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Bishop FL, Cross N, Dewar-Haggart R, Teasdale E, Herbert A, Robinson ME, Ridd MJ, Mallen C, Clarson L, Bostock J, Becque T, Stuart B, Garfield K, Morrison L, Pollet S, Vennik J, Atherton H, Howick J, Leydon GM, Nuttall J, Islam N, Lee PH, Little P, Everitt HA. Talking in primary care (TIP): protocol for a cluster-randomised controlled trial in UK primary care to assess clinical and cost-effectiveness of communication skills e-learning for practitioners on patients' musculoskeletal pain and enablement. BMJ Open 2024; 14:e081932. [PMID: 38508652 PMCID: PMC10953007 DOI: 10.1136/bmjopen-2023-081932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/01/2024] [Indexed: 03/22/2024] Open
Abstract
INTRODUCTION Effective communication can help optimise healthcare interactions and patient outcomes. However, few interventions have been tested clinically, subjected to cost-effectiveness analysis or are sufficiently brief and well-described for implementation in primary care. This paper presents the protocol for determining the effectiveness and cost-effectiveness of a rigorously developed brief eLearning tool, EMPathicO, among patients with and without musculoskeletal pain. METHODS AND ANALYSIS A cluster randomised controlled trial in general practitioner (GP) surgeries in England and Wales serving patients from diverse geographic, socioeconomic and ethnic backgrounds. GP surgeries are randomised (1:1) to receive EMPathicO e-learning immediately, or at trial end. Eligible practitioners (eg, GPs, physiotherapists and nurse practitioners) are involved in managing primary care patients with musculoskeletal pain. Patient recruitment is managed by practice staff and researchers. Target recruitment is 840 adults with and 840 without musculoskeletal pain consulting face-to-face, by telephone or video. Patients complete web-based questionnaires at preconsultation baseline, 1 week and 1, 3 and 6 months later. There are two patient-reported primary outcomes: pain intensity and patient enablement. Cost-effectiveness is considered from the National Health Service and societal perspectives. Secondary and process measures include practitioner patterns of use of EMPathicO, practitioner-reported self-efficacy and intentions, patient-reported symptom severity, quality of life, satisfaction, perceptions of practitioner empathy and optimism, treatment expectancies, anxiety, depression and continuity of care. Purposive subsamples of patients, practitioners and practice staff take part in up to two qualitative, semistructured interviews. ETHICS APPROVAL AND DISSEMINATION Approved by the South Central Hampshire B Research Ethics Committee on 1 July 2022 and the Health Research Authority and Health and Care Research Wales on 6 July 2022 (REC reference 22/SC/0145; IRAS project ID 312208). Results will be disseminated via peer-reviewed academic publications, conference presentations and patient and practitioner outlets. If successful, EMPathicO could quickly be made available at a low cost to primary care practices across the country. TRIAL REGISTRATION NUMBER ISRCTN18010240.
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Affiliation(s)
| | - Nadia Cross
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Rachel Dewar-Haggart
- School of Psychology, University of Southampton, Southampton, UK
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Emma Teasdale
- School of Psychology, University of Southampton, Southampton, UK
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Amy Herbert
- Centre of Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Matthew J Ridd
- Population Health Sciences, University of Bristol Faculty of Health Sciences, Bristol, UK
| | - Christian Mallen
- Keele School of Medicine, Keele University, Newcastle-under-Lyme, UK
| | - Lorna Clarson
- Keele School of Medicine, Keele University, Newcastle-under-Lyme, UK
| | - Jennifer Bostock
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Taeko Becque
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Beth Stuart
- Wolfson Institute of Population Health, Queen Mary University of London, London, London, UK
| | - Kirsty Garfield
- Health Economics Bristol, Population Health Sciences, University of Bristol, Bristol, Bristol, UK
| | - Leanne Morrison
- School of Psychology, University of Southampton, Southampton, UK
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Sebastien Pollet
- School of Psychology, University of Southampton, Southampton, UK
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Jane Vennik
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Helen Atherton
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
- Unit of Academic Primary Care, University of Warwick, Coventry, UK
| | - Jeremy Howick
- Leicester Medical School, University of Leicester, Leicester, UK
- Faculty of Philosophy, University of Oxford, Oxford, UK
| | - Geraldine M Leydon
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Jacqui Nuttall
- Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nazrul Islam
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Paul H Lee
- Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Paul Little
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Hazel A Everitt
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
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Wright AJ, Zhang L, Howes E, Veall C, Corker E, Johnston M, Hastings J, West R, Michie S. Specifying how intervention content is communicated: Development of a Style of Delivery Ontology. Wellcome Open Res 2023; 8:456. [PMID: 39193088 PMCID: PMC11347912 DOI: 10.12688/wellcomeopenres.19899.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 08/29/2024] Open
Abstract
Background: Investigating and enhancing the effectiveness of behaviour change interventions requires detailed and consistent specification of all aspects of interventions. We need to understand not only their content, that is the specific techniques, but also the source, mode, schedule, and style in which this content is delivered. Delivery style refers to the manner by which content is communicated to intervention participants. This paper reports the development of an ontology for specifying the style of delivery of interventions that depend on communication. This forms part of the Behaviour Change Intervention Ontology, which aims to cover all aspects of behaviour change intervention scenarios. Methods: The Style of Delivery Ontology was developed following methods for ontology development used in the Human Behaviour-Change Project, with seven key steps: 1) defining the scope of the ontology, 2) identifying key entities and developing their preliminary definitions by reviewing 100 behaviour change intervention evaluation reports and existing classification systems, 3) refining the ontology by piloting the ontology through annotations of 100 reports, 4) stakeholder review by eight behavioural science and public health experts, 5) inter-rater reliability testing through annotating 100 reports using the ontology, 6) specifying ontological relationships between entities, and 7) disseminating and maintaining the ontology. Results: The resulting ontology is a five-level hierarchical structure comprising 145 unique entities relevant to style of delivery. Key areas include communication processes, communication styles, and attributes of objects used in communication processes. Inter-rater reliability for annotating intervention evaluation reports was α=0.77 (good) for those familiar with the ontology and α=0.62 (acceptable) for those unfamiliar with it. Conclusions: The Style of Delivery Ontology can be used for both annotating and describing behaviour change interventions in a consistent and coherent manner, thereby improving evidence comparison, synthesis, replication, and implementation of effective interventions.
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Affiliation(s)
- Alison J. Wright
- Centre for Behaviour Change, University College London, London, England, UK
- Institute of Pharmaceutical Science, King's College London, London, England, UK
| | - Lisa Zhang
- Centre for Behaviour Change, University College London, London, England, UK
| | - Ella Howes
- Centre for Behaviour Change, University College London, London, England, UK
| | - Clement Veall
- Centre for Behaviour Change, University College London, London, England, UK
| | - Elizabeth Corker
- Grounded Research, Rotherham Doncaster and South Humber NHS Foundation Trust, Doncaster, England, UK
- Clinical and Applied Psychology Unit, The University of Sheffield, Sheffield, England, UK
| | - Marie Johnston
- Aberdeen Health Psychology Group, University of Aberdeen, Aberdeen, Scotland, UK
| | - Janna Hastings
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zürich, Switzerland
- School of Medicine, University of St Gallen, St. Gallen, Switzerland
| | - Robert West
- Institute of Epidemiology and Health Care, University College London, London, England, UK
| | - Susan Michie
- Centre for Behaviour Change, University College London, London, England, UK
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Budd G, Griffiths D, Howick J, Vennik J, Bishop FL, Durieux N, Everitt HA. Empathy in patient-clinician interactions when using telecommunication: A rapid review of the evidence. PEC INNOVATION 2022; 1:100065. [PMID: 35996734 PMCID: PMC9385203 DOI: 10.1016/j.pecinn.2022.100065] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 07/04/2022] [Accepted: 07/12/2022] [Indexed: 12/01/2022]
Abstract
Objectives The COVID-19 pandemic accelerated the replacement of many face-to-face healthcare consultations with telephone consultations. Little is known about the extent to which empathy can be expressed in telephone consultations. Our objective is to review evidence related to empathy in telephone consultations including clinical outcomes, and patient/practitioner experiences. Methods Searches of Medline/Ovid and PsycINFO/Ovid were undertaken. Titles and abstract screening, data extraction, and risk of bias were undertaken by two reviewers. Discrepancies were resolved in discussion with additional reviewers. Included studies were specific to tele-communications with empirical data on empathy related to patient outcomes/views, published (in English), 2010–2021. Studies that did not mention empathy explicitly were excluded. Results Our search yielded 740 individual records and 8 studies (527 patients, 20 practitioners) met inclusion criteria: Some barriers to expression of empathy were noted, but no major obstacles were reported. However, data was sparse and most studies had a high risk of bias. Conclusion Empathy in telephone consultations is possible, (though the loss of non-verbal cues and touch can present barriers) however the research does not yet identify how. Innovation It is possible to establish and display empathy in telephone consultations, but future research needs to identify how this can be optimized. Funding This work was supported by a 10.13039/501100000272National Institute for Health Research (NIHR) 10.13039/501100013374School for Primary Care Research grant (project number 389). The 10.13039/501100000739University of Southampton's Primary Care Department is a member of the 10.13039/501100013374NIHR School for Primary Care Research and supported by NIHR Research funds. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. Protocol registration. PROSPERO (CRD42021238087).
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Affiliation(s)
- Georgina Budd
- College of Human and Health Sciences, Swansea University. Haldane Building, University Singleton Park Campus, Sketty, Swansea SA2 8PP, UK
- Corresponding author at: College of Human and Health Sciences, Swansea University, Haldane Building, University Singleton Park Campus, Sketty, Swansea SA2 8PP, UK.
| | - Dan Griffiths
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, School of Psychology (B44), University Rd, Highfield, Southampton SO17 1BJ, UK
| | - Jeremy Howick
- Faculty of Philosophy, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford OX2 6GG, UK
| | - Jane Vennik
- Primary Care Research Center, University of Southampton. Aldermoor Health Centre, Aldermoor Close Southampton, SO16 5ST, UK
| | - Felicity L. Bishop
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, School of Psychology (B44), University Rd, Highfield, Southampton SO17 1BJ, UK
- Research Unit for a life-Course perspective on Health & Education, Faculty of Psychology, Speech and Language Therapy, and Educational Sciences, University of Liege, Place des Orateurs 2, 4000 Liège, Belgium
| | - Nancy Durieux
- Research Unit for a life-Course perspective on Health & Education, Faculty of Psychology, Speech and Language Therapy, and Educational Sciences, University of Liege, Place des Orateurs 2, 4000 Liège, Belgium
| | - Hazel A. Everitt
- Primary Care Research Center, University of Southampton. Aldermoor Health Centre, Aldermoor Close Southampton, SO16 5ST, UK
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Vennik J, Hughes S, Smith KA, Misurya P, Bostock J, Howick J, Mallen C, Little P, Ratnapalan M, Lyness E, Dambha-Miller H, Morrison L, Leydon G, Everitt H, Bishop FL. Patient and practitioner priorities and concerns about primary healthcare interactions for osteoarthritis: A meta-ethnography. PATIENT EDUCATION AND COUNSELING 2022; 105:1865-1877. [PMID: 35125208 DOI: 10.1016/j.pec.2022.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 11/10/2021] [Accepted: 01/21/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To explore primary care practitioners' (PCPs) and patients' priorities and concerns for healthcare interactions for osteoarthritis (OA) in primary care. METHODS We searched Embase, CINAHL, Medline, PsychInfo (1990 to present) for primary qualitative and mixed methods studies with findings concerning healthcare interactions for OA symptoms. Patient and PCP perceptions were analysed separately then inter-related using a 'line of argument' synthesis. RESULTS Twenty-six studies reporting qualitative data from 557 patients and 199 PCPs were synthesised. Our findings suggest that therapeutic interactions for OA can be based on discordant priorities and concerns; some patients perceive that PCPs hold negative attitudes about OA and feel their concerns about impact are not appreciated; some PCPs feel patients have misconceptions about prognosis, and hold pessimistic views about outcomes; and both tend to de-prioritise OA within consultations. CONCLUSION Greater working in partnership could build mutual trust, facilitate tailored provision of information, and foster a shared understanding of OA upon which to build realistic goals for management. PRACTICE IMPLICATIONS Developing a better shared understanding of OA has the potential to improve the quality of healthcare interactions for both patients and PCPs. The significant impact of OA on everyday life means it should be given higher priority in primary care consultations.
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Affiliation(s)
- Jane Vennik
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK.
| | - Stephanie Hughes
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Kirsten A Smith
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Pranati Misurya
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | | | - Jeremy Howick
- Faculty of Philosophy, University of Oxford, Oxford, UK
| | - Christian Mallen
- School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Paul Little
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Mohana Ratnapalan
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Emily Lyness
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Hajira Dambha-Miller
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Leanne Morrison
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Geraldine Leydon
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Hazel Everitt
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Felicity L Bishop
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
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5
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Hodgson S, Morgan-Harrisskitt J, Hounkpatin H, Stuart B, Dambha-Miller H. Primary care service utilisation and outcomes in type 2 diabetes: a longitudinal cohort analysis. BMJ Open 2022; 12:e054654. [PMID: 35105641 PMCID: PMC8808402 DOI: 10.1136/bmjopen-2021-054654] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To describe primary care utilisation patterns among adults with type 2 diabetes and to quantify the association between utilisation and long-term health outcomes. DESIGN Retrospective cohort study. SETTING 168 primary care practices in Southern England within the Electronic Care and Health Information Analytics database between 2013 and 2020. PARTICIPANTS 110 240 adults with Quality and Outcomes Framework read code of type 2 diabetes diagnosis; age greater than 18 years; linked and continuous records available from April 2013 until April 2020 (or death). PRIMARY AND SECONDARY OUTCOME MEASURES: (1) Rates of service utilisation (total number of primary care contacts per quarter) across the study period; (2) participant characteristics associated with higher and lower rates of service utilisation; and (3) associations between service utilisation and (A) cardiovascular disease (CVD events) and (B) all-cause mortality. RESULTS Mean (SD) number of primary care attendances per quarter in the cohort of 110 240 went from 2.49 (2.01) in 2013 to 2.78 (2.06) in 2020. Patients in the highest usage tertile were more likely to be female, older, more frail, white, from the least deprived quintile and to have five or more comorbidities. In adjusted models, higher rates of service utilisation (per consultation) were associated with higher rates of CVD events (OR 1.0058; 95% CI 1.0053 to 1.0062; p<0.001) and mortality (OR 1.0057; 95% CI 1.0051 to 1.0064; p<0.001). CONCLUSIONS People with type 2 diabetes are using primary care services more frequently, but increased volume of clinical care does not correlate with better outcomes, although this finding may be driven by more unwell patients contacting services more frequently. Further research on the nature and content of contacts is required to understand how to tailor services to deliver effective care to those at greatest risk of complications.
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Affiliation(s)
- Sam Hodgson
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | | | - Hilda Hounkpatin
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Beth Stuart
- Primary Care Research Centre, University of Southampton, Southampton, UK
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Dambha-Miller H, Day A, Kinmonth AL, Griffin SJ. Primary care experience and remission of type 2 diabetes: a population-based prospective cohort study. Fam Pract 2021; 38:141-146. [PMID: 32918549 PMCID: PMC8006762 DOI: 10.1093/fampra/cmaa086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Remission of Type 2 diabetes is achievable through dietary change and weight loss. In the UK, lifestyle advice and referrals to weight loss programmes predominantly occur in primary care where most Type 2 diabetes is managed. OBJECTIVE To quantify the association between primary care experience and remission of Type 2 diabetes over 5-year follow-up. METHODS A prospective cohort study of adults with Type 2 diabetes registered to 49 general practices in the East of England, UK. Participants were followed-up for 5 years and completed the Consultation and Relational Empathy measure (CARE) on diabetes-specific primary care experiences over the first year after diagnosis of the disease. Remission at 5-year follow-up was measured with HbA1c levels. Univariable and multivariable logistic regression models were constructed to quantify the association between primary care experience and remission of diabetes. RESULTS Of 867 participants, 30% (257) achieved remission of Type 2 diabetes at 5 years. Six hundred twenty-eight had complete data at follow-up and were included in the analysis. Participants who reported higher CARE scores in the 12 months following diagnosis were more likely to achieve remission at 5 years in multivariable models; odds ratio = 1.03 (95% confidence interval = 1.01-1.05, P = 0.01). CONCLUSION Primary care practitioners should pay greater attention to delivering optimal patient experiences alongside clinical management of the disease as this may contribute towards remission of Type 2 diabetes. Further work is needed to examine which aspects of the primary care experience might be optimized and how these could be operationalized.
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Affiliation(s)
- Hajira Dambha-Miller
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.,MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.,Division of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Alexander Day
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Ann Louise Kinmonth
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Simon J Griffin
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.,MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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Xu L, Polya DA, Li Q, Mondal D. Association of low-level inorganic arsenic exposure from rice with age-standardized mortality risk of cardiovascular disease (CVD) in England and Wales. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 743:140534. [PMID: 32659549 DOI: 10.1016/j.scitotenv.2020.140534] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/26/2020] [Accepted: 06/24/2020] [Indexed: 05/10/2023]
Abstract
Adverse health outcomes, including death from cardiovascular disease (CVD), arising from chronic exposure to inorganic arsenic (iAs) are well documented. Consumption of rice is a major iAs exposure route for over 3 billion people, however, there is still a lack of epidemiological evidence demonstrating the association between iAs exposure from rice intake and CVD risks. We explored this potential association through an ecological study using data at local authority level across England and Wales. Local authority level daily per capita iAs exposure from rice (E-iAsing,rice) was estimated using ethnicity as a proxy for class of rice consumption. A series of linear and non-linear models were applied to estimate the association between E-iAsing,rice and CVD age-standardized mortality rate (ASMR), using Akaike's Information Criterion as the principle model selection criterion. When adjusted for significant confounders, notably smoking prevalence, education level, employment rate, overweight percentage, PM2.5, female percentage and medical and care establishments, the preferred non-linear model indicated that CVD risks increased with iAs exposure from rice at exposures above 0.3 μg/person/day. Also, the best-fitted linear model indicated that CVD ASMR in the highest quartile of iAs exposure (0.375-2.71 μg/person/day) was 1.06 (1.02, 1.11; p-trend <0.001) times higher than that in the lowest quartile (<0.265 μg/person/day). Notwithstanding the well-known limitations of ecological studies, this study further suggests exposure to iAs, including from rice intake, as a potentially important confounder for studies of the factors controlling CVD risks.
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Affiliation(s)
- Lingqian Xu
- Department of Earth and Environmental Sciences, Williamson Research Centre for Molecular Environmental Science, University of Manchester, Manchester M13 9PL, UK
| | - David A Polya
- Department of Earth and Environmental Sciences, Williamson Research Centre for Molecular Environmental Science, University of Manchester, Manchester M13 9PL, UK.
| | - Qian Li
- Department of Earth and Environmental Sciences, Williamson Research Centre for Molecular Environmental Science, University of Manchester, Manchester M13 9PL, UK
| | - Debapriya Mondal
- School of Science, Engineering & Environment, University of Salford, Salford M5 4WT, UK
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Caro-Bautista J, Villa-Estrada F, Gómez-González A, Lupiáñez-Pérez I, Morilla-Herrera JC, Kaknani-Uttumchandani S, García-Mayor S, Morales-Asencio JM. Effectiveness of a Diabetes Education Program based on Tailored interventions and Theory of Planned Behaviour: Cluster randomized controlled trial protocol. J Adv Nurs 2020; 77:427-438. [PMID: 33009844 DOI: 10.1111/jan.14580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/26/2020] [Accepted: 08/21/2020] [Indexed: 11/29/2022]
Abstract
AIM To measure the Effectiveness of a Diabetes Education Program for people with T2DM, based on Tailored interventions and the Theory of Planned Behaviour. DESIGN Cluster randomized controlled clinical trial. METHODS This multicentre study will be carried out at 30 primary healthcare centres, where 436 persons with Type 2 Diabetes Mellitus (T2DM), aged between 18-75 years, will be recruited. The experimental educational program to be applied is modelled using components obtained from a systematic review and prior qualitative analysis. In addition, a taxonomy of nursing practice is used to standardize the program, based on the Theory of Planned Behaviour as a conceptual model. The intervention will be carried out by community nurses, using ADAPP-Ti® , an application developed with FileMaker Pro v.18. The control group will receive usual care and data will be collected at 6, 12, and 18 months, for both groups. The primary outcome considered will be glycosylated haemoglobin and cardiovascular factors, while the secondary ones will be tobacco consumption, body mass index, barriers to self-care, health-related quality of life, and lifestyle modification. The protocol was approved by the Ethics Committee of the Province of Malaga (Spain) in November 2014. DISCUSSION The degree of metabolic control in T2DM is not always associated with healthy lifestyles and significant levels of medication are often prescribed to achieve clinical objectives. An intervention focused on needs, based on the best available evidence and a solid conceptual framework, might successfully consolidate appropriate self-care behaviour in this population. IMPACT The study will result in the publication of an educational program featuring well-defined interventions and activities that will enable clinicians to tailor health care to the individual's needs and to combat treatment inertia in attending this population.
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Affiliation(s)
- Jorge Caro-Bautista
- Málaga-Valle del Guadalhorce Primary Healthcare District, Andalusian Public Health System, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
| | - Francisca Villa-Estrada
- Málaga-Valle del Guadalhorce Primary Healthcare District, Andalusian Public Health System, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
| | - Alberto Gómez-González
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Department of Nursing and Podiatry, Faculty of Health Sciences, University of Málaga, Málaga, Spain
| | - Inmaculada Lupiáñez-Pérez
- Málaga-Valle del Guadalhorce Primary Healthcare District, Andalusian Public Health System, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Department of Nursing and Podiatry, Faculty of Health Sciences, University of Málaga, Málaga, Spain
| | - Juan Carlos Morilla-Herrera
- Málaga-Valle del Guadalhorce Primary Healthcare District, Andalusian Public Health System, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Department of Nursing and Podiatry, Faculty of Health Sciences, University of Málaga, Málaga, Spain
| | - Shakira Kaknani-Uttumchandani
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Department of Nursing and Podiatry, Faculty of Health Sciences, University of Málaga, Málaga, Spain
| | - Silvia García-Mayor
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Department of Nursing and Podiatry, Faculty of Health Sciences, University of Málaga, Málaga, Spain
| | - José Miguel Morales-Asencio
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Department of Nursing and Podiatry, Faculty of Health Sciences, University of Málaga, Málaga, Spain
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9
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Caro-Bautista J, Kaknani-Uttumchandani S, García-Mayor S, Villa-Estrada F, Morilla-Herrera JC, León-Campos Á, Gómez-González AJ, Morales-Asencio JM. Impact of self-care programmes in type 2 diabetes mellitus population in primary health care: Systematic review and meta-analysis. J Clin Nurs 2020; 29:1457-1476. [PMID: 31944439 DOI: 10.1111/jocn.15186] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/06/2019] [Accepted: 01/10/2020] [Indexed: 01/04/2023]
Abstract
AIMS AND OBJECTIVES To evaluate the effectiveness of self-care programmes in type 2 diabetes mellitus (T2DM) population in primary health care. BACKGROUND The impact of educational interventions on T2DM has been evaluated in various contexts, but there is uncertainty about their impact in that of primary care. DESIGN Systematic review and meta-analysis. METHODS A search was conducted in PubMed, CINAHL, WOS and Cochrane databases for randomised controlled trials carried out in the period January 2005-December 2017, including studies with at least one face-to-face educational interventions. The quality of the evidence for the primary outcome was evaluated using the GRADE System. A meta-analysis was used to determine the effect achieved although only the results classified as critical or important were taken into consideration. Checklist of Preferred Reporting Items for Systematic Reviews and Meta-analyses has been followed. PROSPERO registration Number: CRD42016038833. RESULTS In total, 21 papers (20 studies) were analysed, representing a population of 12,018 persons with T2DM. For the primary outcome, HbA1 c, the overall reduction obtained was -0.29%, decreasing the effect in long-term follow-up. The quality of the evidence was low/very low due to very serious risk of bias, inconsistency and indirectness of results. Better results were obtained for individual randomised trials versus cluster designs and in those programmes in which nurses leaded the interventions. The findings for other cardiovascular risk factors were inconsistent. CONCLUSIONS Educational interventions in primary care addressing T2DM could be effective for metabolic control, but the low quality of the evidence and the lack of measurement of critical results generates uncertainty and highlights the need for high-quality trials. RELEVANCE TO CLINICAL PRACTICE Most of self-care programmes for T2DM in primary care are focused on metabolic control, while other cardiovascular profile variables with greater impact on mortality or patient-reported outcomes are less intensely addressed.
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Affiliation(s)
- Jorge Caro-Bautista
- Servicio Andaluz de Salud, Distrito Sanitario Málaga-Valle del Guadalhorce, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
| | - Shakira Kaknani-Uttumchandani
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Facultad de Ciencias de la Salud, Universidad de Málaga, Málaga, Spain
| | - Silvia García-Mayor
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Facultad de Ciencias de la Salud, Universidad de Málaga, Málaga, Spain
| | - Francisca Villa-Estrada
- Servicio Andaluz de Salud, Distrito Sanitario Málaga-Valle del Guadalhorce, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
| | - Juan Carlos Morilla-Herrera
- Servicio Andaluz de Salud, Distrito Sanitario Málaga-Valle del Guadalhorce, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Facultad de Ciencias de la Salud, Universidad de Málaga, Málaga, Spain
| | - Álvaro León-Campos
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | - José Miguel Morales-Asencio
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Facultad de Ciencias de la Salud, Universidad de Málaga, Málaga, Spain
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Dambha-Miller H, Feldman AL, Kinmonth AL, Griffin SJ. Association Between Primary Care Practitioner Empathy and Risk of Cardiovascular Events and All-Cause Mortality Among Patients With Type 2 Diabetes: A Population-Based Prospective Cohort Study. Ann Fam Med 2019; 17:311-318. [PMID: 31285208 PMCID: PMC6827646 DOI: 10.1370/afm.2421] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 02/12/2019] [Accepted: 03/27/2019] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To examine the association between primary care practitioner (physician and nurse) empathy and incidence of cardiovascular disease (CVD) events and all-cause mortality among patients with type 2 diabetes. METHODS This was a population-based prospective cohort study of 49 general practices in East Anglia (United Kingdom). The study population included 867 individuals with screen-detected type 2 diabetes who were followed up for an average of 10 years until December 31, 2014 in the Anglo-Danish-Dutch Study of Intensive Treatment in People With Screen Detected Diabetes in Primary Care (ADDITION)-Cambridge trial. Twelve months after diagnosis, patients assessed practitioner empathy and their experiences of diabetes care during the preceding year using the consultation and relational empathy (CARE) measure questionnaire. CARE scores were grouped into tertiles. The main outcome measures were first recorded CVD event (a composite of myocardial infarction, revascularization, nontraumatic amputation, stroke, and fatal CVD event) and all-cause mortality, obtained from electronic searches of the general practitioner record, national registries, and hospital records. Hazard ratios (HRs) were estimated using Cox models adjusted for relevant confounders. The ADDITION-Cambridge trial is registered as ISRCTN86769081. RESULTS Of the 628 participants with a completed CARE score, 120 (19%) experienced a CVD event, and 132 (21%) died during follow up. In the multivariable model, compared with the lowest tertile, higher empathy scores were associated with a lower risk of CVD events (although this did not achieve statistical significance) and a lower risk of all-cause mortality (HRs for the middle and highest tertiles, respectively: 0.49; 95% CI, 0.27-0.88, P = .01 and 0.60; 95% CI, 0.35-1.04, P = .05). CONCLUSIONS Positive patient experiences of practitioner empathy in the year after diagnosis of type 2 diabetes may be associated with beneficial long-term clinical outcomes. Further work is needed to understand which aspects of patient perceptions of empathy might influence health outcomes and how to incorporate this understanding into the education and training of practitioners.
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Affiliation(s)
- Hajira Dambha-Miller
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Nuffield Department of Primary Care Health, University of Oxford, Oxford, United Kingdom
| | - Adina L Feldman
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Ann Louise Kinmonth
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Simon J Griffin
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
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11
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Dambha-Miller H, Silarova B, Irving G, Kinmonth AL, Griffin SJ. Patients' views on interactions with practitioners for type 2 diabetes: a longitudinal qualitative study in primary care over 10 years. Br J Gen Pract 2018; 68:e36-e43. [PMID: 29203681 PMCID: PMC5737318 DOI: 10.3399/bjgp17x693917] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 07/18/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND It has been suggested that interactions between patients and practitioners in primary care have the potential to delay progression of complications in type 2 diabetes. However, as primary care faces greater pressures, patient experiences of patient-practitioner interactions might be changing. AIM To explore the views of patients with type 2 diabetes on factors that are of significance to them in patient-practitioner interactions in primary care after diagnosis, and over the last 10 years of living with the disease. DESIGN AND SETTING A longitudinal qualitative analysis over 10 years in UK primary care. METHOD The study was part of a qualitative and quantitative examination of patient experience within the existing ADDITION-Cambridge and ADDITION-Plus trials from 2002 to 2016. The researchers conducted a qualitative descriptive analysis of free-text comments to an open-ended question within the CARE measure questionnaire at 1 and 10 years after diagnosis with diabetes. Data were analysed cross-sectionally at each time point, and at an individual level moving both backwards and forwards between time points to describe emergent topics. RESULTS At the 1-year follow-up, 311 out of 1106 (28%) participants had commented; 101 out of 380 (27%) participants commented at 10-year follow-up; and 46 participants commented at both times. Comments on preferences for face-to-face contact, more time with practitioners, and relational continuity of care were more common over time. CONCLUSION This study highlights issues related to the wider context of interactions between patients and practitioners in the healthcare system over the last 10 years since diagnosis. Paradoxically, these same aspects of care that are valued over time from diagnosis are also increasingly unprotected in UK primary care.
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Affiliation(s)
- Hajira Dambha-Miller
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge
| | - Barbora Silarova
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge
| | - Greg Irving
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge
| | - Ann Louise Kinmonth
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge
| | - Simon J Griffin
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge
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12
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Dambha-Miller H, Cooper AJM, Kinmonth AL, Griffin SJ. Effect on cardiovascular disease risk factors of interventions to alter consultations between practitioners and patients with type 2 diabetes: A systematic review and meta-analysis of trials in primary care. Health Expect 2017; 20:1218-1227. [PMID: 28245085 PMCID: PMC5689230 DOI: 10.1111/hex.12546] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2017] [Indexed: 12/30/2022] Open
Abstract
Objective To examine the effect on cardiovascular (CVD) risk factors of interventions to alter consultations between practitioners and patients with type 2 diabetes. Search Strategy Electronic and manual citation searching to identify relevant randomized controlled trials (RCTs). Inclusion Criteria RCTs that compared usual care to interventions to alter consultations between practitioners and patients. The population was adults aged over 18 years with type 2 diabetes. Trials were set in primary care. Data extraction and synthesis We recorded if explicit theory‐based interventions were used, how consultations were measured to determine whether interventions had an effect on these and calculated weighted mean differences for CVD risk factors including glycated haemoglobin (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), LDL cholesterol (LDL‐C) and HDL cholesterol (HDL‐C). Results We included seven RCTs with a total of 2277 patients with type 2 diabetes. A range of measures of the consultation was reported, and underlying theory to explain intervention processes was generally undeveloped and poorly applied. There were no overall effects on CVD risk factors; however, trials were heterogeneous. Subgroup analysis suggested some benefit among studies in which interventions demonstrated impact on consultations; statistically significant reductions in HbA1c levels (weighted mean difference, −0.53%; 95% CI: [−0.77, −0.28]; P<.0001; I2=46%). Conclusions Evidence of effect on CVD risk factors from interventions to alter consultations between practitioners and patients with type 2 diabetes was heterogeneous and inconclusive. This could be explained by variable impact of interventions on consultations. More research is required that includes robust measures of the consultations and better development of theory to elucidate mechanisms.
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Affiliation(s)
- Hajira Dambha-Miller
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.,MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Andrew J M Cooper
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Ann Louise Kinmonth
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Simon J Griffin
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.,MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
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