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Scott S, Atkins B, Martin-Kerry JM, Pritchard M, Alldred DP, Clark AB, Colles A, Hammond A, Murphy K, Keevil VL, Kellar I, Patel M, Sims E, Taylor J, Turner D, Witham M, Wright D, Bhattacharya D. CompreHensive geriAtRician-led MEdication Review (CHARMER): protocol for a feasibility study of a hospital deprescribing behaviour change intervention. BMJ Open 2023; 13:e075795. [PMID: 37541754 PMCID: PMC10407388 DOI: 10.1136/bmjopen-2023-075795] [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: 05/18/2023] [Accepted: 07/14/2023] [Indexed: 08/06/2023] Open
Abstract
INTRODUCTION Over 50% of older adults are prescribed a medicine where the risk of harm outweighs the chances of benefit. During a hospital admission, older adults and carers expect medicines to be reviewed for appropriateness and any inappropriate medicines proactively deprescribed. While the principle of proactive deprescribing is an expectation of good prescribing practice, it is yet to become routine. The CompreHensive geriAtRician-led MEdication Review (CHARMER) study aims to develop and test a five-component behaviour change intervention to equip geriatricians and pharmacists to proactively deprescribe inappropriate medicines with older adults in hospital. This study aims to test the feasibility and acceptability of study processes and CHARMER implementation. METHODS AND ANALYSIS A two-arm purposive allocation feasibility study is being undertaken at four acute hospitals in England, UK (three intervention and one control). The target sample is 400 patients across all hospitals. Primary outcome measures are: (1) participant recruitment rate and (2) participant attrition rate. Secondary outcome measures are: (1) hospital readmission rate; (2) mortality rate and (3) quality of life. Quantitative data will be checked for completeness and quality, and practitioner and patient demographics descriptively analysed. We will undertake a rapid qualitative analysis on observations, interviews and study meeting minutes data. A subsequent thematic analysis will be undertaken with codes mapped to the Theoretical Domains Framework and Normalisation Process Theory. Triangulation of qualitative and quantitative data will be undertaken. ETHICS AND DISSEMINATION Ethics approval was obtained from Wales Research Ethics Committee 1 (IRAS ID 312494) and study approval from the Health Research Authority (22/WA/0087). Informed consent will be sought from all hospital staff involved in data collection activities and for patients involved in enhanced data collection activities. The findings of this study will be disseminated in peer-reviewed journals and conference presentations. TRIAL REGISTRATION ISRCTN11899506.
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Affiliation(s)
- Sion Scott
- School of Healthcare, College of Life Sciences, University of Leicester, Leicester, UK
| | - Bethany Atkins
- School of Healthcare, College of Life Sciences, University of Leicester, Leicester, UK
| | | | - Megan Pritchard
- Norwich Clinical Trials Unit, Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Allan B Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Antony Colles
- Norwich Clinical Trials Unit, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Amber Hammond
- Norwich Clinical Trials Unit, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Katherine Murphy
- School of Healthcare, College of Life Sciences, University of Leicester, Leicester, UK
| | - Victoria L Keevil
- Department of Medicine for the Elderly, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ian Kellar
- Department of Psychology, The University of Sheffield, Sheffield, UK
| | - Martyn Patel
- Norwich Medical School, University of East Anglia, Norwich, UK
- Older People's Medicine Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Erika Sims
- Norwich Clinical Trials Unit, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Johanna Taylor
- Department of Health Sciences, University of York, York, UK
| | - David Turner
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Miles Witham
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne NHS Foundation Trust, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK
- AGE Research Group, Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK
| | - David Wright
- School of Healthcare, College of Life Sciences, University of Leicester, Leicester, UK
- School of Pharmacy, University of Bergen, Bergen, Norway
| | - Debi Bhattacharya
- School of Healthcare, College of Life Sciences, University of Leicester, Leicester, UK
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Martin-Kerry JM, Graham HM, Lampard P. 'I don't really associate climate change with actual people's health': a qualitative study in England of perceptions of climate change and its impacts on health. Public Health 2023; 219:85-90. [PMID: 37126972 DOI: 10.1016/j.puhe.2023.03.020] [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: 01/04/2023] [Revised: 03/15/2023] [Accepted: 03/21/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVES The health impacts of climate change are increasing, but qualitative evidence on people's perceptions is limited. This qualitative study investigated people's perceptions of climate change and its impacts on health. STUDY DESIGN This was an online study using semistructured interviews. METHODS A total of 41 semistructured interviews were conducted in 2021 with members of the public aged ≥15 years living in England, recruited via community-based groups. Data were analysed using reflexive thematic analysis. RESULTS Participants were concerned about climate change, which was often perceived as extreme weather events happening elsewhere. Changes in the UK's seasons and weather patterns were noted, but participants were uncertain whether these changes resulted from climate change. Participants often struggled to identify health impacts of climate change; where health impacts were described, they tended to be linked to extreme weather events outside the United Kingdom and their associated threats to life. The mental health impacts of such events were also noted. CONCLUSIONS The study found that most participants did not perceive climate change to be affecting people's health in England. This raises questions about whether framing climate change as a health issue, an approach advocated for countries less exposed to the direct effects of climate change, will increase its salience for the British public.
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Affiliation(s)
- J M Martin-Kerry
- School of Healthcare, University of Leicester, University Road, Leicester LE1 7RH, UK
| | - H M Graham
- Department of Health Sciences, Faculty of Sciences, Seebohm Rowntree Building, University of York, York, YO105DD, UK.
| | - P Lampard
- Department of Health Sciences, Faculty of Sciences, Seebohm Rowntree Building, University of York, York, YO105DD, UK
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Moe-Byrne T, Knapp P, Perry D, Achten J, Spoors L, Appelbe D, Roche J, Martin-Kerry JM, Sheridan R, Higgins S. Does digital, multimedia information increase recruitment and retention in a children's wrist fracture treatment trial, and what do people think of it? A randomised controlled Study Within A Trial (SWAT). BMJ Open 2022; 12:e057508. [PMID: 35831055 PMCID: PMC9280884 DOI: 10.1136/bmjopen-2021-057508] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To evaluate digital, multimedia information (MMI) for its effects on trial recruitment, retention, decisions about participation and acceptability by patients, compared with printed information. DESIGN Study Within A Trial using random cluster allocation within the Forearm Fracture Recovery in Children Evaluation (FORCE) study. SETTING Emergency departments in 23 UK hospitals. PARTICIPANTS 1409 children aged 4-16 years attending with a torus (buckle) fracture, and their parents/guardian. Children's mean age was 9.2 years, 41.0% were female, 77.4% were ethnically White and 90.0% spoke English as a first language. INTERVENTIONS Participants and their parents/guardian received trial information either via multimedia, including animated videos, talking head videos and text (revised for readability and age appropriateness when needed) on tablet computer (MMI group; n=681), or printed participant information sheet (PIS group; n=728). OUTCOME MEASURES Primary outcome was recruitment rate to FORCE. Secondary outcomes were Decision-Making Questionnaire (nine Likert items, analysed summatively and individually), three 'free text' questions (deriving subjective evaluations) and trial retention. RESULTS MMI produced a small, not statistically significant increase in recruitment: 475 (69.8%) participants were recruited from the MMI group; 484 (66.5%) from the PIS group (OR=1.35; 95% CI 0.76 to 2.40, p=0.31). A total of 324 (23.0%) questionnaires were returned and analysed. There was no difference in total Decision-Making Questionnaire scores: adjusted mean difference 0.05 (95% CI -1.23 to 1.32, p=0.94). The MMI group was more likely to report the information 'very easy' to understand (89; 57.8% vs 67; 39.4%; Z=2.60, p=0.01) and identify information that was explained well (96; 62.3% vs 71; 41.8%). Almost all FORCE recruits were retained at the 6 weeks' timepoint and there was no difference in retention rate between the information groups: MMI (473; 99.6%); PIS (481; 99.4%). CONCLUSIONS MMI did not increase recruitment or retention in the FORCE trial, but participants rated multimedia as easier to understand and were more likely to evaluate it positively. TRIAL REGISTRATION NUMBER ISRCTN73136092 and ISRCTN13955395.
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Affiliation(s)
| | - Peter Knapp
- Health Sciences and the Hull York Medical School, University of York, York, UK
| | | | | | - Louise Spoors
- NDORMS, University of Oxford, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | - Jenny Roche
- Health Sciences, University of York, York, UK
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Martin-Kerry JM, Whelan M, Rogers J, Raichur A, Cole D, de Silva AM. Addressing disparities in oral disease in Aboriginal people in Victoria: where to focus preventive programs. Aust J Prim Health 2020; 25:317-324. [PMID: 31578164 DOI: 10.1071/py18100] [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: 06/27/2018] [Accepted: 06/14/2019] [Indexed: 11/23/2022]
Abstract
The aim of this study is to determine where Aboriginal people living in Victoria attend public oral health services; whether they access Aboriginal-specific or mainstream services; and the gap between dental caries (tooth decay) experience in Aboriginal and non-Aboriginal people. Analysis was undertaken on routinely collected clinical data for Aboriginal patients attending Victorian public oral health services and the distribution of Aboriginal population across Victoria. Approximately 27% of Aboriginal people attended public oral health services in Victoria across a 2-year period, with approximately one in five of those accessing care at Aboriginal-specific clinics. In regional Victoria, 6-year-old Aboriginal children had significantly higher levels of dental caries than 6-year-old non-Aboriginal children. There was no significant difference in other age groups. This study is the first to report where Aboriginal people access public oral health care in Victoria and the disparity in disease between Aboriginal and non-Aboriginal users of the Victorian public oral healthcare system. Aboriginal people largely accessed mainstream public oral healthcare clinics highlighting the importance for culturally appropriate services and prevention programs to be provided across the entire public oral healthcare system. The findings will guide development of policy and models of care aimed at improving the oral health of Aboriginal people living in Victoria.
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Affiliation(s)
- Jacqueline M Martin-Kerry
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK; and Corresponding author.
| | - Martin Whelan
- Dental Health Services Victoria, 720 Swanston Street, Carlton, Vic. 3053, Australia
| | - John Rogers
- Department of Health & Human Services, 50 Lonsdale Street, Melbourne, Vic. 3000, Australia
| | - Anil Raichur
- Dental Health Services Victoria, 720 Swanston Street, Carlton, Vic. 3053, Australia; and Department of Health & Human Services, 50 Lonsdale Street, Melbourne, Vic. 3000, Australia
| | - Deborah Cole
- Dental Health Services Victoria, 720 Swanston Street, Carlton, Vic. 3053, Australia
| | - Andrea M de Silva
- Worksafe Victoria, 1 Malop Street, Geelong, Vic. 3220, Australia; and School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Vic. 3004, Australia
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Martin-Kerry JM, Knapp P, Atkin K, Bower P, Watt I, Stones C, Higgins S, Sheridan R, Preston J, Horton Taylor D, Baines P, Young B. Supporting children and young people when making decisions about joining clinical trials: qualitative study to inform multimedia website development. BMJ Open 2019; 9:e023984. [PMID: 30782720 PMCID: PMC6340013 DOI: 10.1136/bmjopen-2018-023984] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 11/28/2022] Open
Abstract
OBJECTIVES To understand stakeholders' views regarding the content and design of paediatric clinical trial multimedia websites. To describe how this knowledge informed the development of the multimedia websites. DESIGN Qualitative study comprising two rounds of interviews or focus groups, with thematic analysis of interview transcripts. PARTICIPANTS Sixty-two people (21 children and young people with long-term health conditions, 24 parents and 17 professionals). SETTING One UK children's hospital and one UK Young Persons' Advisory Group. RESULTS When asked what was important in deciding whether to join a trial, children, young people and parents prioritised information about what participation would involve, what the trial was testing, potential benefits and risks of participation and knowing they could leave the trial if they later changed their minds. Young people and parents trusted trial teams to follow regulatory and quality requirements and therefore did not think such information was a priority for the websites, although logos of trusted organisations could lend credibility. Professionals largely concurred with these views. Children and young people advised on the importance of designing the multimedia website to ensure its appearance, tone and wording suited the intended audience and on using animated characters to facilitate children's engagement. CONCLUSIONS Our study provides insights into the information that families value when deciding about healthcare trial participation. It provides guidance on the design of information resources to appeal to children and young people, while also being acceptable to parents and professionals who are often gatekeepers of children's access to information. Our findings will be of use to others developing similar multimedia websites. We report specific information needs and new visual preferences that are not usually addressed in printed trial information. Our work illustrates what qualitative research and participatory design practices can contribute to the development of information resources more generally. TRIAL REGISTRATION NUMBER ISRCTN73136092; Pre-results.
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Affiliation(s)
| | - Peter Knapp
- Department of Health Sciences & Hull York Medical School, University of York, York, UK
| | - Karl Atkin
- Department of Health Sciences, University of York, York, UK
| | - Peter Bower
- NIHR School for Primary Care Research, University of Manchester, Manchester, UK
| | - Ian Watt
- Department of Health Sciences & Hull York Medical School, University of York, York, UK
| | - Catherine Stones
- School of Design, Clothworkers' Central, University of Leeds, Leeds, UK
| | | | | | - Jenny Preston
- University of Liverpool, Liverpool, UK
- Clinical Research Facility, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | | | - Paul Baines
- Paediatric Intensive Care Unit, Alder Hey Children's Hospital, Liverpool, UK
| | - Bridget Young
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
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de Silva AM, Martin-Kerry JM, McKee K, Cole D. Caries and periodontal disease in Indigenous adults in Australia: a case of limited and non-contemporary data. AUST HEALTH REV 2017; 41:469-478. [DOI: 10.1071/ah15229] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 06/26/2016] [Indexed: 02/05/2023]
Abstract
Objective The aim of the present study was to identify all evidence about the prevalence and severity of clinically measured caries and periodontal disease in Indigenous adults in Australia published in peer-reviewed journals and to summarise trends over time. In addition, we examined whether the studies investigated associations between putative risk factors and levels of caries and periodontal disease. Methods PubMed was searched in September 2014, with no date limitations, for published peer-reviewed articles reporting the prevalence rates and/or severity of caries and periodontal disease in Indigenous adults living in Australia. Articles were excluded if measurement was not based on clinical assessment and if oral disease was reported only in a specific or targeted sample, and not the general population. Results The search identified 18 papers (reporting on 10 primary studies) that met the inclusion criteria. The studies published clinical data about dental caries and/or periodontal disease in Australian Indigenous adults. The studies reported on oral health for Indigenous adults living in rural (40%), urban (10%) and both urban and rural (50%) locations. Included studies showed that virtually all Indigenous adults living in rural locations had periodontal disease. The data also showed caries prevalence ranged from 46% to 93%. Although 10 studies were identified, the peer-reviewed literature was extremely limited and no published studies were identified that provided statistics for a significant proportion of Australia (Victoria, Tasmania, Queensland or the Australian Capital Territory). There were also inconsistencies in how the data were reported between studies, making comparisons difficult. Conclusions This review highlights a lack of robust and contemporary data to inform the development of policies and programs to address the disparities in oral health in Indigenous populations living in many parts of Australia. What is known about the topic? Many studies report that Indigenous people in Australia have poorer general health compared with non-Indigenous people. What does this paper add? This paper documents the available caries and periodontal disease prevalence and experience for Indigenous adults in Australia published in peer-reviewed journals. It demonstrates significant limitations in the data, including no data in several large Australian jurisdictions, inconsistency with reporting methods and most data available being for Indigenous adults living in rural locations. Therefore, the oral health data available in the peer-reviewed literature do not reflect the situation of all Indigenous people living in Australia. What are the implications for practitioners? It is important for oral health practitioners to have access to current and relevant statistics on the oral health of Indigenous Australians. However, we have highlighted significant evidence gaps for this population group within the peer-reviewed literature and identified the limitations of the available data upon which decisions are currently being made. This paper also identifies ways to capture and report oral health data in the future to enable more meaningful comparisons and relevance for use in policy development.
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Hopcraft M, Martin-Kerry JM, Calache H. Dental therapists’ expanded scope of practice in Australia: a 12-month follow-up of an educational bridging program to facilitate the provision of oral health care to patients 26+ years. J Public Health Dent 2015; 75:234-44. [DOI: 10.1111/jphd.12094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 02/06/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Matthew Hopcraft
- Assessments & Examinations; Australian Dental Council Ltd; Melbourne Victoria Australia
| | | | - Hanny Calache
- Oral Health Leadership; Dental Health Services Victoria; Carlton Victoria Australia
- Department of Dentistry and Oral Health; La Trobe University; Melbourne Victoria Australia
- Melbourne Dental School; The University of Melbourne; Parkville Victoria Australia
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