hormone Replacement Therapy, Raloxifene and Teriparatide, with free-text statements suggesting that ‘specialists’ (e.g. Rheumatologists) should discuss these medications. Additionally, statements that described the potential consequences of fracture (e.g. ‘the clinician should explain that one in ten patients with a hip fracture will die within 12 months of fracture.’) were removed. Free-text comments described these statements as potentially ‘scary’.
Conclusion
The Delphi survey has informed iFraP intervention development by highlighting essential and optional FLS consultation content. Findings also provide insight into aspects of current osteoporosis clinical guidelines deemed appropriate in nurse/allied health professional led FLSs.
Disclosure
L. Bullock: None. C. Jinks: Grants/research support; CJ is part funded by the NIHR Applied Research Collaboration (ARC) West Midlands. F. Crawford-Manning: Grants/research support; FCM is part funded by the NIHR Clinical Research Network Scholar Programme. S. Leyland: None. J. Fleming: None. E.M. Clark: None. E. Cottrell: None. J. Edwards: Grants/research support; JE is an NIHR Academic Clinical Lecturer in Primary Care (CL-2016-10-003). Z. Paskins: Grants/research support; ZP is funded by the NIHR, Clinician Scientist Award (CS-2018-18-ST2-010)/NIHR Academy.
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Affiliation(s)
- Laurna Bullock
- Keele University, School of Medicine, Newcastle-under-Lyme, UNITED KINGDOM
| | - Clare Jinks
- Keele University, School of Medicine, Newcastle-under-Lyme, UNITED KINGDOM
| | | | - Sarah Leyland
- Royal Osteoporosis Society, Royal Osteoporosis Society, Bath, UNITED KINGDOM
| | - Jane Fleming
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, UNITED KINGDOM
| | - Emma M Clark
- Bristol Medical School, University of Bristol, Bristol, UNITED KINGDOM
| | - Elizabeth Cottrell
- Keele University, School of Medicine, Newcastle-under-Lyme, UNITED KINGDOM
| | - John Edwards
- Keele University, School of Medicine, Newcastle-under-Lyme, UNITED KINGDOM
| | - Zoe Paskins
- Keele University, School of Medicine, Newcastle-under-Lyme, UNITED KINGDOM
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Bullock L, Crawford-Manning F, Cottrell E, Fleming J, Leyland S, Edwards J, Clark EM, Thomas S, Chapman S, Gidlow C, Iglesias CP, Protheroe J, Horne R, O'Neill TW, Mallen C, Jinks C, Paskins Z. Developing a model Fracture Liaison Service consultation with patients, carers and clinicians: a Delphi survey to inform content of the iFraP complex consultation intervention. Arch Osteoporos 2021; 16:58. [PMID: 33761007 PMCID: PMC7989712 DOI: 10.1007/s11657-021-00913-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/02/2021] [Indexed: 02/03/2023]
Abstract
Fracture Liaison Services are recommended to deliver best practice in secondary fracture prevention. This modified Delphi survey, as part of the iFraP (Improving uptake of Fracture Prevention drug Treatments) study, provides consensus regarding tasks for clinicians in a model Fracture Liaison Service consultation. PURPOSE The clinical consultation is of pivotal importance in addressing barriers to treatment adherence. The aim of this study was to agree to the content of the 'model Fracture Liaison Service (FLS) consultation' within the iFraP (Improving uptake of Fracture Prevention drug Treatments) study. METHODS A Delphi survey was co-designed with patients and clinical stakeholders using an evidence synthesis of current guidelines and content from frameworks and theories of shared decision-making, communication and medicine adherence. Patients with osteoporosis and/or fragility fractures, their carers, FLS clinicians and osteoporosis specialists were sent three rounds of the Delphi survey. Participants were presented with potential consultation content and asked to rate their perception of the importance of each statement on a 5-point Likert scale and to suggest new statements (Round 1). Lowest rated statements were removed or amended after Rounds 1 and 2. In Round 3, participants were asked whether each statement was 'essential' and percentage agreement calculated; the study team subsequently determined the threshold for essential content. RESULTS Seventy-two, 49 and 52 patients, carers and clinicians responded to Rounds 1, 2 and 3 respectively. One hundred twenty-two statements were considered. By Round 3, consensus was reached, with 81 statements deemed essential within FLS consultations, relating to greeting/introductions; gathering information; considering therapeutic options; eliciting patient perceptions; establishing shared decision-making preferences; sharing information about osteoporosis and treatments; checking understanding/summarising; and signposting next steps. CONCLUSIONS This Delphi consensus exercise has summarised for the first time patient/carer and clinician consensus regarding clearly defined tasks for clinicians in a model FLS consultation.
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Affiliation(s)
- Laurna Bullock
- School of Medicine, Keele University, Newcastle, Staffordshire, UK.
| | - Fay Crawford-Manning
- School of Medicine, Keele University, Newcastle, Staffordshire, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, Staffordshire, UK
| | | | - Jane Fleming
- Cambridge Public Health, University of Cambridge & Addenbrooke's Hospital Fracture Liaison Service, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | | | - John Edwards
- School of Medicine, Keele University, Newcastle, Staffordshire, UK
| | - Emma M Clark
- Bristol Medical School, Faculty of Health Sciences,, University of Bristol, Bristol, UK
| | - Simon Thomas
- School of Pharmacy and Bioengineering, Keele University, Newcastle, Staffordshire, UK
| | - Stephen Chapman
- School of Pharmacy and Bioengineering, Keele University, Newcastle, Staffordshire, UK
| | - Christopher Gidlow
- Centre for Health and Development, Staffordshire University, Stoke-on-Trent, Staffordshire, UK
| | - Cynthia P Iglesias
- Department of Health Sciences, University of York, York, UK
- Danish Centre for Healthcare Improvement (CHI), Aalborg University, Aalborg, Denmark
| | - Joanne Protheroe
- School of Medicine, Keele University, Newcastle, Staffordshire, UK
| | - Robert Horne
- Centre for Behavioural Medicine, UCL School of Pharmacy, University College London, London, UK
| | - Terence W O'Neill
- Centre for Epidemiology Versus Arthritis, University of Manchester & NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Christian Mallen
- School of Medicine, Keele University, Newcastle, Staffordshire, UK
| | - Clare Jinks
- School of Medicine, Keele University, Newcastle, Staffordshire, UK
| | - Zoe Paskins
- School of Medicine, Keele University, Newcastle, Staffordshire, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, Staffordshire, UK
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Stevenson K, Sarigiovannis P, Finney AG, Cottrell E, Lewis R, Edwards JJ, Hadley-Barrows T, Thomson K, Reay H, Dziedzic KS. Development, spread and impact of primary care and musculoskeletal communities of practice to assist rapid translation of evidence into practice. Musculoskeletal Care 2021; 19:564-569. [PMID: 33755287 DOI: 10.1002/msc.1552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/24/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Embedding research into practice is challenging. Barriers include: a shortage of time, lack of understanding of the evidence and a poor support in the clinical setting. A community of practice (CoP) model has been used to address these issues. Three 'Evidence into Practice' groups use a CoP model to assist the rapid translation of evidence into practice in primary and secondary care settings. We describe how a CoP model supports the functions, operations and outputs of three 'Evidence into Practice Groups'. METHOD A CoP model is used to engage a broad range of clinicians, researchers, managers, patients and librarians in the complex process of acquiring research knowledge and then translating knowledge into practice. The CoP principles of Domain, Community and Practice are used to describe three 'Evidence into Practice Groups' who cater for different elements of the care and academic sector and engage a range of professional groups. This includes primary and secondary care engaging professionals such as general practitioners (GP), practice nurses, allied health professionals, researchers and librarians. All groups are clinically led, academically supported and follow similar processes to identify the best evidence and translate it into practice. As the groups reflect the context in which they work they have different operational arrangements for example frequency and time of meetings. RESULTS The CoP model enabled three 'Evidence into Practice Groups' over time to: engage over 180 clinical and academic staff; answer 130 clinical questions; improve clinical care, gain funding for two randomised controlled trials (enrolled over n = 7000 participants) and identify areas for further research, quality improvement audit and training. CONCLUSION The CoP model encourages the rapid translation of evidence into practice by engaging staff to identify areas of clinical concern in their own context, thereby stimulating their interest and involvement. This creates a meaningful link between research and practice. Clinical leadership and the CoP model ensure that practice change is quick and efficient. This model can be replicated at scale. Consideration needs to be given to the key ingredients to achieve impact.
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Affiliation(s)
- Kay Stevenson
- The Impact Accelerator Unit, The Medical School Keele University, Keele, UK.,Midlands Partnership NHS Foundation Trust, Newcastle-under-Lyme, UK
| | - Panos Sarigiovannis
- The Impact Accelerator Unit, The Medical School Keele University, Keele, UK.,Midlands Partnership NHS Foundation Trust, Newcastle-under-Lyme, UK
| | - Andrew G Finney
- The Impact Accelerator Unit, The Medical School Keele University, Keele, UK.,The School of Nursing and Midwifery, Keele University, Keele, UK
| | - Elizabeth Cottrell
- The Impact Accelerator Unit, The Medical School Keele University, Keele, UK
| | | | - John James Edwards
- The Impact Accelerator Unit, The Medical School Keele University, Keele, UK
| | - Tina Hadley-Barrows
- The Impact Accelerator Unit, The Medical School Keele University, Keele, UK.,The Royal Wolverhampton NHS Foundation Trust, Keele, UK
| | - Kirsty Thomson
- Midlands Partnership NHS Foundation Trust, Newcastle-under-Lyme, UK
| | - Hannah Reay
- West Midland Clinical Research Network, London, UK
| | - Krysia S Dziedzic
- The Impact Accelerator Unit, The Medical School Keele University, Keele, UK
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Østerås N, Blaker IB, Hjortland T, Cottrell E, Quicke JG, Dziedzic KS, Blackburn S, Paulsen A. Improving osteoarthritis management in primary healthcare: results from a quasi-experimental study. BMC Musculoskelet Disord 2021; 22:79. [PMID: 33446167 PMCID: PMC7807869 DOI: 10.1186/s12891-021-03959-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/05/2021] [Indexed: 12/27/2022] Open
Abstract
Background To improve quality of care for patients with hip and knee osteoarthritis (OA), general practitioners (GPs) and physiotherapists (PTs) in a Norwegian municipality initiated an intervention. The intervention aimed to increase provision of core OA treatment (information, exercise, and weight control) prior to referral for surgery, rational use of imaging for assessing OA and improve communication between healthcare professionals. This study assessed the effectiveness of this intervention. Methods Forty-eight PTs and one hundred one GPs were invited to the intervention that included two interactive workshops outlining best practice and an accompanying template for PT discharge reports. Using interrupted time series research design, the study period was divided into three: pre-implementation, transition (implementation) and post-implementation. Comparing the change between pre- and post-implementation, the primary outcome was patient-reported quality of OA care measured with the OsteoArthritis Quality Indicator questionnaire. Secondary outcomes were number of PT discharge reports, information included in GP referral letters to orthopaedic surgeon, the proportion of GP referral letters indicating use of core treatment, and the use of imaging within OA assessment. Analyses involved linear mixed and logistic regression models. Results The PT workshop had 30 attendees, and 31 PTs and 33 GPs attended the multidisciplinary workshop. Two hundred eight and one hundred twenty-five patients completed the questionnaire during pre- and post-implementation, respectively. The adjusted model showed a small, statistically non-significant, increase in mean total score for quality of OA care (mean change = 4.96, 95% CI -0.18, 10.12, p:0.057), which was mainly related to items on OA core treatment. Patients had higher odds of reporting receipt of information on treatment alternatives (odds ratio (OR) 1.9, 95% CI 1.08, 3.24) and on self-management (OR 2.4, 95% CI 1.33, 4.32) in the post-implementation phase. There was a small, statistically non-significant, increase in the proportion of GP referral letters indicating prior use of core treatment modalities. There were negligible changes in the number of PT discharge reports, in the information included in the GP referral letters, and in the use of imaging for OA assessment. Conclusion This study suggests that a primary care intervention including two inter-active workshops can shift the quality of care towards best practice recommendations. Trial registration ClinicalTrials.gov: NCT02876120. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-03959-6.
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Affiliation(s)
- Nina Østerås
- Division of Rheumatology and Research, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
| | | | | | - Elizabeth Cottrell
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, Keele University, Staffordshire, ST5 5BG, UK
| | - Jonathan G Quicke
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, Keele University, Staffordshire, ST5 5BG, UK
| | - Krysia S Dziedzic
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, Keele University, Staffordshire, ST5 5BG, UK
| | - Steven Blackburn
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, Keele University, Staffordshire, ST5 5BG, UK
| | - Aksel Paulsen
- Department of Orthopaedics, Division of Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Public Health, The Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Riley V, Ellis NJ, Cowap L, Grogan S, Cottrell E, Crone D, Chambers R, Clark-Carter D, Fedorowicz S, Gidlow C. A qualitative exploration of two risk calculators using video-recorded NHS health check consultations. BMC Fam Pract 2020; 21:250. [PMID: 33272217 PMCID: PMC7716424 DOI: 10.1186/s12875-020-01315-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 11/12/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The aim of the study was to explore practitioner-patient interactions and patient responses when using QRISK®2 or JBS3 cardiovascular disease (CVD) risk calculators. Data were from video-recorded NHS Health Check (NHSHC) consultations captured as part of the UK RIsk COmmunication (RICO) study; a qualitative study of video-recorded NHSHC consultations from 12 general practices in the West Midlands, UK. Participants were those eligible for NHSHC based on national criteria (40-74 years old, no existing diagnoses for cardiovascular-related conditions, not on statins), and practitioners, who delivered the NHSHC. METHOD NHSHCs were video-recorded. One hundred twenty-eight consultations were transcribed and analysed using deductive thematic analysis and coded using a template based around Protection Motivation Theory. RESULTS Key themes used to frame the analysis were Cognitive Appraisal (Threat Appraisal, and Coping Appraisal), and Coping Modes (Adaptive, and Maladaptive). Analysis showed little evidence of CVD risk communication, particularly in consultations using QRISK®2. Practitioners often missed opportunities to check patient understanding and encourage risk- reducing behaviour, regardless of the risk calculator used resulting in practitioner verbal dominance. JBS3 appeared to better promote opportunities to initiate risk-factor discussion, and Heart Age and visual representation of risk were more easily understood and impactful than 10-year percentage risk. However, a lack of effective CVD risk discussion in both risk calculator groups increased the likelihood of a maladaptive coping response. CONCLUSIONS The analysis demonstrates the importance of effective, shared practitioner-patient discussion to enable adaptive coping responses to CVD risk information, and highlights a need for effective and evidence-based practitioner training. TRIAL REGISTRATION ISRCTN ISRCTN10443908 . Registered 7th February 2017.
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Affiliation(s)
- Victoria Riley
- Staffordshire University, Brindley Building, Leek Road, Stoke-on-Trent, ST4 2DF UK
| | - Naomi J. Ellis
- Staffordshire University, Brindley Building, Leek Road, Stoke-on-Trent, ST4 2DF UK
| | - Lisa Cowap
- Staffordshire University, Brindley Building, Leek Road, Stoke-on-Trent, ST4 2DF UK
| | - Sarah Grogan
- Manchester Metropolitan University, Manchester Campus, Bonsall Street, Manchester, M15 6GX UK
| | | | - Diane Crone
- Cardiff Metropolitan University, Cyncoed Campus, Cyncoed Road, Cardiff, CF23 6XD UK
| | - Ruth Chambers
- Stoke-on-Trent Clinical Commissioning Group, Smithfield One Building, Stoke-on-Trent, ST1 4FA UK
| | - David Clark-Carter
- Staffordshire University, Brindley Building, Leek Road, Stoke-on-Trent, ST4 2DF UK
| | - Sophia Fedorowicz
- Staffordshire University, Brindley Building, Leek Road, Stoke-on-Trent, ST4 2DF UK
| | - Christopher Gidlow
- Staffordshire University, Brindley Building, Leek Road, Stoke-on-Trent, ST4 2DF UK
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Ormesher L, Higson S, Luckie M, Roberts SA, Glossop H, Trafford A, Cottrell E, Johnstone ED, Myers JE. Postnatal Enalapril to Improve Cardiovascular Function Following Preterm Preeclampsia (PICk-UP):: A Randomized Double-Blind Placebo-Controlled Feasibility Trial. Hypertension 2020; 76:1828-1837. [PMID: 33012200 PMCID: PMC7610547 DOI: 10.1161/hypertensionaha.120.15875] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/19/2020] [Indexed: 12/16/2022]
Abstract
Hypertensive disease in pregnancy is associated with future cardiovascular disease and, therefore, provides an opportunity to identify women who could benefit from targeted interventions aimed at reducing cardiovascular morbidity. This study focused on the highest-risk group, women with preterm preeclampsia, who have an 8-fold risk of death from future cardiovascular disease. We performed a single-center feasibility randomized controlled trial of 6 months' treatment with enalapril to improve postnatal cardiovascular function. Echocardiography and hemodynamic measurements were performed at baseline (<3 days), 6 weeks, and 6 months postdelivery on 60 women. At randomization, 88% of women had diastolic dysfunction, and 68% had concentric remodeling/hypertrophy. No difference was seen in total vascular resistance (P=0.59) or systolic function (global longitudinal strain: P=0.14) between groups at 6 months. However, women treated with enalapril had echocardiographic measurements consistent with improved diastolic function (E/E'[the ratio of early mitral inflow velocity and early mitral annular diastolic velocity]: P=0.04) and left ventricular remodeling (relative wall thickness: P=0.01; left ventricular mass index: P=0.03) at 6 months, compared with placebo. Urinary enalapril was detectable in 85% and 63% of women in the enalapril arm at 6 weeks and 6 months, respectively. All women responded positively to taking enalapril in the future. Our study confirmed acceptability and feasibility of the study protocol with a recruitment to completion rate of 2.2 women per month. Importantly, postnatal enalapril treatment was associated with improved echocardiographic measurements; these early improvements have the potential to reduce long-term cardiovascular disease risk. A definitive, multicenter randomized controlled trial is now required to confirm these findings. Registration- URL: https://www.clinicaltrials.gov; Unique identifier: NCT03466333.
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Affiliation(s)
- Laura Ormesher
- From the Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine (L.O., E.C., E.D.J., J.E.M.), University of Manchester, United Kingdom
- St Mary's Hospital (L.O., H.G., E.D.J., J.E.M.), Manchester University NHS Foundation Trust, United Kingdom
| | - Suzanne Higson
- Manchester Heart Centre (S.H., M.L.), Manchester University NHS Foundation Trust, United Kingdom
| | - Matthew Luckie
- Manchester Heart Centre (S.H., M.L.), Manchester University NHS Foundation Trust, United Kingdom
| | - Stephen A Roberts
- Centre for Biostatistics (S.A.R.), University of Manchester, United Kingdom
| | - Heather Glossop
- St Mary's Hospital (L.O., H.G., E.D.J., J.E.M.), Manchester University NHS Foundation Trust, United Kingdom
| | - Andrew Trafford
- Division of Cardiovascular Sciences (A.T.), University of Manchester, United Kingdom
| | - Elizabeth Cottrell
- From the Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine (L.O., E.C., E.D.J., J.E.M.), University of Manchester, United Kingdom
| | - Edward D Johnstone
- From the Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine (L.O., E.C., E.D.J., J.E.M.), University of Manchester, United Kingdom
- St Mary's Hospital (L.O., H.G., E.D.J., J.E.M.), Manchester University NHS Foundation Trust, United Kingdom
| | - Jenny E Myers
- From the Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine (L.O., E.C., E.D.J., J.E.M.), University of Manchester, United Kingdom
- St Mary's Hospital (L.O., H.G., E.D.J., J.E.M.), Manchester University NHS Foundation Trust, United Kingdom
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Yu D, Appleyard T, Cottrell E, Peat G. Co-prescription of gabapentinoids and opioids among adults with and without osteoarthritis in the United Kingdom between 1995 and 2017. Rheumatology (Oxford) 2020; 60:1942-1950. [DOI: 10.1093/rheumatology/keaa586] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/12/2020] [Indexed: 02/04/2023] Open
Abstract
Abstract
Objectives
To produce national and regional estimates and trends for gabapentinoid–opioid co-prescribing rates in patients with OA, both in absolute terms and relative to matched controls without OA.
Methods
Using the UK Clinical Practice Research Datalink database we first constructed age–sex–practice–date 1:1 matched cohorts of patients aged ≥40 years with and without a new diagnosis of OA between 1995–2017 and estimated the relative incidence of a first gabapentinoid prescription. Incident gabapentinoid users in both cohorts were followed to estimate and compare the event rate of gabapentinoid–opioid co-prescription (prescription from both classes within the same 28-day window).
Results
The incidence of first gabapentinoid prescription was 3-fold higher in patients with OA than in matched controls [n = 215 357; incidence rate ratio (IRR) 2.93; 95% CI: 2.87, 3.00]. Among incident gabapentinoid users with OA (n = 27 374, median follow-up 3.9 years) the event rate of gabapentinoid–opioid co-prescription was 4.03 (4.02–4.05) per person-year. The rate was higher in OA patients classed as long-term gabapentinoid users (6.24; 6.22–6.26). These rates were significantly higher than in incident gabapentinoid users without OA [adjusted-IRR: 1.29 (1.28–1.30)]. This elevated risk was observed across age, sex, geographic regions, and calendar years, when restricted to strong opioids and to long-term gabapentinoid users, and when co-prescription was defined as within 14 days and same-day prescribing.
Conclusions
Patients with OA not only have a higher risk of being prescribed a gabapentinoid but, once prescribed a gabapentinoid, are also at greater risk of opioid co-prescription. Strict restriction of gabapentinoid–opioid co-prescription, and improved access to, and uptake of, effective non-pharmacological and surgical alternatives for OA are required.
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Affiliation(s)
- Dahai Yu
- Primary Care Centre Versus Arthritis, School of Medicine, Community and Social Care, Keele University, Keele, UK
| | - Tom Appleyard
- Primary Care Centre Versus Arthritis, School of Medicine, Community and Social Care, Keele University, Keele, UK
| | - Elizabeth Cottrell
- Primary Care Centre Versus Arthritis, School of Medicine, Community and Social Care, Keele University, Keele, UK
| | - George Peat
- Primary Care Centre Versus Arthritis, School of Medicine, Community and Social Care, Keele University, Keele, UK
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Paskins Z, Crawford-Manning F, Cottrell E, Corp N, Wright J, Jinks C, Bishop S, Doyle A, Ong T, Gittoes N, Leonardi-Bee J, Langley T, Horne R, Sahota O. Acceptability of bisphosphonates among patients, clinicians and managers: a systematic review and framework synthesis. BMJ Open 2020; 10:e040634. [PMID: 33148763 PMCID: PMC7640526 DOI: 10.1136/bmjopen-2020-040634] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To explore the acceptability of different bisphosphonate regimens for the treatment of osteoporosis among patients, clinicians and managers, payers and academics. DESIGN A systematic review of primary qualitative studies. Seven databases were searched from inception to July 2019. Screening, data extraction and quality assessment of full-articles selected for inclusion were performed independently by two authors. A framework synthesis was applied to extracted data based on the theoretical framework of acceptability (TFA). The TFA includes seven domains relating to sense-making, emotions, opportunity costs, burden, perceived effectiveness, ethicality and self-efficacy. Confidence in synthesis findings was assessed. SETTING Any developed country healthcare setting. PARTICIPANTS Patients, healthcare professionals, managers, payers and academics. INTERVENTION Experiences and views of oral and intravenous bisphosphonates. RESULTS Twenty-five studies were included, mostly describing perceptions of oral bisphosphonates. We identified, with high confidence, how patients and healthcare professionals make sense (coherence) of bisphosphonates by balancing perceptions of need against concerns, how uncertainty prevails about bisphosphonate perceived effectiveness and a number of individual and service factors that have potential to increase self-efficacy in recommending and adhering to bisphosphonates. We identified, with moderate confidence, that bisphosphonate taking induces concern, but has the potential to engender reassurance, and that both side effects and special instructions for taking oral bisphosphonates can result in treatment burden. Finally, we identified with low confidence that multimorbidity plays a role in people's perception of bisphosphonate acceptability. CONCLUSION By using the lens of acceptability, our findings demonstrate with high confidence that a theoretically informed, whole-system approach is necessary to both understand and improve adherence. Clinicians and patients need supporting to understand the need for bisphosphonates, and clinicians need to clarify to patients what constitutes bisphosphonate treatment success. Further research is needed to explore perspectives of male patients and those with multimorbidity receiving bisphosphonates, and patients receiving intravenous treatment. PROSPERO REGISTRATION NUMBER CRD42019143526.
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Affiliation(s)
- Zoe Paskins
- School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK
| | - Fay Crawford-Manning
- School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK
| | | | - Nadia Corp
- School of Medicine, Keele University, Keele, UK
| | | | - Clare Jinks
- School of Medicine, Keele University, Keele, UK
| | - Simon Bishop
- Centre for Health Innovation, Leadership and Learning, University of Nottingham, Nottingham, UK
| | - Alison Doyle
- Operations and Clinical Practice, Royal Osteoporosis Society, Bath, UK
| | - Terence Ong
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Neil Gittoes
- Centre for Endocrinology Diabetes and Metabolism, University of Birmingham, Birmingham, UK
| | - Jo Leonardi-Bee
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - Tessa Langley
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Robert Horne
- School of Pharmacy, University College London, London, UK
| | - Opinder Sahota
- Department of Geriatric Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Sewell R, Cottrell E, Gutman K, Clemons M, Friedman D, Kotin E, Smith E, Whitehouse J, Pratt C. Which behavioral health screening tool should you use-and when? J Fam Pract 2020; 69:454-460. [PMID: 33176341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This review focuses on screens to assess everything from mood and substance use to pain and cognition. It also offers an algorithm to aid with clinical decision making.
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Affiliation(s)
| | | | - Karina Gutman
- Alliant International UniversityCSPP, San Diego, USA
| | | | | | | | - Emma Smith
- Midwestern University, Glendale, AZ, USA
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Swaithes L, Dziedzic K, Finney A, Cottrell E, Jinks C, Mallen C, Currie G, Paskins Z. Understanding the uptake of a clinical innovation for osteoarthritis in primary care: a qualitative study of knowledge mobilisation using the i-PARIHS framework. Implement Sci 2020; 15:95. [PMID: 33115490 PMCID: PMC7594414 DOI: 10.1186/s13012-020-01055-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/15/2020] [Indexed: 01/31/2023] Open
Abstract
Background Osteoarthritis is a leading cause of pain and disability worldwide. Despite research supporting best practice, evidence-based guidelines are often not followed. Little is known about the implementation of non-surgical models of care in routine primary care practice. From a knowledge mobilisation perspective, the aim of this study was to understand the uptake of a clinical innovation for osteoarthritis and explore the journey from a clinical trial to implementation. Methods This study used two methods: secondary analysis of focus groups undertaken with general practice staff from the Managing OSteoArthritis in ConsultationS research trial, which investigated the effectiveness of an enhanced osteoarthritis consultation, and interviews with stakeholders from an implementation project which started post-trial following demand from general practices. Data from three focus groups with 21 multi-disciplinary clinical professionals (5–8 participants per group), and 13 interviews with clinical and non-clinical stakeholders, were thematically analysed utilising the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, in a theoretically informative approach. Public contributors were involved in topic guide design and interpretation of results. Results In operationalising implementation of an innovation for osteoarthritis following a trial, the importance of a whole practice approach, including the opportunity for reflection and planning, were identified. The end of a clinical trial provided opportune timing for facilitating implementation planning. In the context of osteoarthritis in primary care, facilitation by an inter-disciplinary knowledge brokering service, nested within an academic institution, was instrumental in supporting ongoing implementation by providing facilitation, infrastructure and resource to support the workload burden. ‘Instinctive facilitation’ may involve individuals who do not adopt formal brokering roles or fully recognise their role in mobilising knowledge for implementation. Public contributors and lay communities were not only recipients of healthcare innovations but also potential powerful facilitators of implementation. Conclusion This theoretically informed knowledge mobilisation study into the uptake of a clinical innovation for osteoarthritis in primary care has enabled further characterisation of the facilitation and recipient constructs of i-PARIHS by describing optimum timing for facilitation and roles and characteristics of facilitators. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-020-01055-2.
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Affiliation(s)
- Laura Swaithes
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK.
| | - Krysia Dziedzic
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
| | - Andrew Finney
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
| | - Elizabeth Cottrell
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
| | - Clare Jinks
- Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
| | - Christian Mallen
- Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
| | - Graeme Currie
- Entrepreneurship & Innovation, Organising Healthcare Research Network, Warwick Business School, The University of Warwick, Coventry, CV4 7AL, UK
| | - Zoe Paskins
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
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Gidlow CJ, Ellis NJ, Cowap L, Riley VA, Crone D, Cottrell E, Grogan S, Chambers R, Clark-Carter D. Quantitative examination of video-recorded NHS Health Checks: comparison of the use of QRISK2 versus JBS3 cardiovascular risk calculators. BMJ Open 2020; 10:e037790. [PMID: 32978197 PMCID: PMC7520846 DOI: 10.1136/bmjopen-2020-037790] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Quantitatively examine the content of National Health Service Health Check (NHSHC), patient-practitioner communication balance and differences when using QRISK2 versus JBS3 cardiovascular disease (CVD) risk calculators. DESIGN RIsk COmmunication in NHSHC was a qualitative study with quantitative process evaluation, comparing NHSHC using QRISK2 or JBS3. We present data from the quantitative process evaluation. SETTING AND PARTICIPANTS Twelve general practices in the West Midlands (England) conducted NHSHC using JBS3 or QRISK2 (6/group). Patients were eligible for NHSHC based on national criteria (aged 40-74, no existing cardiovascular-related diagnoses, not taking statins). Recruitment was stratified by patients' age, gender and ethnicity. METHODS Video recordings of NHSHC were coded, second-by-second, to quantify who was speaking and what was being discussed. Outcomes included consultation duration, practitioner verbal dominance (ratio of practitioner:patient speaking time (pr:pt ratio)) and proportion of time discussing CVD risk, risk factors and risk management. RESULTS 173 video-recorded NHSHC were analysed (73 QRISK, 100 JBS3). The sample was 51% women, 83% white British, with approximately equal proportions across age groups. NHSHC duration varied greatly (6.8-38.0 min). Most (60%) lasted less than 20 min. On average, CVD risk was discussed for less than 2 min (9.06%±4.30% of consultation time). There were indications that, compared with NHSHC using JBS3, those with QRISK2 involved less CVD risk discussion (JBS3 M=10.24%, CI: 8.01-12.48 vs QRISK2 M=7.44%, CI: 5.29-9.58) and were more verbally dominated by practitioners (pr:pt ratio JBS3 M=3.21%, CI: 2.44-3.97 vs QRISK2=2.35%, CI: 1.89-2.81). The largest proportion of NHSHC time was spent discussing causal risk factors (M=37.54%, CI: 32.92-42.17). CONCLUSIONS There was wide variation in NHSHC duration. Many were short and practitioner-dominated, with little time discussing CVD risk. JBS3 appears to extend CVD risk discussion and patient contribution. Qualitative examination of how it is used is necessary to fully understand the potential benefits of these differences. TRIAL REGISTRATION NUMBER ISRCTN10443908.
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Affiliation(s)
| | - Naomi J Ellis
- Centre for Health and Development, Staffordshire University, Stoke-on-Trent, UK
| | - Lisa Cowap
- Department of Psychology, Staffordshire University, Stoke on Trent, UK
| | - Victoria A Riley
- Centre for Health and Development, Staffordshire University, Stoke-on-Trent, UK
| | - Diane Crone
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Elizabeth Cottrell
- School of Primary, Community and Social Care, Keele University, Staffordshire, UK
| | - Sarah Grogan
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Ruth Chambers
- Stoke-on-Trent Clinical Commissioning Group, Stoke on Trent, UK
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Willmott T, McBain AJ, Humphreys GJ, Myers J, Cottrell E. Does the Oral Microbiome Play a Role in Hypertensive Pregnancies? Front Cell Infect Microbiol 2020; 10:389. [PMID: 32850488 PMCID: PMC7406642 DOI: 10.3389/fcimb.2020.00389] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/25/2020] [Indexed: 01/09/2023] Open
Abstract
Chronic hypertension during gestation is associated with an increased risk of adverse pregnancy outcomes including pre-eclampsia, fetal growth restriction and preterm birth. Research into new chemotherapeutic regimes for the treatment of hypertension in pregnancy is limited due to concerns about fetal toxicity and teratogenicity, and new therapeutic avenues are being sought in alternative physiological pathways. Historically, generation of the vasodilator nitric oxide was believed to be solely from L-arginine by means of nitric oxide synthase enzymes. Recently, a novel pathway for the reduction of dietary inorganic nitrate to nitrite by the bacteria in the oral cavity and subsequently to vasodilatory nitric oxide within the body has been uncovered. Dietary nitrate is abundant in green leafy vegetables, including beetroot and spinach, and reduction of exogenous nitrate to nitrite by oral bacteria can increase nitric oxide in the vasculature, lessening hypertension. Supplements rich in nitrate may be an attractive choice for treatment due to fewer side effects than drugs that are currently used to treat hypertensive pregnancy disorders. Additionally, manipulation of the composition of the oral microbiota using pro- and prebiotics in tandem with additional dietary interventions to promote cardiovascular health during gestation may offer a safe and effective means of treating hypertensive pregnancy disorders including gestational hypertension and pre-eclampsia. The use of dietary inorganic nitrate as a supplement during pregnancy requires further exploration and large scale studies before it may be considered as part of a treatment regime. The aim of this article is to review the current evidence that oral microbiota plays a role in hypertensive pregnancies and whether it could be manipulated to improve patient outcomes.
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Affiliation(s)
- Thomas Willmott
- Maternal and Fetal Health Research Centre, Division of Developmental Biology & Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.,Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Andrew J McBain
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Gavin J Humphreys
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Jenny Myers
- Maternal and Fetal Health Research Centre, Division of Developmental Biology & Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Elizabeth Cottrell
- Maternal and Fetal Health Research Centre, Division of Developmental Biology & Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
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Babatunde OO, Bishop A, Cottrell E, Jordan JL, Corp N, Humphries K, Hadley-Barrows T, Huntley AL, van der Windt DA. A systematic review and evidence synthesis of non-medical triage, self-referral and direct access services for patients with musculoskeletal pain. PLoS One 2020; 15:e0235364. [PMID: 32628696 PMCID: PMC7337346 DOI: 10.1371/journal.pone.0235364] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/13/2020] [Indexed: 12/20/2022] Open
Abstract
Introduction The demand for musculoskeletal (MSK) care is rising, and is a growing challenge for general practice. Direct access to physiotherapy and other healthcare services may offer appropriate care for MSK pain patients but there is uncertainty regarding the effectiveness or efficiency of this approach in practice. This study aimed to review the evidence regarding characteristics, outcomes, barriers and facilitators of MSK triage and direct access services. Methods A comprehensive search of eight databases (including MEDLINE, EMBASE, and Cochrane library) up to February 2018 was conducted to identify studies (trials, cohorts and qualitative evidence) on direct access services for MSK in primary care settings. Using predefined inclusion and exclusion criteria, titles, abstracts, and subsequent full texts were independently screened by reviewers. Methodological quality of eligible studies was assessed using the mixed methods appraisal tool, and extracted data regarding study characteristics and results were independently reviewed. A narrative synthesis and grading of evidence was undertaken. Approaches to MSK triage and direct access were profiled along with their respective outcomes of care relating to patient-oriented and socioeconomic outcomes. Barriers and facilitators of each model of direct access services were also highlighted. Results 9010 unique citations were screened, of which 26 studies were eligible. Three approaches (open access, combination and service pathway models) to MSK triage and direct access shared similar goals but were heterogeneous in application. MSK patients using direct access showed largely similar characteristics (age, sex and duration of symptoms) compared to GP-led care, although they were often younger, slightly more educated and with better socio-economic status than patients seen through GP-led care. Although many studies showed limitations in design or methods, outcomes of care (patient oriented outcomes of pain, and disability) did not show large differences between direct access and GP-led care. In most studies direct access patients were reported to have lower healthcare utilisation (fewer physiotherapy or GP consultations, analgesics or muscle relaxants prescriptions, or imaging procedures) and less time off work compared to GP-led care. Discussion This study provides insight into the current state of evidence regarding MSK triage and direct access services and highlights potential implications for future research, healthcare services planning, resource utilisation and organising care for MSK patients in primary care. There is consistent, although limited, evidence to suggest that MSK triage and direct access services lead to comparable clinical outcomes with lower healthcare consumption, and can help to manage GP workload. However, due to the paucity of strong empirical data from methodologically robust studies, a scale up and widespread roll out of direct access services cannot as yet be assumed to result in long term health and socio-economic gains. PROSPERO-ID: CRD42018085978.
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Affiliation(s)
- Opeyemi O. Babatunde
- Arthritis Research UK Primary Care Centre, School of Primary, Community & Social Care, Keele University, Keele, United Kingdom
- * E-mail:
| | - Annette Bishop
- Arthritis Research UK Primary Care Centre, School of Primary, Community & Social Care, Keele University, Keele, United Kingdom
| | - Elizabeth Cottrell
- Arthritis Research UK Primary Care Centre, School of Primary, Community & Social Care, Keele University, Keele, United Kingdom
| | - Joanne L. Jordan
- Arthritis Research UK Primary Care Centre, School of Primary, Community & Social Care, Keele University, Keele, United Kingdom
| | - Nadia Corp
- Arthritis Research UK Primary Care Centre, School of Primary, Community & Social Care, Keele University, Keele, United Kingdom
| | - Katrina Humphries
- Arthritis Research UK Primary Care Centre, School of Primary, Community & Social Care, Keele University, Keele, United Kingdom
| | - Tina Hadley-Barrows
- Arthritis Research UK Primary Care Centre, School of Primary, Community & Social Care, Keele University, Keele, United Kingdom
| | - Alyson L. Huntley
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Danielle A. van der Windt
- Arthritis Research UK Primary Care Centre, School of Primary, Community & Social Care, Keele University, Keele, United Kingdom
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Cottrell E, George A, Coulson C, Chambers R. Telescopic otology referrals: Evaluation of feasibility and acceptability. Laryngoscope Investig Otolaryngol 2020; 5:221-227. [PMID: 32337353 PMCID: PMC7178442 DOI: 10.1002/lio2.367] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/22/2020] [Accepted: 02/08/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE A remote telemedical otology referral and advice service was introduced to interested general practices. General practitioners (GPs) were given a new device, "endoscope-i" that combines an optimized smartphone high definition video app with an otoendoscope. They were specifically trained to examine and capture images of patients' eardrums, which were sent electronically with a summary of clinical information and an in-app hearing testing (if required), for specialist advice to two ear, nose, and throat (ENT) consultants. We describe the findings from an evaluation of the first 6 months of this service to establish the feasibility and acceptability of an otology telemedical referral and advice service. METHODS The new service was advertised to GP practices in Northern Staffordshire. All interested GPs were provided with training and equipment to deliver the remote referral service. Data were collected from GPs at baseline, informal feedback in response to referral outcomes and end of service feedback. Referral data were collected routinely during the service delivery. RESULTS Fifteen GP leads from 15 practices received training and equipment. One quickly lost the equipment. Of the remaining 14 practices, eight sent a total of 53 remote referrals using this technology over 6 months. The most common reason for referral was an uncertainty of what could be seen in or around the eardrum. The primary barrier for implementation was lack of wireless internet connections within practices. GPs reported that they used this technology to share examination findings with patients. CONCLUSIONS GPs were positive about the technology, from initial engagement with training and after advice were given. Some GPs expanded the role of the technology to a consultation aid. Referral volume was manageable. Commissioners should consider tariffs structures for such services; empirical cost-effectiveness and workload-impact evaluation would inform this.
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Affiliation(s)
| | - Ajith George
- Department of ENT University Hospital of North Midlands UK
| | - Chris Coulson
- Department of ENT Queen Elizabeth Hospital Birmingham UK
| | - Ruth Chambers
- Staffordshire Sustainability & Transformation Partnership Clinical Lead for Technology Enabled Care Services, Digital Workstream UK
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Hare D, Coates C, Kelly M, Cottrell E, Connolly E, Muldoon EG, O' Connell B, Rogers TR, Talento AF. Antifungal stewardship in critical care: Implementing a diagnostics-driven care pathway in the management of invasive candidiasis. Infect Prev Pract 2020; 2:100047. [PMID: 34368697 PMCID: PMC8336030 DOI: 10.1016/j.infpip.2020.100047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 02/08/2020] [Indexed: 12/01/2022] Open
Abstract
Background Invasive candidiasis (IC) is the most common invasive fungal disease in patients admitted to critical care and is associated with high mortality rates. Diagnosis can be delayed by the poor sensitivity of culture-based methods, leading to unnecessary use of empirical antifungal therapy (EAFT). The fungal biomarker (1–3)-β-d-glucan (BDG) has been shown to aid in the diagnosis of IC in critical care and has been incorporated into antifungal stewardship (AFS) programmes. Aim To describe our experience using a diagnostics-driven AFS programme incorporating the fungal biomarker BDG, analyse its impact on antifungal therapy (AFT), and gain an improved understanding of the epidemiology of IC in our critical care unit (CrCU). Methods An AFS care pathway incorporating BDG was introduced in the CrCU in St James's Hospital, Dublin. Following an educational programme, compliance with the pathway was prospectively audited between December 1st, 2017 and July 31st, 2018. Results and Conclusion One hundred and nine AFT episodes were included, of which 95 (87%) had a BDG sent. Of those with BDG results available at the time of decision-making, 38 (63%) were managed in accordance with the care pathway. In compliant episodes without IC, median EAFT duration was 5.5 days [IQR 4–7] and no increase in mortality or subsequent IC was observed. Although adopting a diagnostics-driven approach was found to be useful in the cohort of patients with BDG results available, the use of once-weekly BDG testing did not result in an observed reduction in the consumption of anidulafungin, highlighting an important limitation of this approach.
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Affiliation(s)
- D Hare
- Department of Microbiology, St James's Hospital, Dublin, Ireland
| | - C Coates
- Department of Microbiology, St James's Hospital, Dublin, Ireland
| | - M Kelly
- Pharmacy Department, St James's Hospital, Dublin, Ireland
| | - E Cottrell
- Pharmacy Department, St James's Hospital, Dublin, Ireland
| | - E Connolly
- Department of Critical Care and Anaesthesia, St James's Hospital, Dublin, Ireland
| | - E G Muldoon
- Department of Infectious Disease, Mater Misericordiae University Hospital, Dublin, Eccles St, Dublin, Ireland
| | - B O' Connell
- Department of Microbiology, St James's Hospital, Dublin, Ireland
| | - T R Rogers
- Department of Microbiology, St James's Hospital, Dublin, Ireland.,Department of Clinical Microbiology, Trinity College Dublin, Ireland
| | - A F Talento
- Department of Microbiology, St James's Hospital, Dublin, Ireland
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Gidlow CJ, Ellis NJ, Cowap L, Riley V, Crone D, Cottrell E, Grogan S, Chambers R, Clark-Carter D. A qualitative study of cardiovascular disease risk communication in NHS Health Check using different risk calculators: protocol for the RIsk COmmunication in NHS Health Check (RICO) study. BMC Fam Pract 2019; 20:11. [PMID: 30642267 PMCID: PMC6332912 DOI: 10.1186/s12875-018-0897-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 12/26/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND NHS Health Check is a national cardiovascular disease (CVD) risk assessment programme for 40-74 year olds in England, in which practitioners should assess and communicate CVD risk, supported by appropriate risk-management advice and goal-setting. This requires effective communication, to equip patients with knowledge and intention to act. Currently, the QRISK®2 10-year CVD risk score is most common way in which CVD risk is estimated. Newer tools, such as JBS3, allow manipulation of risk factors and can demonstrate the impact of positive actions. However, the use, and relative value, of these tools within CVD risk communication is unknown. We will explore practitioner and patient CVD risk perceptions when using QRISK®2 or JBS3, the associated advice or treatment offered by the practitioner, and patients' responses. METHODS RIsk COmmunication in NHS Health Check (RICO) is a qualitative study with quantitative process evaluation. Twelve general practices in the West Midlands of England will be randomised to one of two groups: usual practice, in which practitioners use QRISK®2 to assess and communicate CVD risk; intervention, in which practitioners use JBS3. Twenty Health Checks per practice will be video-recorded (n = 240, 120 per group), with patients stratified by age, gender and ethnicity. Post-Health Check, video-stimulated recall (VSR) interviews will be conducted with 48 patients (n = 24 per group) and all practitioners (n = 12-18), using video excerpts to enhance participant recall/reflection. Patient medical record reviews will detect health-protective actions in the first 12-weeks following a Health Check (e.g., lifestyle referrals, statin prescription). Risk communication, patient response and intentions for health-protective behaviours in each group will be explored through thematic analysis of video-recorded Health Checks (using Protection Motivation Theory as a framework) and VSR interviews. Process evaluation will include between-group comparisons of quantitatively coded Health Check content and post-Health Check patient outcomes. Finally, 10 patients with the most positive intentions or behaviours will be selected for case study analysis (using all data sources). DISCUSSION This study will produce novel insights about the utility of QRISK®2 and JBS3 to promote patient and practitioner understanding and perception of CVD risk and associated implications for patient intentions with respect to health-protective behaviours (and underlying mechanisms). Recommendations for practice will be developed. TRIAL REGISTRATION ISRCTN ISRCTN10443908 . Registered 7th February 2017.
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Affiliation(s)
| | - Naomi J. Ellis
- Staffordshire University, Brindley Building, Leek Road, Stoke-on-Trent, ST4 2DF UK
| | - Lisa Cowap
- Staffordshire University, Brindley Building, Leek Road, Stoke-on-Trent, ST4 2DF UK
| | - Victoria Riley
- Staffordshire University, Brindley Building, Leek Road, Stoke-on-Trent, ST4 2DF UK
| | - Diane Crone
- Cardiff Metropolitan University, Cyncoed Campus, Cyncoed Road, Cardiff, CF23 6XD UK
| | | | - Sarah Grogan
- Manchester Metropolitan University, Manchester Campus, Bonsall Street, Manchester, M15 6GX UK
| | - Ruth Chambers
- Stoke-on-Trent Clinical Commissioning Group, Smithfield One Building, Stoke-on-Trent, ST1 4FA UK
| | - David Clark-Carter
- Staffordshire University, The Science Centre, Leek Road, Stoke-on-Trent, ST4 2DF UK
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Holden MA, Whittle R, Waterfield J, Chesterton L, Cottrell E, Quicke JG, Mallen CD. A mixed methods exploration of physiotherapist's approaches to analgesic use among patients with hip osteoarthritis. Physiotherapy 2018; 105:328-337. [PMID: 30318127 DOI: 10.1016/j.physio.2018.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 08/08/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To explore how physiotherapists currently address analgesic use among patients with hip osteoarthritis, and their beliefs about the acceptability of prescribing for these patients. METHODS A cross-sectional questionnaire was mailed to 3126 UK-based physiotherapists. Approaches to analgesic use among patients with hip osteoarthritis were explored using a case vignette. Semi-structured telephone interviews were undertaken with 21 questionnaire responders and analysed thematically. SETTING UK. PARTICIPANTS Physiotherapists who had treated a patient with hip osteoarthritis in the previous 6 months. RESULTS Questionnaire response: 53% (n=1646). One thousand one hundred forty eight physiotherapists reported treating a patient with hip osteoarthritis in the last 6 months (applicable responses), of whom nine (1%) were non-medical prescribers. Nearly all physiotherapists (98%) reported that they would address analgesic use for the patient with hip osteoarthritis, most commonly by signposting them to their GP (83%). Fifty six percent would discuss optimal use of current medication, and 33%, would discuss use of over-the-counter medications. Interviews revealed that variations in physiotherapists' approaches to analgesic use were influenced by personal confidence, patient safety concerns, and their perceived professional remit. Whilst many recognised the benefits of analgesia prescribing for both patients and GP workload, additional responsibility for patient safety was a perceived barrier. CONCLUSIONS How physiotherapists currently address analgesic use with patients with hip osteoarthritis is variable. Although the potential benefits of independent prescribing were recognised, not all physiotherapist want the additional responsibility. Further guidance supporting optimisation of analgesic use among patients with hip OA may help better align care with best practice guidelines and reduce GP referrals.
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Affiliation(s)
- M A Holden
- Arthritis Research UK Primary Care Centre, Institute for Primary Care and Health Sciences, Keele University, David Weatherall Building, United Kingdom.
| | - R Whittle
- Arthritis Research UK Primary Care Centre, Institute for Primary Care and Health Sciences, Keele University, David Weatherall Building, United Kingdom.
| | - J Waterfield
- Division of Dietetics, Nutrition & Biological Sciences, Physiotherapy, Podiatry and Radiography, School of Health Sciences, Queen Margaret University, United Kingdom.
| | - L Chesterton
- Arthritis Research UK Primary Care Centre, Institute for Primary Care and Health Sciences, Keele University, David Weatherall Building, United Kingdom.
| | - E Cottrell
- Arthritis Research UK Primary Care Centre, Institute for Primary Care and Health Sciences, Keele University, David Weatherall Building, United Kingdom.
| | - J G Quicke
- Arthritis Research UK Primary Care Centre, Institute for Primary Care and Health Sciences, Keele University, David Weatherall Building, United Kingdom.
| | - C D Mallen
- Arthritis Research UK Primary Care Centre, Institute for Primary Care and Health Sciences, Keele University, David Weatherall Building, United Kingdom.
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