Using the Primary care Academic CollaboraTive to explore the characteristics and healthcare use of older housebound patients in England: protocol for a retrospective observational study and clinician survey (the CHiP study)

BACKGROUND

Older housebound people are an under-researched group for whom achieving good primary health care can be resource intensive.

AIMS

To describe the characteristics and healthcare use of older (≥65 years) housebound people; explore clinician views on delivery of care to housebound people; and assess the feasibility of using a new network of healthcare professionals to deliver high quality research.

DESIGN & SETTING

Retrospective observational study of electronic GP records and clinician survey in England.

METHOD

Clinical members of a new UK research network called the Primary care Academic CollaboraTive (PACT) will collect the data. For part A, around 20 GP practices will be recruited and clinicians will identify 20 housebound and 20 non-housebound people, matched by age and gender (around 400 total in each group). Anonymised data will be collected on characteristics (age, gender, ethnicity, deprivation decile), long-term conditions, prescribed medicines, quality of healthcare (via Quality Outcomes Framework targets), and continuity of care. Reports with benchmarked practice-level data will be provided to practices to identify areas for quality improvement and to enhance engagement. For part B, 2-4 clinicians will be recruited from around 50 practices in England (around 150 clinicians) to complete a survey about delivery of healthcare for housebound people. For part C, data will be collected to assess the feasibility of using the PACT network to deliver primary care research.

CONCLUSION

Older housebound people are a neglected group both in terms of research and clinical care. Understanding the characteristics and use of primary healthcare of housebound people will help identify how to improve their care.

Systematic review of the relationship between burn-out and spiritual health in doctors

OBJECTIVE

To investigate the relationship between burn-out and spiritual health among medical doctors.

DESIGN

Systematic literature review and narrative synthesis of cross-sectional studies.

SETTING

Any setting, worldwide.

DATA SOURCES

Five databases were searched from inception to March 2022, including Medline, Embase, PsycINFO, Scopus and Web of Science.

ELIGIBILITY CRITERIA

Any study design that involved medical doctors (and other healthcare staff if assessed alongside medical doctors), that measured (in any way) both burn-out (or similar) and spiritual health (or similar) medical doctors.

DATA EXTRACTION AND SYNTHESIS

All records were double screened. Data extraction was performed by one reviewer and a proportion (10%) checked by a second reviewer. Quality was assessed using the Appraisal of Cross-sectional Studies tool. Due to the heterogeneity of the included studies, a narrative review was undertaken without a meta-analysis.

RESULTS

Searches yielded 1049 studies. 40 studies met eligibility criteria and were included in this review. Low reported levels of spirituality were associated with high burn-out scores and vice versa. Religion was not significantly associated with lower levels of burn-out. Few studies reported statistically significant findings, few used validated spiritual scores and most were vulnerable to sampling bias.

CONCLUSIONS

Published research suggests that burn-out is linked to spiritual health in medical doctors but not to religion. Robust research is needed to confirm these findings and develop effective interventions.

PROSPERO REGISTRATION NUMBER

CRD42020200145.

A national study of burnout and spiritual health in UK general practitioners during the COVID-19 pandemic

OBJECTIVES

To quantify the burnout and spiritual health of general practitioners (GPs) in the United Kingdom (UK) who worked during the Covid-19 Pandemic.

DESIGN

Online survey, April/May 2021, distributed via emails to general practices, Clinical Commissioning Groups (CCGs), Health boards, Clinical Research Networks, professional groups, social media GP groups and networks.

SETTING

United Kingdom.

PARTICIPANTS

1318 GPs who had worked in the National Health Service (NHS) during the COVID-19 pandemic (March 2020 -May 2021).

MAIN OUTCOME MEASURES

Burnout scores, measured by the Maslach Burnout Inventory (MBI) for Medical Personnel; spiritual health, measured using the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being, Non-Illness (FACIT-SP-NI).

RESULTS

19% of surveyed GPs were at the highest risk for burnout, using accepted MBI 'cut off' levels. There was no evidence of a difference in burnout by gender, ethnicity, or length of service. GP burnout was associated with GP spiritual health, regardless of identification with a religion. GPs with low spiritual health were five times more likely to be in the highest risk group for burnout.

CONCLUSIONS

Burnout is at crisis levels amongst GPs in the UK NHS. A comprehensive response is required, identifying protective and precipitating factors for burnout. The potentially protective impact of spiritual health merits further investigation.

Measuring older people's socioeconomic position: a scoping review of studies of self-rated health, health service and social care use

Background

The challenges of measuring socioeconomic position in older populations were first set out two decades ago. However, the question of how best to measure older people’s socioeconomic position remains pertinent as populations age and health inequalities widen.

Methods

A scoping review aimed to identify and appraise measures of socioeconomic position used in studies of health inequalities in older populations in high-income countries. Medline, Scopus, EMBASE, HMIC and references lists of systematic reviews were searched for observational studies of socioeconomic health inequalities in adults aged 60 years and over, published between 2000 and 2020. A narrative synthesis was conducted.

Findings

One-hundred and thirty-eight studies were included; 20 approaches to measuring socioeconomic position were identified. Few studies considered which pathways the chosen measures of socioeconomic position intended to capture. The validity of subjective socioeconomic position measures, and measures that assume shared income and educational capital, should be verified in older populations. Incomplete financial data risk under-representation of some older groups when missing data are socially patterned. Older study samples were largely homogeneous on measures of housing tenure, and to a lesser extent, measures of educational attainment. Measures that use only two response categories risk missing subtle differences in older people’s socioeconomic circumstances.

Conclusion

Poor choice of measures of socioeconomic position risk underestimating the size of health inequalities in older populations. Choice of measures should be shaped by considerations of theory, context and response categories that detect subtle, yet important, inequalities. Further evidence is required to ascertain the validity of some measures identified in this review.

What are the consequences of caring for older people and what interventions are effective for supporting unpaid carers? A rapid review of systematic reviews

OBJECTIVES

To identify and map evidence about the consequences of unpaid caring for all carers of older people, and effective interventions to support this carer population.

DESIGN

A rapid review of systematic reviews, focused on the consequences for carers of unpaid caring for older people, and interventions to support this heterogeneous group of carers. Reviews of carers of all ages were eligible, with any outcome measures relating to carers' health, and social and financial well-being. Searches were conducted in MEDLINE, PsycInfo and Epistemonikos (January 2000 to January 2020). Records were screened, and included systematic reviews were quality appraised. Summary data were extracted and a narrative synthesis produced.

RESULTS

Twelve systematic reviews reporting evidence about the consequences of caring for carers (n=6) and assessing the effectiveness of carer interventions (n=6) were included. The review evidence typically focused on mental health outcomes, with little information identified about carers' physical, social and financial well-being. Clear estimates of the prevalence and severity of carer outcomes, and how these differ between carers and non-carers, were absent. A range of interventions were identified, but there was no strong evidence of effectiveness. In some studies, the choice of outcome measure may underestimate the full impact of an intervention.

CONCLUSIONS

Current evidence fails to fully quantify the impacts that caring for older people has on carers' health and well-being. Information on social patterning of the consequences of caring is absent. Systematic measurement of a broad range of outcomes, with comparison to the general population, is needed to better understand the true consequences of caring. Classification of unpaid caring as a social determinant of health could be an effective lever to bring greater focus and support to this population. Further work is needed to develop and identify suitable interventions in order to support evidence-based policymaking and practice.

DISCUSSING SPIRITUAL HEALTH IN PRIMARY CARE IN ENGLAND

The organisation that regulates doctors and family physicians’ professional body in the UK both require doctors to consider patients’ spiritual health, especially towards the end of life. Discussion of spiritual health can encapsulate positive aspects of patients’ lives, and may be valuable for older people as physical and mental health decline. Tools are available for doctors to structure discussion of spiritual health in consultations but anecdotal reports suggest that this seldom happens. This study aimed to understand the barriers to GPs discussing spiritual health and their knowledge and views of current tools, particularly the HOPE tool by Anandarajah and Hight. Narrative literature review using systematic methods and mixed methods investigation into current practice, An online survey was conducted with 177 family physicians in England, investigating how doctors define spiritual health, their comfort with the topic, and their knowledge and acceptability of the HOPE tool, using patient vignettes. Definitions of spiritual health were heterogeneous, within three themes: self-actualisation and meaning; transcendence and relationships beyond self; and expressions of spirituality. Doctors felt more comfortable discussing spiritual health after a patient-led cue. Introduction of the HOPE tool increased doctors’ comfort with the topic. Discordance between doctor and patient beliefs and cultural backgrounds influenced views and practice. Concerns about regulator disapproval was a major barrier to discussions. Spiritual health does not appear to be a routine part of family practice in the UK. Tailored education, containing a structured tool such as HOPE, with regulatory approval, may help overcome barriers to discussion of spiritual health.