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Saunders B, Chew-Graham C, Sowden G, Cooke K, Walker-Bone K, Madan I, Parsons V, Linaker CH, Wynne-Jones G. Constructing therapeutic support and negotiating competing agendas: A discourse analysis of vocational advice provided to individuals who are absent from work due to ill-health. Health (London) 2024; 28:185-202. [PMID: 37092765 PMCID: PMC10900846 DOI: 10.1177/13634593221148446] [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] [Indexed: 04/25/2023]
Abstract
Work participation is known to benefit people's overall health and wellbeing, but accessing vocational support during periods of sickness absence to facilitate return-to-work can be challenging for many people. In this study, we explored how vocational advice was delivered by trained vocational support workers (VSWs) to people who had been signed-off from work by their General Practitioner (GP), as part of a feasibility study testing a vocational advice intervention. We investigated the discursive and interactional strategies employed by VSWs and people absent from work, to pursue their joint and respective goals. Theme-oriented discourse analysis was carried out on eight VSW consultations. These consultations were shown to be complex interactions, during which VSWs utilised a range of strategies to provide therapeutic support in discussions about work. These included; signalling empathy with the person's perspective; positively evaluating their personal qualities and prior actions; reflecting individuals' views back to them to show they had been heard and understood; fostering a collaborative approach to action-planning; and attempting to reassure individuals about their return-to-work concerns. Some individuals were reluctant to engage in return-to-work planning, resulting in back-and-forth interactional negotiations between theirs and the VSW's individual goals and agendas. This led to VSWs putting in considerable interactional 'work' to subtly shift the discussion towards return-to-work planning. The discursive strategies we have identified have implications for training health professionals to facilitate work-orientated conversations with their patients, and will also inform training provided to VSWs ahead of a randomised controlled trial.
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Affiliation(s)
| | | | | | | | | | | | - Vaughan Parsons
- King's College London, UK
- Guy's and St Thomas' NHS Foundation Trust, UK
- University of Southampton, UK
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Chew-Graham C, Rawson S, Taylor L. Research Paper of the Year: relevance to the broader primary care team. Br J Gen Pract 2023; 73:522-523. [PMID: 37884364 PMCID: PMC10617968 DOI: 10.3399/bjgp23x735537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Affiliation(s)
- Carolyn Chew-Graham
- School of Medicine, Keele University, Staffordshire; GP, Chorlton Family Practice, Manchester
| | | | - Lisa Taylor
- Chorlton Family Practice, Chorlton, Manchester
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Husain N, Kiran T, Chaudhry IB, Williams C, Emsley R, Arshad U, Ansari MA, Bassett P, Bee P, Bhatia MR, Chew-Graham C, Husain MO, Irfan M, Khaliq A, Minhas FA, Naeem F, Naqvi H, Nizami AT, Noureen A, Panagioti M, Rasool G, Saeed S, Bukhari SQ, Tofique S, Zadeh ZF, Zafar SN, Chaudhry N. A culturally adapted manual-assisted problem-solving intervention (CMAP) for adults with a history of self-harm: a multi-centre randomised controlled trial. BMC Med 2023; 21:282. [PMID: 37525207 PMCID: PMC10391745 DOI: 10.1186/s12916-023-02983-8] [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: 12/22/2022] [Accepted: 07/18/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Self-harm is an important predictor of a suicide death. Culturally appropriate strategies for the prevention of self-harm and suicide are needed but the evidence is very limited from low- and middle-income countries (LMICs). This study aims to investigate the effectiveness of a culturally adapted manual-assisted problem-solving intervention (CMAP) for patients presenting after self-harm. METHODS This was a rater-blind, multicenter randomised controlled trial. The study sites were all participating emergency departments, medical wards of general hospitals and primary care centres in Karachi, Lahore, Rawalpindi, Peshawar, and Quetta, Pakistan. Patients presenting after a self-harm episode (n = 901) to participating recruitment sites were assessed and randomised (1:1) to one of the two arms; CMAP with enhanced treatment as usual (E-TAU) or E-TAU. The intervention (CMAP) is a manual-assisted, cognitive behaviour therapy (CBT)-informed problem-focused therapy, comprising six one-to-one sessions delivered over three months. Repetition of self-harm at 12-month post-randomisation was the primary outcome and secondary outcomes included suicidal ideation, hopelessness, depression, health-related quality of life (QoL), coping resources, and level of satisfaction with service received, assessed at baseline, 3-, 6-, 9-, and 12-month post-randomisation. The trial is registered on ClinicalTrials.gov. NCT02742922 (April 2016). RESULTS We screened 3786 patients for eligibility and 901 eligible, consented patients were randomly assigned to the CMAP plus E-TAU arm (n = 440) and E-TAU arm (N = 461). The number of self-harm repetitions for CMAP plus E-TAU was lower (n = 17) compared to the E-TAU arm (n = 23) at 12-month post-randomisation, but the difference was not statistically significant (p = 0.407). There was a statistically and clinically significant reduction in other outcomes including suicidal ideation (- 3.6 (- 4.9, - 2.4)), depression (- 7.1 (- 8.7, - 5.4)), hopelessness (- 2.6 (- 3.4, - 1.8), and improvement in health-related QoL and coping resources after completion of the intervention in the CMAP plus E-TAU arm compared to the E-TAU arm. The effect was sustained at 12-month follow-up for all the outcomes except for suicidal ideation and hopelessness. On suicidal ideation and hopelessness, participants in the intervention arm scored lower compared to the E-TAU arm but the difference was not statistically significant, though the participants in both arms were in low-risk category at 12-month follow-up. The improvement in both arms is explained by the established role of enhanced care in suicide prevention. CONCLUSIONS Suicidal ideation is considered an important target for the prevention of suicide, therefore, CMAP intervention should be considered for inclusion in the self-harm and suicide prevention guidelines. Given the improvement in the E-TAU arm, the potential use of brief interventions such as regular contact requires further exploration.
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Affiliation(s)
- Nusrat Husain
- Division of Psychology and Mental Health, University of Manchester, Oxford Rd, Manchester, M13 9PL, England, UK
- Mersey Care NHS Foundation Trust, Kings Business Park, Trust Offices/V7 Buildings, Prescot, L34 1PJ, England, UK
| | - Tayyeba Kiran
- Pakistan Institute of Living and Learning, Suite No. 201, 2nd Floor, The Plaza, Do-Talwar, Khayaban-E-Iqbal, Clifton, Karachi, Pakistan.
| | - Imran Bashir Chaudhry
- Division of Psychology and Mental Health, University of Manchester, Oxford Rd, Manchester, M13 9PL, England, UK
- Department of Psychiatry, Ziauddin University and Hospital, 4/B Shahrah-E-Ghalib Rd, Block 6 Clifton, Karachi, Pakistan
| | - Christopher Williams
- Institute of Health and Well Being, University of Glasgow, Glasgow, G12 8QQ, Scotland, UK
| | - Richard Emsley
- Medical Statistics & Trials Methodology, Institute of Psychiatry, Kings College London, Strand, London, WC2R 2LS, England, UK
| | - Usman Arshad
- Pakistan Institute of Living and Learning, Suite No. 201, 2nd Floor, The Plaza, Do-Talwar, Khayaban-E-Iqbal, Clifton, Karachi, Pakistan
| | - Moin Ahmed Ansari
- Liaquat University of Medical and Health Sciences, C7PC+337, Hyderabad, Jamshoro, Pakistan
| | - Paul Bassett
- Statistical Consultancy, Hemel Hempstead, England, UK
| | - Penny Bee
- Division of Nursing, Midwifery and Social Work, University of Manchester, Oxford Rd, Manchester, M13 9PL, England, UK
| | - Moti Ram Bhatia
- Peoples University of Medical & Health Science for Women Nawabshah, 6CV3+7HW, Hospital Road, Shaheed Benazirabad, Nawabshah, Pakistan
| | | | - Muhammad Omair Husain
- Department of Psychiatry, University of Toronto, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada
| | - Muhammad Irfan
- Department of Mental Health, Psychiatry and Behavioural Sciences, Peshawar Medical College, Riphah International University, Islamabad, Pakistan
| | - Ayesha Khaliq
- Pakistan Institute of Living and Learning, Suite No. 201, 2nd Floor, The Plaza, Do-Talwar, Khayaban-E-Iqbal, Clifton, Karachi, Pakistan
| | | | - Farooq Naeem
- CAMH, University of Toronto, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada
| | - Haider Naqvi
- Department of Psychiatry, Dow University of Health Sciences, Mission Rd, New Labour Colony Nanakwara, Karachi, Pakistan
| | - Asad Tamizuddin Nizami
- Institute of Psychiatry, Benazir Bhutto Hospital, Near Chandni Chowk, Murree Rd, Chah Sultan, Rawalpindi, Pakistan
| | - Amna Noureen
- Pakistan Institute of Living and Learning, Suite No. 201, 2nd Floor, The Plaza, Do-Talwar, Khayaban-E-Iqbal, Clifton, Karachi, Pakistan
| | - Maria Panagioti
- Division of Population Health, Health Services Research & Primary Care, Institute for Health Policy and Organisation/Alliance Manchester Business School, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
| | - Ghulam Rasool
- Balochistan Institute of Psychiatry & Behavioural Sciences, Bolan Medical College, 5XRG+VGC, Brewery Rd, Quetta, Pakistan
| | - Sofiya Saeed
- Pakistan Institute of Living and Learning, Suite No. 201, 2nd Floor, The Plaza, Do-Talwar, Khayaban-E-Iqbal, Clifton, Karachi, Pakistan
| | - Sumira Qambar Bukhari
- Department of Psychiatry, Services Institute of Medical Sciences, G8QM+JWR, Jail Rd, Shadman 1 Shadman, Lahore, Pakistan
| | - Sehrish Tofique
- Pakistan Institute of Living and Learning, Suite No. 201, 2nd Floor, The Plaza, Do-Talwar, Khayaban-E-Iqbal, Clifton, Karachi, Pakistan
| | - Zainab F Zadeh
- Pakistan Institute of Living and Learning, Suite No. 201, 2nd Floor, The Plaza, Do-Talwar, Khayaban-E-Iqbal, Clifton, Karachi, Pakistan
| | - Shehla Naeem Zafar
- Institute of Nursing, Iqra University, G-16/1 Allama Rasheed Turabi Rd, Block-B Block B, North Nazimabad Town, Karachi, Pakistan
| | - Nasim Chaudhry
- Pakistan Institute of Living and Learning, Suite No. 201, 2nd Floor, The Plaza, Do-Talwar, Khayaban-E-Iqbal, Clifton, Karachi, Pakistan
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Leach H, Atherton H, Eccles A, Chew-Graham C. The experiences of remote consulting for people with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) and fibromyalgia in primary care. Br J Gen Pract 2023; 73:bjgp23X733689. [PMID: 37479267 DOI: 10.3399/bjgp23x733689] [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: 07/23/2023] Open
Abstract
BACKGROUND Restrictions due to the COVID-19 pandemic resulted in a sudden shift to a predominantly remote consulting model in primary care from March 2020. Little evidence exists examining the experience of remote consulting for people living with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) or fibromyalgia, with the current literature focusing on the challenges faced by clinicians and people living with these conditions. Clinical guidance highlights the importance of building therapeutic relationships and personalising care, but it is unclear how this translates into a remote or virtual consulting space. AIM To explore how people living with CFS/ME and fibromyalgia experience remote consulting with a primary care clinician, including synchronous and asynchronous methods, that is, e-consultation platforms, email, video, and telephone. METHOD Semi-structured interviews are being recorded and analysed thematically using a Foucauldian theoretical framework. Participants have been recruited across the West Midlands from a range of backgrounds. RESULTS Recruitment is still ongoing. Preliminary analysis indicates that remote consulting is acceptable for these groups of patients, but only if they feel validated, listened to, and with a clinician who considers a holistic view with continuity of care. CONCLUSION Remote consulting has presented new challenges for primary care, and it is important to identify which groups of patients are most suited. This study explores the views from a group of patients that are associated with some complexity, and complements the literature that explores the ability to deliver relationship-based care when consulting digitally/remotely. Recommendations from the findings will be created for use by patients and clinicians alike.
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Camacho E, Shields G, Eisner E, Chew-Graham C, Gilbody S, Littlewood E, McMillan D, Watson K. Exploring the cost-effectiveness of case-finding for antenatal depression: an economic modelling study. Br J Gen Pract 2023; 73:bjgp23X733977. [PMID: 37479293 DOI: 10.3399/bjgp23x733977] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND The NHS has limited human and financial resources, with particular pressures in primary care. The National Institute for Health and Care Excellence (NICE) makes decisions on which services can be commissioned within the NHS. Many women experiencing antenatal depression are not identified as such in routine care and so may not access support. Current NICE guidance does not recommend universal case-finding for antenatal depression; however, a programme targeted towards pregnant women with risk factors (for example, previous mental illness, traumatic life events) has not been considered. AIM To explore the cost-effectiveness of case-finding for antenatal depression: targeted vs. universal vs. no case-finding. METHOD The following case-finding tools were evaluated: Edinburgh Postnatal Depression Scale, Whooley questions, PHQ-9. One- and two-stage strategies were considered (second tool administered following positive response to Whooley questions). A decision tree model of costs and health outcomes from 20-40 weeks' gestation was developed. Health was measured as quality-adjusted-life-years (QALYs). Costs included case-finding and treatment for depression. RESULTS The two-stage Whooley/PHQ-9 option was the most cost-effective case-finding strategy. Implementing a universal case-finding strategy was associated with lower costs than no case-finding (£52 vs £61) and more QALYs (0.3458 vs 0.3455). Targeted case-finding has similar costs to no case-finding and more QALYs (0.3459), requiring a spend of £1775 to improve health by 1 QALY. CONCLUSION Universal case-finding for antenatal depression is cost-saving and improves health compared with no case-finding. It should be considered by policymakers to improve the identification and support of women experiencing antenatal depression in primary and maternity care.
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Campion J, Johnston G, Shiers D, Chew-Graham C. Why should we prioritise smoking cessation for people with mental health conditions? Br J Gen Pract 2023; 73:251-253. [PMID: 37230792 PMCID: PMC10229168 DOI: 10.3399/bjgp23x732921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Affiliation(s)
- Jonathan Campion
- South London and Maudsley NHS Foundation Trust, London, UK; Clinical and Strategic Codirector of Public Mental Health Implementation Centre, Royal College of Psychiatrists, London, UK; Public Mental Health Advisor, World Health Organization Europe; Chair of Public Mental Health Working Group, World Psychiatric Association; Honorary Professor of Public Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - David Shiers
- Psychosis Research Unit, Greater Manchester Mental Health NHS Trust, Manchester, UK; Honorary Reader in early psychosis, Division of Psychology and Mental Health, University of Manchester, Manchester, UK; Honorary Senior Research Fellow, School of Medicine, Keele University, Keele, UK
| | - Carolyn Chew-Graham
- GP, Manchester, UK; Professor of General Practice Research, School of Medicine, Keele University, Keele, UK
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Shearsmith L, Coventry PA, Sloan C, Henry A, Newbronner L, Littlewood E, Bailey D, Gascoyne S, Burke L, Ryde E, Woodhouse R, McMillan D, Ekers D, Gilbody S, Chew-Graham C. Acceptability of a behavioural intervention to mitigate the psychological impacts of COVID-19 restrictions in older people with long-term conditions: a qualitative study. BMJ Open 2023; 13:e064694. [PMID: 36914198 PMCID: PMC10015671 DOI: 10.1136/bmjopen-2022-064694] [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] [Indexed: 03/14/2023] Open
Abstract
OBJECTIVES The COVID-19 pandemic heightened the need to address loneliness, social isolation and associated incidence of depression among older adults. Between June and October 2020, the Behavioural Activation in Social IsoLation (BASIL) pilot study investigated the acceptability and feasibility of a remotely delivered brief psychological intervention (behavioural cctivation) to prevent and reduce loneliness and depression in older people with long-term conditions during the COVID-19 pandemic. DESIGN An embedded qualitative study was conducted. Semi-structured interviews generated data that was analysed inductively using thematic analysis and then deductively using the theoretical framework of acceptability (TFA). SETTING NHS and third sector organisations in England. PARTICIPANTS Sixteen older adults and nine support workers participating in the BASIL pilot study. RESULTS Acceptability of the intervention was high across all constructs of the TFA: Older adults and BASIL Support Workers described a positive Affective Attitude towards the intervention linked to altruism, however the activity planning aspect of the intervention was limited due to COVID-19 restrictions. A manageable Burden was involved with delivering and participating in the intervention. For Ethicality, older adults valued social contact and making changes, support workers valued being able to observe those changes. The intervention was understood by older adults and support workers, although less understanding in older adults without low mood (Intervention Coherence). Opportunity Cost was low for support workers and older adults. Behavioural Activation was perceived to be useful in the pandemic and likely to achieve its aims (Perceived Effectiveness), especially if tailored to people with both low mood and long-term conditions. Self-efficacy developed over time and with experience for both support workers and older adults. CONCLUSIONS Overall, BASIL pilot study processes and the intervention were acceptable. Use of the TFA provided valuable insights into how the intervention was experienced and how the acceptability of study processes and the intervention could be enhanced ahead of the larger definitive trial (BASIL+).
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Affiliation(s)
| | - Peter A Coventry
- Department of Health Sciences, University of York, York, UK
- York Environmental Sustainability Institute, University of York, York, UK
| | - Claire Sloan
- Department of Health Sciences, University of York, York, UK
| | - Andrew Henry
- Department of Health Sciences, University of York, York, UK
- Research and Development, Tees Esk and Wear Valleys NHS Foundation Trust, Flatts Lane Centre, Middlesbrough, UK
| | - Liz Newbronner
- Department of Health Sciences, University of York, York, UK
| | | | - Della Bailey
- Department of Health Sciences, University of York, York, UK
| | | | - Lauren Burke
- Department of Health Sciences, University of York, York, UK
| | - Eloise Ryde
- Department of Health Sciences, University of York, York, UK
- Research and Development, Tees Esk and Wear Valleys NHS Foundation Trust, Flatts Lane Centre, Middlesbrough, UK
| | | | - Dean McMillan
- Department of Health Sciences, University of York, York, UK
- Mental Health and Addiction Research Group, Hull York Medical School, Hull, UK
| | - David Ekers
- Department of Health Sciences, University of York, York, UK
- Research and Development, Tees Esk and Wear Valleys NHS Foundation Trust, Flatts Lane Centre, Middlesbrough, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
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Dunning A, Teoh K, Martin J, Spiers J, Buszewicz M, Chew-Graham C, Taylor AK, Gopfert A, Van Hove M, Appleby L, Riley R. Relationship between working conditions and psychological distress experienced by junior doctors in the UK during the COVID-19 pandemic: a cross-sectional survey study. BMJ Open 2022; 12:e061331. [PMID: 35998957 PMCID: PMC9402444 DOI: 10.1136/bmjopen-2022-061331] [Citation(s) in RCA: 6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This paper explored the self-reported prevalence of depression, anxiety and stress among junior doctors during the COVID-19 pandemic. It also reports the association between working conditions and psychological distress experienced by junior doctors. DESIGN A cross-sectional online survey study was conducted, using the 21-item Depression, Anxiety and Stress Scale and Health and Safety Executive scale to measure psychological well-being and working cultures of junior doctors. SETTING The National Health Service in the UK. PARTICIPANTS A sample of 456 UK junior doctors was recruited online during the COVID-19 pandemic from March 2020 to January 2021. RESULTS Junior doctors reported poor mental health, with over 40% scoring extremely severely depressed (45.2%), anxious (63.2%) and stressed (40.2%). Both gender and ethnicity were found to have a significant influence on levels of anxiety. Hierarchical multiple linear regression analysis outlined the specific working conditions which significantly predicted depression (increased demands (β=0.101), relationships (β=0.27), unsupportive manager (β=-0.111)), anxiety (relationships (β=0.31), change (β=0.18), demands (β=0.179)) and stress (relationships (β=0.18), demands (β=0.28), role (β=0.11)). CONCLUSIONS The findings illustrate the importance of working conditions for junior doctors' mental health, as they were significant predictors for depression, anxiety and stress. Therefore, if the mental health of junior doctors is to be improved, it is important that changes or interventions specifically target the working environment rather than factors within the individual clinician.
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Affiliation(s)
- Alice Dunning
- Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Kevin Teoh
- Department of Organizational Psychology, Birkbeck University of London, London, UK
| | - James Martin
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Johanna Spiers
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Marta Buszewicz
- Research Department of Primary Care and Population Health, University College London, London, UK
| | | | | | - Anya Gopfert
- School of Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Maria Van Hove
- London School of Hygiene & Tropical Medicine, London, UK
| | - Louis Appleby
- Department of Psychiatry & Behavioral Sciences, The University of Manchester Faculty of Medical and Human Sciences, Manchester, UK
| | - Ruth Riley
- School of Health Sciences, University of Surrey, Guildford, UK
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Cordingley L, Nelson PA, Davies L, Ashcroft D, Bundy C, Chew-Graham C, Chisholm A, Elvidge J, Hamilton M, Hilton R, Kane K, Keyworth C, Littlewood A, Lovell K, Lunt M, McAteer H, Ntais D, Parisi R, Pearce C, Rutter M, Symmons D, Young H, Griffiths CEM. Identifying and managing psoriasis-associated comorbidities: the IMPACT research programme. Programme Grants Appl Res 2022. [DOI: 10.3310/lvuq5853] [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] [Indexed: 11/22/2022]
Abstract
Background
Psoriasis is a common, lifelong inflammatory skin disease, the severity of which can range from limited disease involving a small body surface area to extensive skin involvement. It is associated with high levels of physical and psychosocial disability and a range of comorbidities, including cardiovascular disease, and it is currently incurable.
Objectives
To (1) confirm which patients with psoriasis are at highest risk of developing additional long-term conditions and identify service use and costs to patient, (2) apply knowledge about risk of comorbid disease to the development of targeted screening services to reduce risk of further disease, (3) learn how patients with psoriasis cope with their condition and about their views of service provision, (4) identify the barriers to provision of best care for patients with psoriasis and (5) develop patient self-management resources and staff training packages to improve the lives of people with psoriasis.
Design
Mixed methods including two systematic reviews, one population cohort study, one primary care screening study, one discrete choice study, four qualitative studies and three mixed-methodology studies.
Setting
Primary care, secondary care and online surveys.
Participants
People with psoriasis and health-care professionals who manage patients with psoriasis.
Results
Prevalence rates for psoriasis vary by geographical location. Incidence in the UK was estimated to be between 1.30% and 2.60%. Knowledge about the cost-effectiveness of therapies is limited because high-quality clinical comparisons of interventions have not been done or involve short-term follow-up. After adjusting for known cardiovascular risk factors, psoriasis (including severe forms) was not found to be an independent risk factor for major cardiovascular events; however, co-occurrence of inflammatory arthritis was a risk factor. Traditional risk factors were high in patients with psoriasis. Large numbers of patients with suboptimal management of known risk factors were found by screening patients in primary care. Risk information was seldom discussed with patients as part of screening consultations, meaning that a traditional screening approach may not be effective in reducing comorbidities associated with psoriasis. Gaps in training of health-care practitioners to manage psoriasis effectively were identified, including knowledge about risk factors for comorbidities and methods of facilitating behavioural change. Theory-based, high-design-quality patient materials broadened patient understanding of psoriasis and self-management. A 1-day training course based on motivational interviewing principles was effective in increasing practitioner knowledge and changing consultation styles. The primary economic analysis indicated a high level of uncertainty. Sensitivity analysis indicated some situations when the interventions may be cost-effective. The interventions need to be assessed for long-term (cost-)effectiveness.
Limitations
The duration of patient follow-up in the study of cardiovascular disease was relatively short; as a result, future studies with longer follow-up are recommended.
Conclusions
Recognition of the nature of the psoriasis and its impact, knowledge of best practice and guideline use are all limited in those most likely to provide care for the majority of patients. Patients and practitioners are likely to benefit from the provision of appropriate support and/or training that broadens understanding of psoriasis as a complex condition and incorporates support for appropriate health behaviour change. Both interventions were feasible and acceptable to patients and practitioners. Cost-effectiveness remains to be explored.
Future work
Patient support materials have been created for patients and NHS providers. A 1-day training programme with training materials for dermatologists, specialist nurses and primary care practitioners has been designed. Spin-off research projects include a national study of responses to psoriasis therapy and a global study of the prevalence and incidence of psoriasis. A new clinical service is being developed locally based on the key findings of the Identification and Management of Psoriasis Associated ComorbidiTy (IMPACT) programme.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 10, No. 3. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Lis Cordingley
- Division of Musculoskeletal and Dermatological Sciences, University of Manchester, Manchester, UK
| | - Pauline A Nelson
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | - Linda Davies
- Centre for Health Economics, University of Manchester, Manchester, UK
| | - Darren Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Manchester, UK
| | - Christine Bundy
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | | | - Anna Chisholm
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | - Jamie Elvidge
- Centre for Health Economics, University of Manchester, Manchester, UK
| | - Matthew Hamilton
- Centre for Health Economics, University of Manchester, Manchester, UK
| | - Rachel Hilton
- Bridgewater Community Healthcare NHS Foundation Trust, Wigan, UK
| | - Karen Kane
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | | | - Alison Littlewood
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | - Karina Lovell
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Mark Lunt
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
| | | | - Dionysios Ntais
- Centre for Health Economics, University of Manchester, Manchester, UK
| | - Rosa Parisi
- Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Manchester, UK
| | - Christina Pearce
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | - Martin Rutter
- Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Deborah Symmons
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
| | - Helen Young
- Dermatology Research Centre, University of Manchester, Manchester, UK
- Salford Royal NHS Foundation Trust, Salford, UK
| | - Christopher EM Griffiths
- Dermatology Research Centre, University of Manchester, Manchester, UK
- Salford Royal NHS Foundation Trust, Salford, UK
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Taylor AK, Chang D, Chew-Graham C, Rimmer L, Kausar A. 'It's always in the back of my mind': understanding the psychological impact of recovery following pancreaticoduodenectomy for cancer: a qualitative study. BMJ Open 2021; 11:e050016. [PMID: 34916310 PMCID: PMC8679127 DOI: 10.1136/bmjopen-2021-050016] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Ten per cent of patients diagnosed with pancreatic cancer undergo pancreaticoduodenectomy. There is limited previous research focusing on psychological well-being; unmet support needs impact negatively on quality of life. This paper reports the psychological impact of a pancreatic cancer diagnosis and subsequent pancreaticoduodenectomy, exploring how patients' lives alter following surgery and how they seek support. DESIGN Inductive qualitative study involving in-depth semistructured interviews with 20 participants who had undergone pancreaticoduodenectomy for pancreatic or distal biliary duct cancer. Interviews were audiorecorded, transcribed and anonymised, and thematic analysis used principles of constant comparison. SETTING Single National Health Service Trust in Northwest England. PARTICIPANTS Patients were eligible for inclusion if they had had pancreaticoduodenectomy for head of pancreas cancer, periampullary cancer or distal cholangiocarcinoma between 6 months and 6 years previously, and had completed adjuvant chemotherapy. RESULTS Analysis identified the following main themes: diagnosis and decision making around surgery; recovery from surgery and chemotherapy; burden of monitoring and ongoing symptoms; adjusting to 'a new normal'; understanding around prognosis; support-seeking. Participants seized the chance to have surgery, often without seeming to absorb the risks or their prognosis. They perceived that they were unable to control their life trajectory and, although they valued close monitoring, experienced anxiety around their appointments. Participants expressed uncertainty about whether they would be able to return to their former activities. There were tensions in their comments about support-seeking, but most felt that emotional support should be offered proactively. CONCLUSIONS Patients should be made aware of potential psychological sequelae, and that treatment completion may trigger the need for more support. Clinical nurse specialists (CNSs) were identified as key members of the team in proactively offering support; further training for CNSs should be encouraged. Understanding patients' experience of living with cancer and the impact of treatment is crucial in enabling the development of improved support interventions.
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Affiliation(s)
- Anna Kathryn Taylor
- School of Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - David Chang
- Department of General Surgery, Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | | | - Lara Rimmer
- Department of General Surgery, Blackpool Victoria Hospital, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Ambareen Kausar
- Department of General Surgery, Blackpool Victoria Hospital, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
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11
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Spiers J, Buszewicz M, Chew-Graham C, Dunning A, Taylor AK, Gopfert A, Van Hove M, Teoh KRH, Appleby L, Martin J, Riley R. What challenges did junior doctors face while working during the COVID-19 pandemic? A qualitative study. BMJ Open 2021; 11:e056122. [PMID: 34903552 PMCID: PMC8671849 DOI: 10.1136/bmjopen-2021-056122] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES This paper reports findings exploring junior doctors' experiences of working during the COVID-19 pandemic in the UK. DESIGN Qualitative study using in-depth interviews with 15 junior doctors. Interviews were audio-recorded, transcribed, anonymised and imported into NVivo V.12 to facilitate data management. Data were analysed using reflexive thematic analysis. SETTING National Health Service (NHS) England. PARTICIPANTS A purposive sample of 12 female and 3 male junior doctors who indicated severe depression and/or anxiety on the DASS-21 questionnaire or high suicidality on Paykel's measure were recruited. These doctors self-identified as having lived experience of distress due to their working conditions. RESULTS We report three major themes. First, the challenges of working during the COVID-19 pandemic, which were both personal and organisational. Personal challenges were characterised by helplessness and included the trauma of seeing many patients dying, fears about safety and being powerless to switch off. Work-related challenges revolved around change and uncertainty and included increasing workloads, decreasing staff numbers and negative impacts on relationships with colleagues and patients. The second theme was strategies for coping with the impact of COVID-19 on work, which were also both personal and organisational. Personal coping strategies, which appeared limited in their usefulness, were problem and emotion focused. Several participants appeared to have moved from coping towards learnt helplessness. Some organisations reacted to COVID-19 collaboratively and flexibly. Third, participants reported a positive impact of the COVID-19 pandemic on working practices, which included simplified new ways of working-such as consistent teams and longer rotations-as well as increased camaraderie and support. CONCLUSIONS The trauma that junior doctors experienced while working during COVID-19 led to powerlessness and a reduction in the benefit of individual coping strategies. This may have resulted in feelings of resignation. We recommend that, postpandemic, junior doctors are assigned to consistent teams and offered ongoing support.
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Affiliation(s)
- Johanna Spiers
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Marta Buszewicz
- Research Department of Primary Care and Population Health, University College London, London, UK
| | | | - Alice Dunning
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Anna Kathryn Taylor
- Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | | | | | - Kevin Rui-Han Teoh
- Department of Organizational Psychology, Birkbeck, University of London, London, Greater London, UK
| | - Louis Appleby
- Department of Psychology and Mental Health, School of Medicine, University of Manchester, Manchester, UK
| | - James Martin
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
| | - Ruth Riley
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
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12
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Brown L, Heaven A, Quinn C, Goodwin V, Chew-Graham C, Mahmood F, Hallas S, Jacob I, Brundle C, Best K, Daffu-O'Reilly A, Spilsbury K, Young TA, Hawkins R, Hanratty B, Teale E, Clegg A. Community Ageing Research 75+ (CARE75+) REMOTE study: a remote model of recruitment and assessment of the health, well-being and social circumstances of older people. BMJ Open 2021; 11:e048524. [PMID: 34810183 PMCID: PMC8609936 DOI: 10.1136/bmjopen-2020-048524] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The Community Ageing Research 75+ (CARE75+) study is a longitudinal cohort study collecting extensive health and social data, with a focus on frailty, independence and quality of life in older age. CARE75+ was the first international experimental frailty research cohort designed using trial within cohorts (TwiCs) methodology, aligning epidemiological research with clinical trial evaluation of interventions to improve the health and well-being of older people. CARE75+ REMOTE is an extension of CARE75+ using a remote model that does not require face-to-face interactions for data collection in the current circumstances of a global pandemic and will provide an efficient, sustainable data collection model. METHODS AND ANALYSIS Prospective cohort study using TwiCs. One thousand community-dwelling older people (≥75 years) will be recruited from UK general practices by telephone. Exclusions include: nursing home/care home residents; those with an estimated life expectancy of 3 months or less; and people receiving palliative care. DATA COLLECTION Assessments will be conducted by telephone, web-submission or postal questionnaire: baseline, 6 months, 12 months, 18 months, 24 months, 30 months and 36 months. Measures include activities of daily living, mood, health-related quality of life, comorbidities, medications, frailty, informal care, healthcare and social care service use. Consent will be sought for data linkage and invitations to additional studies (sub-studies). ETHICS AND DISSEMINATION CARE75+ was approved by the National Research Ethics Service (NRES) Committee Yorkshire and the Humber-Bradford Leeds 10 October 2014 (14/YH/1120). CARE75+ REMOTE (amendment 13) was approved on the 18th November 2020. Consent is sought if an individual is willing to participate and has capacity to provide informed consent. Consultee assent is sought if an individual lacks capacity. Results will be disseminated in peer-reviewed scientific journals and conferences. Results will be summarised and disseminated to study participants via newsletters, local engagement events and on a bespoke website. TRIAL REGISTRATION NUMBER ISRCTN16588124.
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Affiliation(s)
- Lesley Brown
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford, UK
| | - Anne Heaven
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford, UK
| | - Catherine Quinn
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Victoria Goodwin
- College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Farhat Mahmood
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford, UK
| | - Sarah Hallas
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford, UK
| | - Ikhlaq Jacob
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford, UK
| | - Caroline Brundle
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford, UK
| | - Kate Best
- Academic Unit for Ageing and Stroke Research, University of Leeds, Faculty of Medicine and Health, Leeds, UK
| | - Amrit Daffu-O'Reilly
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Karen Spilsbury
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Tracey Anne Young
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Rebecca Hawkins
- Academic Unit for Ageing and Stroke Research, University of Leeds, Faculty of Medicine and Health, Leeds, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Elizabeth Teale
- Academic Unit for Ageing and Stroke Research, University of Leeds, Faculty of Medicine and Health, Leeds, UK
| | - Andrew Clegg
- Academic Unit for Ageing and Stroke Research, University of Leeds, Faculty of Medicine and Health, Leeds, UK
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13
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Affiliation(s)
- Ian Maidment
- School of Pharmacy, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Dolly Sud
- School of Pharmacy, College of Health and Life Sciences, Aston University, Birmingham, UK
- Pharmacy, Leicestershire Partnership NHS Trust, Leicester, UK
| | - Carolyn Chew-Graham
- School of Medicine, Keele University Institute for Primary Care and Health Sciences, Keele, UK
- West Midlands Applied Research Collaboration, West Midlands, UK
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14
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Riley R, Buszewicz M, Kokab F, Teoh K, Gopfert A, Taylor AK, Van Hove M, Martin J, Appleby L, Chew-Graham C. Sources of work-related psychological distress experienced by UK-wide foundation and junior doctors: a qualitative study. BMJ Open 2021; 11:e043521. [PMID: 34162634 PMCID: PMC8231022 DOI: 10.1136/bmjopen-2020-043521] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES This paper reports findings exploring work cultures, contexts and conditions associated with psychological distress in foundation and junior doctors. DESIGN Qualitative study using in-depth interviews with 21 junior doctor participants. The interviews were audio-recorded, transcribed, anonymised and imported into NVivo V.11 to facilitate data management. Data were analysed using a thematic analysis employing the constant comparative method. SETTING NHS in England. PARTICIPANTS A purposive sample of 16 female and five male junior doctor junior doctor participants who self-identified as having stress, distress, anxiety, depression and suicidal thoughts, or having attempted to kill themselves. RESULTS Analysis reported four key themes: (1) workload and working conditions; (2) toxic work cultures-including abuse and bullying, sexism and racism, culture of blaming and shaming; (3) lack of support; (4) stigma and a perceived need to appear invulnerable. CONCLUSION This study highlights the need for future solutions and interventions targeted at improving work cultures and conditions. There needs to be greater recognition of the components and cumulative effects of potentially toxic workplaces and stressors intrinsic to the work of junior doctors, such as the stress of managing high workloads and lack of access to clinical and emotional support. A cultural shift is needed within medicine to more supportive and compassionate leadership and work environments, and a zero-tolerance approach to bullying, harassment and discrimination.
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Affiliation(s)
- Ruth Riley
- Institute of Applied Health Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Marta Buszewicz
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Farina Kokab
- School of Social Policy, University of Birmingham, Birmingham, UK
| | - Kevin Teoh
- Department of Organizational Psychology, Birkbeck University of London, London, UK
| | - Anya Gopfert
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - Anna K Taylor
- Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Maria Van Hove
- London School of Hygiene & Tropical Medicine, London, UK
| | - James Martin
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Louis Appleby
- Psychiatry and Behavioral Sciences, University of Manchester, Manchester, UK
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15
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Riley R, Kokab F, Buszewicz M, Gopfert A, Van Hove M, Taylor AK, Teoh K, Martin J, Appleby L, Chew-Graham C. Protective factors and sources of support in the workplace as experienced by UK foundation and junior doctors: a qualitative study. BMJ Open 2021; 11:e045588. [PMID: 34162643 PMCID: PMC8231035 DOI: 10.1136/bmjopen-2020-045588] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES This paper reports findings identifying foundation and junior doctors' experiences of occupational and psychological protective factors in the workplace and sources of effective support. DESIGN Interpretative, inductive, qualitative study involving in-depth interviews with 21 junior doctor participants. The interviews were audio-recorded, transcribed, anonymised and imported into NVivo V.11 to facilitate data management. Data were analysed using a thematic analysis employing the constant comparative method. SETTING National Health Service in the UK. PARTICIPANTS Participants were recruited from junior doctors through social media (eg, the British Medical Association (BMA) junior doctors' Facebook group, Twitter and the mental health research charity websites). A purposive sample of 16 females and 5 males, ethnically diverse, from a range of specialities, across the UK. Junior doctor participants self-identified as having stress, distress, anxiety, depression and suicidal thoughts or having attempted to kill themselves. RESULTS Analysis identified three main themes, with corresponding subthemes relating to protective work factors and facilitators of support: (1) support from work colleagues - help with managing workloads and emotional support; (2) supportive leadership strategies, including feeling valued and accepted, trust and communication, supportive learning environments, challenging stigma and normalising vulnerability; and (3) access to professional support - counselling, cognitive-behavioural therapy and medication through general practitioners, specialist support services for doctors and private therapy. CONCLUSIONS Findings show that supportive leadership, effective management practices, peer support and access to appropriate professional support can help mitigate the negative impact of working conditions and cultures experienced by junior doctors. Feeling connected, supported and valued by colleagues and consultants acts as an important buffer against emotional distress despite working under challenging working conditions.
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Affiliation(s)
- Ruth Riley
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Farina Kokab
- School of Social Policy, University of Birmingham, Birmingham, UK
| | - Marta Buszewicz
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Anya Gopfert
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - Maria Van Hove
- London School of Hygiene & Tropical Medicine, London, UK
| | - Anna K Taylor
- Faculty of Medicine and Health, Leeds Institute of Health Sciences, Leeds, UK
| | - Kevin Teoh
- Department of Organizational Psychology, Birkbeck University of London, London, UK
| | - James Martin
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Louis Appleby
- Department of Psychiatry & Behavioral Sciences, University of Manchester, Manchester, UK
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16
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Wu P, Chew-Graham C, Maas A, Chappell L, Potts J, Gulati M, Jordan K, Mamas M. Hypertensive disorders of pregnancy and impact on in-hospital cardio-obstetric outcomes. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3306] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Hypertensive disorders of pregnancy (HDP) are a major cause of maternal morbidity. However, short-term outcomes of HDP subgroups remain unknown.
Methods
Using the United States National Inpatient Sample database, all delivery hospitalizations between 2004 and 2014 with or without HDP (preeclampsia/eclampsia, chronic hypertension, superimposed preeclampsia on chronic hypertension and gestational hypertension) were analysed to examine the association between HDP and adverse in-hospital outcomes.
Results
We identified >44 million delivery hospitalizations, within which the prevalence of HDP increased from 8% to 11% over a decade with increasing comorbidity burden. Women with chronic hypertension have higher risks of myocardial infarction, peripartum cardiomyopathy, arrhythmia and stillbirth compared to women with preeclampsia. Out of all HDP subgroups, the superimposed preeclampsia population had the highest risk of stroke (OR 7.83, 95% CI 6.25, 9.80), myocardial infarction (OR 5.20, 95% CI 3.11, 8.69), peripartum cardiomyopathy (OR 4.37, 95% CI 3.64, 5.26), preterm birth (OR 4.65, 95% CI 4.48, 4.83), placental abruption (OR 2.22, 95% CI 2.09, 2.36), and stillbirth (OR 1.78, 95% CI 1.66, 1.92) compared to women without HDP. In conclusion, we are the first to evaluate chronic SH without superimposed preeclampsia as a distinct subgroup in HDP and show that women with chronic SH are at even higher risk of some adverse outcomes compared to women with preeclampsia.
Conclusion
The chronic hypertension population, with and without superimposed preeclampsia, is a particularly high risk group and may benefit from increased antenatal surveillance and the use of a prognostic risk assessment model incorporating HDP to stratify intrapartum care.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): NIHR
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Affiliation(s)
- P Wu
- Keele University, School of Primary, Social and Community Care, Stoke-on-Trent, United Kingdom
| | - C Chew-Graham
- Keele University, School of Primary, Social and Community Care, Stoke-on-Trent, United Kingdom
| | - A Maas
- University Medical Center St Radboud (UMCN), Nijmegen, Netherlands (The)
| | - L Chappell
- University College London, London, United Kingdom
| | - J Potts
- Keele University, School of Primary, Social and Community Care, Stoke-on-Trent, United Kingdom
| | - M Gulati
- University of Arizona, Phoenix, United States of America
| | - K Jordan
- Keele University, School of Primary, Social and Community Care, Stoke-on-Trent, United Kingdom
| | - M Mamas
- Keele University, School of Primary, Social and Community Care, Stoke-on-Trent, United Kingdom
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17
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Mohamed M, Rashid M, Farooq S, Siddiqui N, Parwani P, Shiers D, Thamman R, Gulati M, Shoaib A, Chew-Graham C, Mamas M. Acute myocardial infarction in several mental illness: a nationwide analysis of prevalence, management strategies and outcomes. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3146] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Severe mental illness (SMI) is associated with an increased risk of cardiovascular disease and mortality. However, it is unclear whether SMI patients are just as likely to receive guideline-recommended therapy for AMI as those without mental illness.
Purpose
To examine national-level estimates of the prevalence, management strategies and in-hospital clinical outcomes of SMI patients presenting with AMI.
Methods
All AMI hospitalisations from the United States National Inpatient Sample were included, stratified by mental health status in to 5 groups: no-SMI, Schizophrenia, “Other non-organic psychoses” (ONOP), Bipolar Disorder and Major Depression. Multivariable logistic regression modelling was performed to examine the association between SMI subtypes and receipt of invasive management and subsequent in-hospital clinical outcomes, expressed as adjusted odds ratios (aOR) and 95% confidence intervals (CI).
Results
Out of 6,968,777 AMI hospitalisations between 2004 and 2014, a total of 439,544 (6.5%) had an SMI diagnosis. The prevalence of SMI amongst the ACS population doubled over the study period (from 4.5% in 2004 to 9.5% in 2014), primarily due to an increase in Major Depression and Bipolar Disorder diagnoses. All SMI subtypes were less likely to receive coronary angiography and PCI, with the Schizophrenia group being at least odds of either procedure (aOR 0.46 95% CI 0.45, 0.48 and aOR 0.57 95% CI 0.55, 0.59, respectively). Although patients with Schizophrenia and ONOP experienced higher crude rates of in-hospital mortality and stroke compared to those without SMI, only Schizophrenia patients were associated with increased odds of mortality (aOR 1.10 95% CI 1.04, 1.16), while ONOP were the only group at increased odds of stroke (aOR 1.53 95% CI 1.42,1.65) following multivariate adjustment. Patients with ONOP were the only group associated with increased odds of in-hospital bleeding compared to those without SMI (aOR 1.11 95% CI 1.04,1.17).
Conclusion
Patients with SMI are less likely to receive invasive management for AMI, with women and schizophrenia diagnosis being the strongest predictors of conservative management. Schizophrenia and “other non-organic psychoses” are the only SMI subtypes associated with adverse clinical outcomes after AMI. A multidisciplinary approach between psychiatrists and cardiologists could improve outcomes of this high-risk population.
Odds of management and clinical outcomes
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Mohamed
- Keele University, Cardiology, Keele, United Kingdom
| | - M Rashid
- Keele University, Keele, United Kingdom
| | - S Farooq
- Keele University, Keele, United Kingdom
| | - N Siddiqui
- Nevill Hall Hospital, Abergavenny, United Kingdom
| | - P Parwani
- Loma Linda University Medical Center, Loma Linda, United States of America
| | - D Shiers
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - R Thamman
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, United States of America
| | - M Gulati
- University of Arizona College of Medicine, Phoenix, United States of America
| | - A Shoaib
- Keele University, Cardiology, Keele, United Kingdom
| | | | - M.A Mamas
- Keele University, Cardiology, Keele, United Kingdom
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18
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Watts V, Brown B, Ahmed M, Charlett A, Chew-Graham C, Cleary P, Decraene V, Dodgson K, George R, Hopkins S, Esmail A, Welfare W. Routine laboratory surveillance of antimicrobial resistance in community-acquired urinary tract infections adequately informs prescribing policy in England. JAC Antimicrob Resist 2020; 2:dlaa022. [PMID: 34222986 PMCID: PMC8210191 DOI: 10.1093/jacamr/dlaa022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/14/2020] [Accepted: 02/20/2020] [Indexed: 12/28/2022] Open
Abstract
Objectives To assess whether resistance estimates obtained from sentinel surveillance for antimicrobial resistance (AMR) in community-acquired urinary tract infections (UTIs) differ from routinely collected laboratory community UTI data. Methods All patients aged ≥18 years presenting to four sentinel general practices with a suspected UTI, from 13 November 2017 to 12 February 2018, were asked to provide urine specimens for culture and susceptibility. Specimens were processed at the local diagnostic laboratory. Antibiotic susceptibility testing was conducted using automated methods. We calculated the proportion of Escherichia coli isolates that were non-susceptible (according to contemporaneous EUCAST guidelines) to trimethoprim, nitrofurantoin, cefalexin, ciprofloxacin and amoxicillin/clavulanic acid, overall and by age group and sex, and compared this with routine estimates. Results Sentinel practices submitted 740 eligible specimens. The specimen submission rate had increased by 28 specimens per 1000 population per year (95% CI 21-35). Uropathogens were isolated from 23% (169/740) of specimens; 67% were E. coli (113/169). Non-susceptibility of E. coli to trimethoprim was 28.2% (95% CI 20.2-37.7) on sentinel surveillance (33.4%; 95% CI 29.5-37.6 on routine data) and to nitrofurantoin was 0.9% (95% CI 0-5.7) (1.5%; 95% CI 0.7-3.0 on routine data). Conclusions Routine laboratory data resulted in a small overestimation in resistance (although the difference was not statistically significant) and our findings suggest that it provides an adequate estimate of non-susceptibility to key antimicrobials in community-acquired UTIs in England. This study does not support the need for ongoing local sentinel surveillance.
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Affiliation(s)
- Vicky Watts
- Field Service North West, National Infection Service, Public Health England, Liverpool, UK
| | - Benjamin Brown
- Centre for Primary Care, Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Centre for Health Informatics, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Maria Ahmed
- Manchester Medical, Moss Side Health Centre, Manchester, UK.,NIHR Clinical Research Network: Greater Manchester, Manchester, UK
| | - André Charlett
- Statistics Unit, Data and Analytical Sciences, National Infection Service, Public Health England, London, UK
| | - Carolyn Chew-Graham
- School of Primary, Community and Social Care, Keele University, Keele, Newcastle-under-Lyme, UK
| | - Paul Cleary
- Field Service North West, National Infection Service, Public Health England, Liverpool, UK
| | - Valerie Decraene
- Field Service North West, National Infection Service, Public Health England, Liverpool, UK
| | - Kirsty Dodgson
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Ryan George
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Susan Hopkins
- HCAI & AMR Division, National Infection Service, Public Health England, London, UK
| | - Aneez Esmail
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - William Welfare
- Health Protection Team, Public Health England North West, Manchester, UK.,Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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19
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Hawarden AW, Paskins Z, Desilva EE, Herron D, Machin A, Jinks C, Hider S, Chew-Graham C. P193 Experiences of delivering a nurse-led fracture risk assessment for patients with inflammatory rheumatological conditions in primary care. Rheumatology (Oxford) 2020. [DOI: 10.1093/rheumatology/keaa111.188] [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: 11/14/2022] Open
Abstract
Abstract
Background
The INCLUDE (INtegrating and improving Care for patients with infLammatory rheUmatological DisordErs in the community) pilot trial aimed to evaluate the feasibility and acceptability of a nurse-delivered review in primary care for people with inflammatory rheumatological conditions (IRCs), to identify and manage common comorbidities including anxiety and depression, cardiovascular and fracture risk. We report analysis of data focusing on the fracture risk assessment component of the review.
Methods
Ethical approvals obtained. Semi-structured interviews were conducted to explore experiences of participating in INCLUDE, with 20 patients, the two nurses delivering the intervention and three General Practitioners (GPs) within participating practices. 24 consenting patients had their INCLUDE review recorded for fidelity checking. Selected extracts were played within some interviews to stimulate discussion (tape-assisted recall). Extracts from recorded consultations relating to fracture risk assessment were transcribed and coded. Interviews were digitally recorded, with consent, transcribed and anonymised. Thematic analysis of the interview data was followed by mapping to the Theoretical Domains Framework (TDF).
Results
Findings mapped to 10/14 TDF domains relating to knowledge, skills, social/professional role and identity, beliefs about capabilities, optimism, beliefs about consequences, reinforcement, intentions, memory attention and decision processes and environmental context/resources. GPs and nurses identified a lack of knowledge and skills in relation to the identification and management of osteoporosis, due to lack of exposure and repeated changes in clinical guidance. GPs reported differing opinions about whether osteoporosis screening was the role of primary or secondary care. GPs and nurses had differing views about the limits of the nurse role in communicating risk. The INCLUDE nurses reported confidence (self-efficacy) in undertaking FRAX assessments. Nurses valued the opportunity to learn new skills and believed that they were improving patient care. They described practical barriers using FRAX including the difficulty navigating between different IT systems. Nurses described uncertainty over when to refer to the GP. Fidelity checks of recorded reviews, showed that FRAX was appropriately calculated for 22/24 patients; whilst INCLUDE nurses introduced the reason for calculating fracture risk, explanations of the meaning of risk were limited, and patients’ understanding was not always checked and queries not responded to; patient interview findings confirmed patients had limited understanding of the meaning of FRAX. Life-style advice related to bone health was given in few consultations.
Conclusion
Screening for fracture risk in people with IRCs in a review consultation is acceptable and feasible, although explanations of the meaning of risk assessment could be improved. Integration of a fracture risk assessment tool within GP software would facilitate risk calculation. More work is needed to understand barriers to risk assessment, including clarity over roles and professional boundaries, and develop management pathways to optimise management of fracture risk in people with IRCs.
Disclosures
A.W. Hawarden None. Z. Paskins None. E. Ediriweera Desilva None. D. Herron None. A. Machin None. C. Jinks None. S. Hider None. C. Chew-Graham None.
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Affiliation(s)
- Ashley W Hawarden
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Stoke on Trent, UNITED KINGDOM
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke on Trent, UNITED KINGDOM
| | - Zoe Paskins
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Stoke on Trent, UNITED KINGDOM
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke on Trent, UNITED KINGDOM
| | - Erandie Ediriweera Desilva
- Family Medicine Unit, Faculty of Medicine, University of Colombo, SRI LANKA
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Stoke on Trent, UNITED KINGDOM
| | - Daniel Herron
- University of Derby Online Learning, University of Derby, Derby, UNITED KINGDOM
| | - Anabelle Machin
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Stoke on Trent, UNITED KINGDOM
| | - Clare Jinks
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Stoke on Trent, UNITED KINGDOM
| | - Samantha Hider
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Stoke on Trent, UNITED KINGDOM
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke on Trent, UNITED KINGDOM
| | - Carolyn Chew-Graham
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Stoke on Trent, UNITED KINGDOM
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20
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Hider S, Machin A, Bucknall M, Cooke K, Jinks C, Healey E, Finney A, Cooke K, Wathall S, Mallen C, Chew-Graham C. P146 Undertaking an integrated nurse led review (INCLUDE) for patients with inflammatory conditions: does it change management of morbidities? Rheumatology (Oxford) 2020. [DOI: 10.1093/rheumatology/keaa111.141] [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
People with inflammatory rheumatological conditions (IRCs), including rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), polymyalgia rheumatica (PMR) and giant cell arteritis (GCA), are at an increased risk of common comorbidities, such as cardiovascular disease (CVD), osteoporosis and mood problems, which result in poorer patient outcomes. The INCLUDE study assessed the feasibility of conducting a randomised controlled trial (RCT) of a nurse-led, holistic, integrated review in primary care.
Methods
A pilot cluster RCT was delivered across four general practices. Patients with a Read code for an IRC were recruited by postal invitation. In intervention practices (n = 2), eligible patients were invited to attend a nurse-delivered INCLUDE review - an integrated consultation assessing CVD risk (QRisk2), bone health (FRAX) and mood (PHQ2 and GAD2), using a study-specific computerised template. Patients received an individualized patient management plan, including signposting to additional services as appropriate. Medical record review was undertaken (in consenting participants) at 12 months. We compared primary care contacts (which include consultations, letters and test results) and prescribing rates (of antihypertensives, lipid-lowering, osteoporosis and antidepressant/anxiety medication) at baseline and 12 months.
Results
333 patients participated in the study. The mean (SD) age was 68.2 (13.4) years and 200 (60%) were female. Of these 172 (52%) had RA and 88 (26%) had PMR. 154 (46%) reported high blood pressure, 70 (21%) existing anxiety/depression and 37 (11%) osteoporosis. Medical record data was available for 299/333 participants. Participants in intervention practices had more primary care contacts (mean 29 vs 22). Over the 12-month follow-up, there was higher prescribing of all medication classes in participants in intervention practices (see Table), particularly so for osteoporosis medication (baseline 29% vs 12 month 46%).
Conclusion
Nurse-delivered integrated reviews for patients with IRCs identified a significant comorbidity burden. Practices undertaking these reviews had higher prescribing rates at 12 months following treatment of previously un-identified conditions, suggesting that patients with IRCs would benefit from an integrated care review to identify and manage common morbidities.
Disclosures
S. Hider None. A. Machin None. M. Bucknall None. K. Cooke None. C. Jinks None. E. Healey None. A. Finney None. K. Cooke None. S. Wathall None. C. Mallen None. C. Chew-Graham None.
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Affiliation(s)
- Samantha Hider
- School of Primary Community and Social Care, Keele University, Staffordshire, UNITED KINGDOM
- Haywood Academic Rheumatology Centre, Midlands Partnership Foundation Trust, Staffordshire, UNITED KINGDOM
| | - Annabelle Machin
- School of Primary Community and Social Care, Keele University, Staffordshire, UNITED KINGDOM
| | - Milica Bucknall
- School of Primary Community and Social Care, Keele University, Staffordshire, UNITED KINGDOM
| | - Kendra Cooke
- Clinical Trials Unit, Keele University, Staffordshire, UNITED KINGDOM
| | - Clare Jinks
- School of Primary Community and Social Care, Keele University, Staffordshire, UNITED KINGDOM
- NIHR, Applied Research Collaboration, (West Midlands), UNITED KINGDOM
| | - Emma Healey
- School of Primary Community and Social Care, Keele University, Staffordshire, UNITED KINGDOM
| | - Andrew Finney
- School of Primary Community and Social Care, Keele University, Staffordshire, UNITED KINGDOM
- School of Nursing and Midwifery, Keele University, Staffordshire, UNITED KINGDOM
| | - Kelly Cooke
- Haywood Academic Rheumatology Centre, Midlands Partnership Foundation Trust, Staffordshire, UNITED KINGDOM
| | - Simon Wathall
- School of Primary Community and Social Care, Keele University, Staffordshire, UNITED KINGDOM
| | - Christian Mallen
- School of Primary Community and Social Care, Keele University, Staffordshire, UNITED KINGDOM
- NIHR, Applied Research Collaboration, (West Midlands), UNITED KINGDOM
| | - Carolyn Chew-Graham
- School of Primary Community and Social Care, Keele University, Staffordshire, UNITED KINGDOM
- NIHR, Applied Research Collaboration, (West Midlands), UNITED KINGDOM
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21
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Saunders B, Hill JC, Foster NE, Cooper V, Protheroe J, Chudyk A, Chew-Graham C, Bartlam B. Stratified primary care versus non-stratified care for musculoskeletal pain: qualitative findings from the STarT MSK feasibility and pilot cluster randomized controlled trial. BMC Fam Pract 2020; 21:31. [PMID: 32046656 PMCID: PMC7014618 DOI: 10.1186/s12875-020-1098-1] [Citation(s) in RCA: 12] [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] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 01/27/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Stratified care involves subgrouping patients based on key characteristics, e.g. prognostic risk, and matching these subgroups to appropriate early treatment options. The STarT MSK feasibility and pilot cluster randomised controlled trial (RCT) examined the feasibility of a future main trial and of delivering prognostic stratified primary care for patients with musculoskeletal pain. The pilot RCT was conducted in 8 UK general practices (4 stratified care; 4 usual care) with 524 patients. GPs in stratified care practices were asked to use i) the Keele STarT MSK development tool for risk-stratification and ii) matched treatment options for patients at low-, medium- and high-risk of persistent pain. This paper reports on a nested qualitative study exploring the feasibility of delivering stratified care ahead of the main trial. METHODS 'Stimulated-recall' interviews were conducted with patients and GPs in the stratified care arm (n = 10 patients; 10 GPs), prompted by consultation recordings. Data were analysed thematically and mapped onto the COM-B behaviour change model; exploring the Capability, Opportunity and Motivation GPs and patients had to engage with stratified care. RESULTS Patients reported positive views that stratified care enabled a more 'structured' consultation, and felt tool items were useful in making GPs aware of patients' worries and concerns. However, the closed nature of the tool's items was seen as a barrier to opening up discussion. GPs identified difficulties integrating the tool within consultations (Opportunity), but found this easier as it became more familiar. Whilst both groups felt the tool had added value, they identified 'cumbersome' items which made it more difficult to use (Capability). Most GPs reported that the matched treatment options aided their clinical decision-making (Motivation), but identified some options that were not available to them (e.g. pain management clinics), and other options that were not included in the matched treatments but which were felt appropriate for some patients (e.g. consider imaging). CONCLUSION This nested qualitative study, using the COM-B model, identified amendments required for the main trial including changes to the Keele STarT MSK tool and matched treatment options, targeting the COM-B model constructs, and these have been implemented in the current main trial. TRIAL REGISTRATION ISRCTN 15366334.
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Affiliation(s)
- Benjamin Saunders
- Primary Care Centre Versus Arthritis, School for Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK.
| | - Jonathan C Hill
- Primary Care Centre Versus Arthritis, School for Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Nadine E Foster
- Primary Care Centre Versus Arthritis, School for Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK
- Keele Clinical Trials Unit (CTU), School for Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Vince Cooper
- Primary Care Centre Versus Arthritis, School for Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Joanne Protheroe
- Primary Care Centre Versus Arthritis, School for Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Adrian Chudyk
- Primary Care Centre Versus Arthritis, School for Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Carolyn Chew-Graham
- Primary Care Centre Versus Arthritis, School for Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Bernadette Bartlam
- Primary Care Centre Versus Arthritis, School for Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 308232, Singapore
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22
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Nowakowska M, Zghebi SS, Ashcroft DM, Buchan I, Chew-Graham C, Holt T, Mallen C, Van Marwijk H, Peek N, Perera-Salazar R, Reeves D, Rutter MK, Weng SF, Qureshi N, Mamas MA, Kontopantelis E. Correction to: The comorbidity burden of type 2 diabetes mellitus: patterns, clusters and predictions from a large English primary care cohort. BMC Med 2020; 18:22. [PMID: 31980024 PMCID: PMC6982380 DOI: 10.1186/s12916-020-1492-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The original article [1] contains an omitted grant acknowledgement and affiliation as relates to the contribution of co-author, Rafael Perera-Salazar. As such, the following two amendments should apply to the original article.
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Affiliation(s)
- Magdalena Nowakowska
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, Manchester Academic Health Science Centre (MAHSC), University of Manchester, 5th floor Williamson Building, Manchester, M13 9PL, UK. .,Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, 5th floor Williamson Building, Manchester, M13 9PL, UK.
| | - Salwa S Zghebi
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, Manchester Academic Health Science Centre (MAHSC), University of Manchester, 5th floor Williamson Building, Manchester, M13 9PL, UK.,Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, 5th floor Williamson Building, Manchester, M13 9PL, UK
| | - Darren M Ashcroft
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, Manchester Academic Health Science Centre (MAHSC), University of Manchester, 5th floor Williamson Building, Manchester, M13 9PL, UK.,Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, M13 9PL, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, M13 9PL, UK
| | - Iain Buchan
- Division of Informatics, Imaging, and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, M13 9PL, UK.,Department of Public Health and Policy, Institute of Population Health Sciences, University of Liverpool, Liverpool, L69 3BX, UK
| | - Carolyn Chew-Graham
- Research Institute for Primary Care and Health Sciences, Faculty of Medicine and Health Sciences, Keele University, DJW 1.54a, Staffordshire, ST5 5BJ, UK
| | - Tim Holt
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Christian Mallen
- Research Institute for Primary Care and Health Sciences, Faculty of Medicine and Health Sciences, Keele University, DJW 1.54a, Staffordshire, ST5 5BJ, UK
| | - Harm Van Marwijk
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9PH, UK
| | - Niels Peek
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, M13 9PL, UK.,Division of Informatics, Imaging, and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, M13 9PL, UK.,NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, M13 9PL, UK
| | - Rafael Perera-Salazar
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK.,NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - David Reeves
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, Manchester Academic Health Science Centre (MAHSC), University of Manchester, 5th floor Williamson Building, Manchester, M13 9PL, UK.,Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, 5th floor Williamson Building, Manchester, M13 9PL, UK.,Centre for Biostatistics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PL, UK
| | - Martin K Rutter
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Medicine, Biology and Health, University of Manchester, Manchester, M13 9PL, UK.,Manchester Diabetes Centre, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, M13 0JE, UK
| | - Stephen F Weng
- Primary Care Stratified Medicine (PRISM), Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Nadeem Qureshi
- Primary Care Stratified Medicine (PRISM), Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, ST4 7QB, UK
| | - Evangelos Kontopantelis
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, Manchester Academic Health Science Centre (MAHSC), University of Manchester, 5th floor Williamson Building, Manchester, M13 9PL, UK.,Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, 5th floor Williamson Building, Manchester, M13 9PL, UK.,Division of Informatics, Imaging, and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, M13 9PL, UK
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23
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Silverwood V, Chew-Graham C, Kingstone T. Maternal six week postnatal check should assess for postnatal anxiety. BMJ 2020; 368:m256. [PMID: 31980433 DOI: 10.1136/bmj.m256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Victoria Silverwood
- School of Primary, Community, and Social Care, David Weatherall Building, Keele University, Keele ST5 5BG, UK
| | - Carolyn Chew-Graham
- School of Primary, Community, and Social Care, David Weatherall Building, Keele University, Keele ST5 5BG, UK
| | - Tom Kingstone
- School of Primary, Community, and Social Care, David Weatherall Building, Keele University, Keele ST5 5BG, UK
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24
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Nowakowska M, Zghebi SS, Ashcroft DM, Buchan I, Chew-Graham C, Holt T, Mallen C, Van Marwijk H, Peek N, Perera-Salazar R, Reeves D, Rutter MK, Weng SF, Qureshi N, Mamas MA, Kontopantelis E. The comorbidity burden of type 2 diabetes mellitus: patterns, clusters and predictions from a large English primary care cohort. BMC Med 2019; 17:145. [PMID: 31345214 PMCID: PMC6659216 DOI: 10.1186/s12916-019-1373-y] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [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: 04/08/2019] [Accepted: 06/20/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The presence of additional chronic conditions has a significant impact on the treatment and management of type 2 diabetes (T2DM). Little is known about the patterns of comorbidities in this population. The aims of this study are to quantify comorbidity patterns in people with T2DM, to estimate the prevalence of six chronic conditions in 2027 and to identify clusters of similar conditions. METHODS We used the Clinical Practice Research Datalink (CPRD) linked with the Index of Multiple Deprivation (IMD) data to identify patients diagnosed with T2DM between 2007 and 2017. 102,394 people met the study inclusion criteria. We calculated the crude and age-standardised prevalence of 18 chronic conditions present at and after the T2DM diagnosis. We analysed longitudinally the 6 most common conditions and forecasted their prevalence in 2027 using linear regression. We used agglomerative hierarchical clustering to identify comorbidity clusters. These analyses were repeated on subgroups stratified by gender and deprivation. RESULTS More people living in the most deprived areas had ≥ 1 comorbidities present at the time of diagnosis (72% of females; 64% of males) compared to the most affluent areas (67% of females; 59% of males). Depression prevalence increased in all strata and was more common in the most deprived areas. Depression was predicted to affect 33% of females and 15% of males diagnosed with T2DM in 2027. Moderate clustering tendencies were observed, with concordant conditions grouped together and some variations between groups of different demographics. CONCLUSIONS Comorbidities are common in this population, and high between-patient variability in comorbidity patterns emphasises the need for patient-centred healthcare. Mental health is a growing concern, and there is a need for interventions that target both physical and mental health in this population.
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Affiliation(s)
- Magdalena Nowakowska
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, Manchester Academic Health Science Centre (MAHSC), University of Manchester, 5th floor Williamson Building, Manchester, M13 9PL, UK. .,Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, 5th floor Williamson Building, Manchester, M13 9PL, UK.
| | - Salwa S Zghebi
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, Manchester Academic Health Science Centre (MAHSC), University of Manchester, 5th floor Williamson Building, Manchester, M13 9PL, UK.,Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, 5th floor Williamson Building, Manchester, M13 9PL, UK
| | - Darren M Ashcroft
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, Manchester Academic Health Science Centre (MAHSC), University of Manchester, 5th floor Williamson Building, Manchester, M13 9PL, UK.,Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, M13 9PL, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, M13 9PL, UK
| | - Iain Buchan
- Division of Informatics, Imaging, and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, M13 9PL, UK.,Department of Public Health and Policy, Institute of Population Health Sciences, University of Liverpool, Liverpool, L69 3BX, UK
| | - Carolyn Chew-Graham
- Research Institute for Primary Care and Health Sciences, Faculty of Medicine and Health Sciences, Keele University, DJW 1.54a, Staffordshire, ST5 5BJ, UK
| | - Tim Holt
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Christian Mallen
- Research Institute for Primary Care and Health Sciences, Faculty of Medicine and Health Sciences, Keele University, DJW 1.54a, Staffordshire, ST5 5BJ, UK
| | - Harm Van Marwijk
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9PH, UK
| | - Niels Peek
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, M13 9PL, UK.,Division of Informatics, Imaging, and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, M13 9PL, UK.,NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, M13 9PL, UK
| | - Rafael Perera-Salazar
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - David Reeves
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, Manchester Academic Health Science Centre (MAHSC), University of Manchester, 5th floor Williamson Building, Manchester, M13 9PL, UK.,Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, 5th floor Williamson Building, Manchester, M13 9PL, UK.,Centre for Biostatistics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PL, UK
| | - Martin K Rutter
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Medicine, Biology and Health, University of Manchester, Manchester, M13 9PL, UK.,Manchester Diabetes Centre, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, M13 0JE, UK
| | - Stephen F Weng
- Primary Care Stratified Medicine (PRISM), Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Nadeem Qureshi
- Primary Care Stratified Medicine (PRISM), Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, ST4 7QB, UK
| | - Evangelos Kontopantelis
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, Manchester Academic Health Science Centre (MAHSC), University of Manchester, 5th floor Williamson Building, Manchester, M13 9PL, UK.,Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, 5th floor Williamson Building, Manchester, M13 9PL, UK.,Division of Informatics, Imaging, and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, M13 9PL, UK
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25
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Littlewood E, Ali S, Badenhorst J, Bailey D, Bambra C, Chew-Graham C, Coleman E, Crosland S, Gascoyne S, Gilbody S, Hewitt C, Jones C, Keding A, Kitchen C, McMillan D, Pearson C, Rhodes S, Sloan C, Todd A, Watson M, Whittlesea C, Ekers D. Community Pharmacies Mood Intervention Study (CHEMIST): feasibility and external pilot randomised controlled trial protocol. Pilot Feasibility Stud 2019; 5:71. [PMID: 31161045 PMCID: PMC6540405 DOI: 10.1186/s40814-019-0457-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/09/2019] [Indexed: 11/10/2022] Open
Abstract
FEASIBILITY STUDY Objectives:Refine a bespoke enhanced support intervention (ESI) (including self-help materials, intervention manual and training) for implementation by community pharmacy (CP) staff to people with sub-threshold depression and long-term conditions (LTCs) based upon evidence-supported interventions in primary careDevelop and refine study procedures (recruitment strategies and set up, screening, participant recruitment, assessment, suitability of outcome measures and data collection procedures) for testing in the pilot study phaseDesign: A case series/qualitative studySetting: UK community pharmacyPopulation: Adults with long-term health conditions who screen-positive for depression but who do not reach the threshold for DSM IV Moderate Depressive disorderIntervention: Enhanced support intervention (ESI) delivered by an appropriately trained community pharmacy team member involving four to six sessions over four months. ESI is a modified form of an intervention within the collaborative care framework for sub-threshold depression validated in previous studies in UK primary care which appears suitable for implementation in community settings.Sample size: 20-30 participantsOutcomes: Study implementation (recruitment and attrition rates), quality of data collection at baseline and 4 months and ESI adherence (number of contacts, DNA and drop out) as per objectives 1a/bQualitative evaluation: Semi-structured interviews with up to 10 participants and ESI facilitators and focus group(s) (range of pharmacy staff n = 8-10) will be conducted to explore the acceptability of the intervention and feasibility of the study, training and study procedures. EXTERNAL PILOT STUDY Objectives:Quantify the flow of participants (eligibility, recruitment and follow-up rate)Evaluate proposed recruitment, assessment and outcome measure collection methodsExamine the delivery of the enhanced support intervention in a community pharmacy setting (intervention uptake, retention and dose) to inform process evaluationProcess evaluation, using semi-structured interviews with participants across a range of socio-economic settings, and pharmacy staff to explore the acceptability of the ESI within community pharmacy, elements of the intervention that were considered useful (or not) and appropriateness of study proceduresDesign: Pilot randomised controlled trial, including a prospective economic and qualitative evaluationSetting: As abovePopulation: As aboveIntervention: As above with adaptations post feasibility studyComparator: Usual careSample size: 100 participantsOutcomes: Data will be used to estimate recruitment, intervention delivery and study completion rates as per objectives 2a-d. Definitive estimates of the effectiveness of ESI will not be made.Primary outcome: Depression severity (Patient Health Questionnaire 9) at four months.Secondary outcomes: Patient acceptance, uptake and attrition. ICD10 depression status, anxiety (GAD 7), health-related quality of life (SF-12v2) and health-state utility (EQ5D 3L) will be measured at four months.Economic evaluation: The incremental cost per QALY will be calculated from both the NHS and societal perspective.Process evaluation: Using mixed methods, potential mediators/moderators of the intervention, the acceptability (to participants and pharmacy staff), barriers and facilitators to the use of ESI in community pharmacy, and impact on usual practice will be examined. Semi-structured interviews with approximately 30 study participants, 20 pharmacy staff and eight GPs near participating pharmacies will be conducted. TRIAL REGISTRATION ISRCTN: ISRCTN11290592Protocol version number: Version 4.1 (dated 16th January 2018)Study Sponsor Tees Esk and Wear Valleys NHS Foundation Trust.
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Affiliation(s)
| | - Shehzad Ali
- Department of Health Sciences, University of York, York, YO10 5DD UK
| | - Jay Badenhorst
- Whitworth Chemists Ltd, 2C Atkinson Way, Foxhill Industrial Estate, Scunthorpe, DN15 8QJ UK
| | - Della Bailey
- Department of Health Sciences, University of York, York, YO10 5DD UK
| | - Clare Bambra
- Institute of Health & Society, Newcastle University, Richardson Road, Newcastle Upon Tyne, NE2 4AX UK
| | - Carolyn Chew-Graham
- Research Institute, Primary Care and Health Sciences, Keele University, Staffordshire, ST5 5BG UK
| | - Elizabeth Coleman
- Department of Health Sciences, University of York, York, YO10 5DD UK
| | - Suzanne Crosland
- Department of Health Sciences, University of York, York, YO10 5DD UK
| | - Samantha Gascoyne
- Department of Health Sciences, University of York, York, YO10 5DD UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, YO10 5DD UK
| | - Catherine Hewitt
- Department of Health Sciences, University of York, York, YO10 5DD UK
| | - Claire Jones
- Public Health Team, Children & Adult Services, Durham County Council, County Hall, DH1 5UJ UK
| | - Ada Keding
- Department of Health Sciences, University of York, York, YO10 5DD UK
| | - Charlotte Kitchen
- Department of Health Sciences, University of York, York, YO10 5DD UK
| | - Dean McMillan
- Department of Health Sciences, University of York, York, YO10 5DD UK
| | - Caroline Pearson
- Department of Health Sciences, University of York, York, YO10 5DD UK
| | - Shelley Rhodes
- University of Exeter Medical School, University of Exeter, Exeter, EX1 2LU UK
| | - Claire Sloan
- Department of Health Sciences, University of York, York, YO10 5DD UK
| | - Adam Todd
- Institute of Health & Society, Newcastle University, Richardson Road, Newcastle Upon Tyne, NE2 4AX UK
- School of Pharmacy, King George VI Building, Queen Victoria Road, Newcastle Upon Tyne, NE1 7RU UK
| | - Michelle Watson
- Department of Health Sciences, University of York, York, YO10 5DD UK
| | - Cate Whittlesea
- UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London, WC1N 1AX UK
| | - David Ekers
- Department of Health Sciences, University of York, York, YO10 5DD UK
- Tees Esk and Wear Valleys NHS FT/University of York, Tarncroft House, Lanchester Road Hospital, Durham, DH1 5RD UK
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Mohamed MO, Rashid M, Farooq S, Siddiqui N, Parwani P, Shiers D, Thamman R, Gulati M, Shoaib A, Chew-Graham C, Mamas MA. Acute Myocardial Infarction in Severe Mental Illness: Prevalence, Clinical Outcomes, and Process of Care in U.S. Hospitalizations. Can J Cardiol 2019; 35:821-830. [PMID: 31292080 DOI: 10.1016/j.cjca.2019.04.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 04/25/2019] [Accepted: 04/25/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Severe mental illness (SMI) is associated with increased cardiovascular mortality. We sought to examine the prevalence, clinical outcomes, and management strategy of patients with SMI presenting with acute myocardial infarction (AMI). METHODS All AMI hospitalizations from the National Inpatient Sample were included, stratified by mental health status into 5 groups: no SMI, schizophrenia, other non-organic psychoses (ONOP), bipolar disorder, and major depression. Regression analyses were performed to assess the association (adjusted odds ratios [ORs], P ≤ 0.001 for all outcomes) between SMI subtypes and clinical outcomes. RESULTS Of 6,968,777 AMI hospitalizations between 2004 and 2014, 439,544 patients (6.5%) had an SMI diagnosis. Although patients with schizophrenia and ONOP experienced higher crude rates of in-hospital mortality and stroke compared with those without SMI, only schizophrenic patients were at increased odds of mortality (OR, 1.10; 95% confidence interval [CI], 1.04-1.16), whereas ONOP was the only group at increased odds of stroke (OR, 1.53; 95% CI, 1.42-1.65) after multivariate adjustment. Patients with ONOP were the only group associated with increased odds of in-hospital bleeding compared with those without SMI (OR, 1.11; 95% CI, 1.04-1.17). All those with SMI subtypes were less likely to receive coronary angiography and percutaneous coronary intervention, with the schizophrenia group being at least odds of either procedure (OR, 0.46; 95% CI, 0.45-0.48 and OR, 0.57; 95% CI, 0.55-0.59, respectively). CONCLUSION Schizophrenia and ONOP are the only SMI subtypes associated with adverse clinical outcomes after AMI. However, all patients with SMI were less likely to receive invasive management for AMI, with female gender and schizophrenia diagnosis being the strongest predictors of conservative management. A multidisciplinary approach between psychiatrists and cardiologists could improve the outcomes of this high-risk population.
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Affiliation(s)
- Mohamed Osama Mohamed
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Saeed Farooq
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom; Midlands Partnership NHS Foundation Trust, Staffordshire, United Kingdom
| | - Nishat Siddiqui
- Nevill Hall Hospital, Aneurin Bevan University Health Board, Wales, United Kingdom
| | - Purvi Parwani
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, California, USA
| | - David Shiers
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Ritu Thamman
- Department of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Martha Gulati
- Division of Cardiology, University of Arizona, Phoenix, Arizona, USA
| | - Ahmad Shoaib
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Carolyn Chew-Graham
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom; Midlands Partnership NHS Foundation Trust, Staffordshire, United Kingdom
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Keele, United Kingdom.
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Kessler D, Burns A, Tallon D, Lewis G, MacNeill S, Round J, Hollingworth W, Chew-Graham C, Anderson I, Campbell J, Dickens C, Macleod U, Gilbody S, Davies S, Peters TJ, Wiles N. Combining mirtazapine with SSRIs or SNRIs for treatment-resistant depression: the MIR RCT. Health Technol Assess 2019; 22:1-136. [PMID: 30468145 DOI: 10.3310/hta22630] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Depression is usually managed in primary care and antidepressants are often the first-line treatment, but only half of those treated respond to a single antidepressant. OBJECTIVES To investigate whether or not combining mirtazapine with serotonin-noradrenaline reuptake inhibitor (SNRI) or selective serotonin reuptake inhibitor (SSRI) antidepressants results in better patient outcomes and more efficient NHS care than SNRI or SSRI therapy alone in treatment-resistant depression (TRD). DESIGN The MIR trial was a two-parallel-group, multicentre, pragmatic, placebo-controlled randomised trial with allocation at the level of the individual. SETTING Participants were recruited from primary care in Bristol, Exeter, Hull/York and Manchester/Keele. PARTICIPANTS Eligible participants were aged ≥ 18 years; were taking a SSRI or a SNRI antidepressant for at least 6 weeks at an adequate dose; scored ≥ 14 points on the Beck Depression Inventory-II (BDI-II); were adherent to medication; and met the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, criteria for depression. INTERVENTIONS Participants were randomised using a computer-generated code to either oral mirtazapine or a matched placebo, starting at a dose of 15 mg daily for 2 weeks and increasing to 30 mg daily for up to 12 months, in addition to their usual antidepressant. Participants, their general practitioners (GPs) and the research team were blind to the allocation. MAIN OUTCOME MEASURES The primary outcome was depression symptoms at 12 weeks post randomisation compared with baseline, measured as a continuous variable using the BDI-II. Secondary outcomes (at 12, 24 and 52 weeks) included response, remission of depression, change in anxiety symptoms, adverse events (AEs), quality of life, adherence to medication, health and social care use and cost-effectiveness. Outcomes were analysed on an intention-to-treat basis. A qualitative study explored patients' views and experiences of managing depression and GPs' views on prescribing a second antidepressant. RESULTS There were 480 patients randomised to the trial (mirtazapine and usual care, n = 241; placebo and usual care, n = 239), of whom 431 patients (89.8%) were followed up at 12 weeks. BDI-II scores at 12 weeks were lower in the mirtazapine group than the placebo group after adjustment for baseline BDI-II score and minimisation and stratification variables [difference -1.83 points, 95% confidence interval (CI) -3.92 to 0.27 points; p = 0.087]. This was smaller than the minimum clinically important difference and the CI included the null. The difference became smaller at subsequent time points (24 weeks: -0.85 points, 95% CI -3.12 to 1.43 points; 12 months: 0.17 points, 95% CI -2.13 to 2.46 points). More participants in the mirtazapine group withdrew from the trial medication, citing mild AEs (46 vs. 9 participants). CONCLUSIONS This study did not find convincing evidence of a clinically important benefit for mirtazapine in addition to a SSRI or a SNRI antidepressant over placebo in primary care patients with TRD. There was no evidence that the addition of mirtazapine was a cost-effective use of NHS resources. GPs and patients were concerned about adding an additional antidepressant. LIMITATIONS Voluntary unblinding for participants after the primary outcome at 12 weeks made interpretation of longer-term outcomes more difficult. FUTURE WORK Treatment-resistant depression remains an area of important, unmet need, with limited evidence of effective treatments. Promising interventions include augmentation with atypical antipsychotics and treatment using transcranial magnetic stimulation. TRIAL REGISTRATION Current Controlled Trials ISRCTN06653773; EudraCT number 2012-000090-23. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 63. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- David Kessler
- Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Alison Burns
- Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Debbie Tallon
- Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Glyn Lewis
- Mental Health Services Unit, University College London, London, UK
| | - Stephanie MacNeill
- Bristol Randomised Trials Collaboration, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Jeff Round
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - William Hollingworth
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Carolyn Chew-Graham
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Ian Anderson
- Neuroscience and Psychiatry Unit, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | | | | | - Una Macleod
- Hull York Medical School, University of Hull, Hull, UK
| | - Simon Gilbody
- Mental Health Research Group, University of York, York, UK
| | - Simon Davies
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Tim J Peters
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Nicola Wiles
- Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
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Stuart B, Leydon G, Woods C, Gennery E, Elsey C, Summers R, Stevenson F, Chew-Graham C, Barnes R, Drew P, Moore M, Little P. The elicitation and management of multiple health concerns in GP consultations. Patient Educ Couns 2019; 102:687-693. [PMID: 30473249 DOI: 10.1016/j.pec.2018.11.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/23/2018] [Accepted: 11/10/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To describe the nature of patient concerns and to explore if, when and how they are addressed by GPs in the UK. METHODS Detailed coding and descriptive analysis of 185 video recordings from the EPaC study (Elicitation of Patient Concerns, EPaC) RESULTS: An average of 2.1 concerns were raised per consultation and the most common concerns were musculoskeletal, administrative (e.g. test results and medication related issues), and skin symptoms. GPs who had been trained as part of the EPaC intervention to solicit for additional concerns in the opening phase of the consultation did so 92.6% of the time. In contrast, those in the control arm did so only 7% of the time. However, the particular formulation of the GP soliciting question does not seem to be associated with the likelihood of the patient volunteering an additional concern. CONCLUSIONS GP consultations are complex encounters in which multiple concerns are dealt with across a wide range of disease areas. GPs can be trained to solicit for problems/concerns early in the consultation. PRACTICE IMPLICATIONS Soliciting for additional concerns is not routinely done. But very brief training can substantially help in eliciting concerns early in the consultation, which may help with organising the consultation.
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Affiliation(s)
- Beth Stuart
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton SO16 5ST, UK.
| | - Geraldine Leydon
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton SO16 5ST, UK
| | - Catherine Woods
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton SO16 5ST, UK
| | - Elizabeth Gennery
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton SO16 5ST, UK
| | - Christopher Elsey
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton SO16 5ST, UK
| | - Rachael Summers
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton SO16 5ST, UK
| | - Fiona Stevenson
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton SO16 5ST, UK
| | - Carolyn Chew-Graham
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton SO16 5ST, UK
| | - Rebecca Barnes
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton SO16 5ST, UK
| | - Paul Drew
- Department of Lanuage & Linguistic Science, University of York.
| | - Michael Moore
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton SO16 5ST, UK
| | - Paul Little
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton SO16 5ST, UK
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Heaven A, Brown L, Young J, Teale E, Hawkins R, Spilsbury K, Mountain G, Young T, Goodwin V, Hanratty B, Chew-Graham C, Brundle C, Mahmood F, Jacob I, Daffu-O’Reilly A, Clegg A. Community ageing research 75+ study (CARE75+): an experimental ageing and frailty research cohort. BMJ Open 2019; 9:e026744. [PMID: 30850418 PMCID: PMC6429944 DOI: 10.1136/bmjopen-2018-026744] [Citation(s) in RCA: 10] [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: 11/30/2022] Open
Abstract
INTRODUCTION The Community Ageing Research 75+ Study (CARE75+) is a longitudinal cohort study collecting an extensive range of health, social and economic data, with a focus on frailty, independence and quality of life in older age. CARE75+ is the first international experimental frailty research cohort designed using Trial within Cohorts (TwiCs) methodology, to align applied epidemiological research with clinical trial evaluation of interventions to improve the health and well-being of older people living with frailty. METHODS AND ANALYSIS Prospective cohort study using a TwiCs design. One thousand community-dwelling older people (≥75 years) will be recruited from UK general practices. Nursing home residents, those with an estimated life expectancy of 3 months or less and people receiving palliative care will be excluded. Data collection assessments will be face to face in the person's home at baseline, 6 months, 12 months, 24 months and 48 months, including assessments of frailty, cognition, mood, health-related quality of life, comorbidity, medications, resilience, loneliness, pain and self-efficacy. A modified protocol for follow-up by telephone or web based will be offered at 6 months. Consent will be sought for data linkage and invitations to additional studies, including intervention studies using the TwiCs design. A blood sample biobank will be established for future basic science studies. ETHICS AND DISSEMINATION CARE75+ was approved by the NRES Committee Yorkshire and the Humber-Bradford Leeds 10 October 2014 (14/YH/1120). Formal written consent is sought if an individual is willing to participate and has capacity to provide informed consent. Consultee assent is sought if an individual lacks capacity.Study results will be disseminated in peer-reviewed scientific journals and scientific conferences. Key study results will be summarised and disseminated to all study participants via newsletters, local older people's publications and local engagement events. Results will be reported on a bespoke CARE75+ website. TRIAL REGISTRATION NUMBER ISRCTN16588124;Results stage.
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Affiliation(s)
- Anne Heaven
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford, UK
| | - Lesley Brown
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford, UK
| | - John Young
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford, UK
| | - Elizabeth Teale
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford, UK
| | - Rebecca Hawkins
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford, UK
| | | | - Gail Mountain
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Tracey Young
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | | | - Barbara Hanratty
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Carolyn Chew-Graham
- Research Institute for Primary Care and Health Sciences, University of Keele, Keele, UK
| | - Caroline Brundle
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford, UK
| | - Farhat Mahmood
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford, UK
| | - Ikhlaq Jacob
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford, UK
| | - Amrit Daffu-O’Reilly
- Academic Unit of Midwifery, Social Work, Pharmacy and Counselling and Psychotherapy, University of Leeds, Leeds, UK
| | - Andrew Clegg
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford, UK
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Panagioti M, Geraghty K, Johnson J, Zhou A, Panagopoulou E, Chew-Graham C, Peters D, Hodkinson A, Riley R, Esmail A. Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction: A Systematic Review and Meta-analysis. JAMA Intern Med 2018; 178:1317-1331. [PMID: 30193239 PMCID: PMC6233757 DOI: 10.1001/jamainternmed.2018.3713] [Citation(s) in RCA: 562] [Impact Index Per Article: 93.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Physician burnout has taken the form of an epidemic that may affect core domains of health care delivery, including patient safety, quality of care, and patient satisfaction. However, this evidence has not been systematically quantified. OBJECTIVE To examine whether physician burnout is associated with an increased risk of patient safety incidents, suboptimal care outcomes due to low professionalism, and lower patient satisfaction. DATA SOURCES MEDLINE, EMBASE, PsycInfo, and CINAHL databases were searched until October 22, 2017, using combinations of the key terms physicians, burnout, and patient care. Detailed standardized searches with no language restriction were undertaken. The reference lists of eligible studies and other relevant systematic reviews were hand-searched. STUDY SELECTION Quantitative observational studies. DATA EXTRACTION AND SYNTHESIS Two independent reviewers were involved. The main meta-analysis was followed by subgroup and sensitivity analyses. All analyses were performed using random-effects models. Formal tests for heterogeneity (I2) and publication bias were performed. MAIN OUTCOMES AND MEASURES The core outcomes were the quantitative associations between burnout and patient safety, professionalism, and patient satisfaction reported as odds ratios (ORs) with their 95% CIs. RESULTS Of the 5234 records identified, 47 studies on 42 473 physicians (25 059 [59.0%] men; median age, 38 years [range, 27-53 years]) were included in the meta-analysis. Physician burnout was associated with an increased risk of patient safety incidents (OR, 1.96; 95% CI, 1.59-2.40), poorer quality of care due to low professionalism (OR, 2.31; 95% CI, 1.87-2.85), and reduced patient satisfaction (OR, 2.28; 95% CI, 1.42-3.68). The heterogeneity was high and the study quality was low to moderate. The links between burnout and low professionalism were larger in residents and early-career (≤5 years post residency) physicians compared with middle- and late-career physicians (Cohen Q = 7.27; P = .003). The reporting method of patient safety incidents and professionalism (physician-reported vs system-recorded) significantly influenced the main results (Cohen Q = 8.14; P = .007). CONCLUSIONS AND RELEVANCE This meta-analysis provides evidence that physician burnout may jeopardize patient care; reversal of this risk has to be viewed as a fundamental health care policy goal across the globe. Health care organizations are encouraged to invest in efforts to improve physician wellness, particularly for early-career physicians. The methods of recording patient care quality and safety outcomes require improvements to concisely capture the outcome of burnout on the performance of health care organizations.
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Affiliation(s)
- Maria Panagioti
- National Institute for Health Research (NIHR) School for Primary Care Research, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Keith Geraghty
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Judith Johnson
- Bradford Institute for Health Research, University of Leeds, Leeds, United Kingdom
| | - Anli Zhou
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Efharis Panagopoulou
- Laboratory of Hygiene, Aristotle Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Carolyn Chew-Graham
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, Newcastle, United Kingdom
| | - David Peters
- Westminster Centre for Resilience, Faculty of Science and Technology, University of Westminster, London, United Kingdom
| | - Alexander Hodkinson
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Ruth Riley
- Institute of Applied Health Research College of Medical and Dental Sciences, Murray Learning Centre, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Aneez Esmail
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
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Creed F, Tomenson B, Chew-Graham C, Macfarlane G, McBeth J. The associated features of multiple somatic symptom complexes. J Psychosom Res 2018; 112:1-8. [PMID: 30097128 DOI: 10.1016/j.jpsychores.2018.06.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/25/2018] [Accepted: 06/11/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To assess whether two or more functional somatic symptom complexes (SSCs) showed stronger association with psychosocial correlates than single or no SSC after adjustment for depression/anxiety and general medical disorders. METHODS In a population-based sample we identified, by standardised questionnaire, participants with chronic widespread pain, chronic fatigue and irritable bowel syndrome, excluding those with a medical cause for pain/fatigue. We compared psychosocial variables in three groups: multiple (>1), single or no FSS, adjusting for depression/anxiety and general medical disorders using ordinal logistic regression. We evaluated whether multiple SSCs predicted health status 1 year later using multiple regression to adjust for confounders. RESULTS Of 1443 participants (58.0% response) medical records were examined in 990: 4.4% (n = 44) had 2 or 3 symptom complexes, 16.2% a single symptom complex. Many psychosocial adversities were significantly associated with number of SSCs in the expected direction but, for many, statistical significance was lost after adjustment for depression/anxiety and medical illness. Somatic symptoms, health anxiety, impairment and number of prior doctor visits remained significantly associated. Impaired health status 1 year later was predicted by multiple somatic symptom complexes even after adjustment for depression, anxiety, medical disorders and number of symptoms. CONCLUSIONS Depression, anxiety, medical illness and health anxiety, demonstrated an exposure-response relationship with number of somatic symptom complexes. These may be core features of all Functional Somatic Syndromes and may explain why number of somatic symptom complexes predicted subsequent health status. These features merit inclusion in prospective studies to ascertain causal relationships.
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Affiliation(s)
- Francis Creed
- Neuroscience and Mental Health, University of Manchester, UK.
| | - Barbara Tomenson
- Biostatistics Unit, Institute of Population Health, The University of Manchester, Manchester, UK
| | - Carolyn Chew-Graham
- Research Institute, Primary Care and Health Sciences, West Midlands CLAHRC, Keele University, Newcastle ST5 5BG, UK
| | - Gary Macfarlane
- Epidemiology Group, Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, UK
| | - John McBeth
- Arthritis Research UK Epidemiology Unit, The University of Manchester, Manchester, UK
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Camacho EM, Davies LM, Hann M, Small N, Bower P, Chew-Graham C, Baguely C, Gask L, Dickens CM, Lovell K, Waheed W, Gibbons CJ, Coventry P. Long-term clinical and cost-effectiveness of collaborative care (versus usual care) for people with mental-physical multimorbidity: cluster-randomised trial. Br J Psychiatry 2018; 213:456-463. [PMID: 29761751 PMCID: PMC6429252 DOI: 10.1192/bjp.2018.70] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Collaborative care can support the treatment of depression in people with long-term conditions, but long-term benefits and costs are unknown.AimsTo explore the long-term (24-month) effectiveness and cost-effectiveness of collaborative care in people with mental-physical multimorbidity. METHOD A cluster randomised trial compared collaborative care (integrated physical and mental healthcare) with usual care for depression alongside diabetes and/or coronary heart disease. Depression symptoms were measured by the symptom checklist-depression scale (SCL-D13). The economic evaluation was from the perspective of the English National Health Service. RESULTS 191 participants were allocated to collaborative care and 196 to usual care. At 24 months, the mean SCL-D13 score was 0.27 (95% CI, -0.48 to -0.06) lower in the collaborative care group alongside a gain of 0.14 (95% CI, 0.06-0.21) quality-adjusted life-years (QALYs). The cost per QALY gained was £13 069. CONCLUSIONS In the long term, collaborative care reduces depression and is potentially cost-effective at internationally accepted willingness-to-pay thresholds.Declaration of interestNone.
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Affiliation(s)
- Elizabeth M. Camacho
- Division of Population Health, Health Services Research, and Primary Care, The University of Manchester, UK,Correspondence: Elizabeth M. Camacho, PhD, Centre for Health Economics, Division of Population Health, Health Services Research, and Primary Care, School of Health Sciences, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
| | - Linda M. Davies
- Division of Population Health, Health Services Research, and Primary Care, The University of Manchester, UK
| | - Mark Hann
- Division of Population Health, Health Services Research, and Primary Care, The University of Manchester, UK
| | - Nicola Small
- Division of Population Health, Health Services Research, and Primary Care, The University of Manchester, UK
| | - Peter Bower
- NIHR School for Primary Care Research, The University of Manchester, Manchester Academic Health Science Centre, UK
| | - Carolyn Chew-Graham
- Primary Care & Health Sciences, University of Keele, UK, Division of Population Health, Health Services Research, and Primary Care, The University of Manchester, UKand NIHR Collaboration for Leadership in Applied Health Research and Care West Midlands, UK
| | | | - Linda Gask
- Division of Population Health, Health Services Research, and Primary Care, The University of Manchester, UK
| | | | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester Academic Health Science Centre, UK
| | - Waquas Waheed
- Division of Population Health, Health Services Research, and Primary Care, The University of Manchester, UK
| | - Chris J. Gibbons
- The Psychometrics Centre, University of Cambridge, UKand Division of Population Health, Health Services Research, and Primary Care, The University of Manchester, UK
| | - Peter Coventry
- Department of Health Sciences, University of York, UKand Centre for Reviews and Dissemination, University of York, UK
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Bosanquet K, Adamson J, Atherton K, Bailey D, Baxter C, Beresford-Dent J, Birtwistle J, Chew-Graham C, Clare E, Delgadillo J, Ekers D, Foster D, Gabe R, Gascoyne S, Haley L, Hamilton J, Hargate R, Hewitt C, Holmes J, Keding A, Lewis H, McMillan D, Meer S, Mitchell N, Nutbrown S, Overend K, Parrott S, Pervin J, Richards DA, Spilsbury K, Torgerson D, Traviss-Turner G, Trépel D, Woodhouse R, Gilbody S. CollAborative care for Screen-Positive EldeRs with major depression (CASPER plus): a multicentred randomised controlled trial of clinical effectiveness and cost-effectiveness. Health Technol Assess 2018; 21:1-252. [PMID: 29171379 DOI: 10.3310/hta21670] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Depression in older adults is common and is associated with poor quality of life, increased morbidity and early mortality, and increased health and social care use. Collaborative care, a low-intensity intervention for depression that is shown to be effective in working-age adults, has not yet been evaluated in older people with depression who are managed in UK primary care. The CollAborative care for Screen-Positive EldeRs (CASPER) plus trial fills the evidence gap identified by the most recent guidelines on depression management. OBJECTIVES To establish the clinical effectiveness and cost-effectiveness of collaborative care for older adults with major depressive disorder in primary care. DESIGN A pragmatic, multicentred, two-arm, parallel, individually randomised controlled trial with embedded qualitative study. Participants were automatically randomised by computer, by the York Trials Unit Randomisation Service, on a 1 : 1 basis using simple unstratified randomisation after informed consent and baseline measures were collected. Blinding was not possible. SETTING Sixty-nine general practices in the north of England. PARTICIPANTS A total of 485 participants aged ≥ 65 years with major depressive disorder. INTERVENTIONS A low-intensity intervention of collaborative care, including behavioural activation, delivered by a case manager for an average of six sessions over 7-8 weeks, alongside usual general practitioner (GP) care. The control arm received only usual GP care. MAIN OUTCOME MEASURES The primary outcome measure was Patient Health Questionnaire-9 items score at 4 months post randomisation. Secondary outcome measures included depression severity and caseness at 12 and 18 months, the EuroQol-5 Dimensions, Short Form questionnaire-12 items, Patient Health Questionnaire-15 items, Generalised Anxiety Disorder-7 items, Connor-Davidson Resilience Scale-2 items, a medication questionnaire, objective data and adverse events. Participants were followed up at 12 and 18 months. RESULTS In total, 485 participants were randomised (collaborative care, n = 249; usual care, n = 236), with 390 participants (80%: collaborative care, 75%; usual care, 86%) followed up at 4 months, 358 participants (74%: collaborative care, 70%; usual care, 78%) followed up at 12 months and 344 participants (71%: collaborative care, 67%; usual care, 75%) followed up at 18 months. A total of 415 participants were included in primary analysis (collaborative care, n = 198; usual care, n = 217), which revealed a statistically significant effect in favour of collaborative care at the primary end point at 4 months [8.98 vs. 10.90 score points, mean difference 1.92 score points, 95% confidence interval (CI) 0.85 to 2.99 score points; p < 0.001], equivalent to a standard effect size of 0.34. However, treatment differences were not maintained in the longer term (at 12 months: 0.19 score points, 95% CI -0.92 to 1.29 score points; p = 0.741; at 18 months: < 0.01 score points, 95% CI -1.12 to 1.12 score points; p = 0.997). The study recorded details of all serious adverse events (SAEs), which consisted of 'unscheduled hospitalisation', 'other medically important condition' and 'death'. No SAEs were related to the intervention. Collaborative care showed a small but non-significant increase in quality-adjusted life-years (QALYs) over the 18-month period, with a higher cost. Overall, the mean cost per incremental QALY for collaborative care compared with usual care was £26,016; however, for participants attending six or more sessions, collaborative care appears to represent better value for money (£9876/QALY). LIMITATIONS Study limitations are identified at different stages: design (blinding unfeasible, potential contamination), process (relatively low overall consent rate, differential attrition/retention rates) and analysis (no baseline health-care resource cost or secondary/social care data). CONCLUSION Collaborative care was effective for older people with case-level depression across a range of outcomes in the short term though the reduction in depression severity was not maintained over the longer term of 12 or 18 months. Participants who received six or more sessions of collaborative care did benefit substantially more than those who received fewer treatment sessions but this difference was not statistically significant. FUTURE WORK RECOMMENDATIONS Recommendations for future research include investigating the longer-term effect of the intervention. Depression is a recurrent disorder and it would be useful to assess its impact on relapse and the prevention of future case-level depression. TRIAL REGISTRATION Current Controlled Trials ISRCTN45842879. 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. 21, No. 67. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | - Joy Adamson
- Department of Health Sciences, University of York, York, UK
| | - Katie Atherton
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Della Bailey
- Department of Health Sciences, University of York, York, UK
| | | | | | | | - Carolyn Chew-Graham
- Research Institute, Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
| | - Emily Clare
- Northumberland, Tyne and Wear NHS Foundation Trust, National Institute for Health Research Clinical Research Network (Mental Health) North East and North Cumbria, Newcastle upon Tyne, UK
| | - Jaime Delgadillo
- Department of Health Sciences, University of York, York, UK.,Primary Care Mental Health Service, Leeds Community Healthcare NHS Trust, Leeds, UK
| | - David Ekers
- Mental Health Research Group, Durham University, Durham, UK.,Research and Development Department, Tees, Esk & Wear Valleys NHS Foundation Trust, Middlesbrough, UK
| | - Deborah Foster
- Department of Health Sciences, University of York, York, UK
| | - Rhian Gabe
- Department of Health Sciences, University of York, York, UK.,Hull York Medical School, University of York, York, UK
| | | | - Lesley Haley
- Research and Development Department, Tees, Esk & Wear Valleys NHS Foundation Trust, Middlesbrough, UK
| | - Jahnese Hamilton
- Northumberland, Tyne and Wear NHS Foundation Trust, National Institute for Health Research Clinical Research Network (Mental Health) North East and North Cumbria, Newcastle upon Tyne, UK
| | | | | | - John Holmes
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Ada Keding
- Department of Health Sciences, University of York, York, UK
| | - Helen Lewis
- Department of Health Sciences, University of York, York, UK
| | - Dean McMillan
- Department of Health Sciences, University of York, York, UK.,Hull York Medical School, University of York, York, UK
| | - Shaista Meer
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Sarah Nutbrown
- Department of Health Sciences, University of York, York, UK
| | - Karen Overend
- Department of Health Sciences, University of York, York, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | - Jodi Pervin
- Department of Health Sciences, University of York, York, UK
| | - David A Richards
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | | | | | - Dominic Trépel
- Department of Health Sciences, University of York, York, UK
| | | | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK.,Hull York Medical School, University of York, York, UK
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Chew-Graham C. i049 The importance of identifying and managing co-morbid anxiety and depression in people with rheumatological conditions. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key075.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Burroughs H, Bartlam B, Ray M, Kingstone T, Shepherd T, Ogollah R, Proctor J, Waheed W, Bower P, Bullock P, Lovell K, Gilbody S, Bailey D, Butler-Whalley S, Chew-Graham C. A feasibility study for NOn-Traditional providers to support the management of Elderly People with Anxiety and Depression: The NOTEPAD study Protocol. Trials 2018; 19:172. [PMID: 29514682 PMCID: PMC5842638 DOI: 10.1186/s13063-018-2550-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 02/16/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Anxiety and depression are common among older people, with up to 20% reporting such symptoms, and the prevalence increases with co-morbid chronic physical health problems. Access to treatment for anxiety and depression in this population is poor due to a combination of factors at the level of patient, practitioner and healthcare system. There is evidence to suggest that older people with anxiety and/or depression may benefit both from one-to-one interventions and group social or educational activities, which reduce loneliness, are participatory and offer some activity. Non-traditional providers (support workers) working within third-sector (voluntary) organisations are a valuable source of expertise within the community but are under-utilised by primary care practitioners. Such a resource could increase access to care, and be less stigmatising and more acceptable for older people. METHODS The study is in three phases and this paper describes the protocol for phase III, which will evaluate the feasibility of recruiting general practices and patients into the study, and determine whether support workers can deliver the intervention to older people with sufficient fidelity and whether this approach is acceptable to patients, general practitioners and the third-sector providers. Phase III of the NOTEPAD study is a randomised controlled trial (RCT) that is individually randomised. It recruited participants from approximately six general practices in the UK. In total, 100 participants aged 65 years and over who score 10 or more on PHQ9 or GAD7 for anxiety or depression will be recruited and randomised to the intervention or usual general practice care. A mixed methods approach will be used and follow-up will be conducted 12 weeks post-randomisation. DISCUSSION This study will inform the design and methods of a future full-scale RCT. TRIAL REGISTRATION ISRCTN, ID: ISRCTN16318986 . Registered 10 November 2016. The ISRCTN registration is in line with the World Health Organization Trial Registration Data Set. The present paper represents the original version of the protocol. Any changes to the protocol will be communicated to ISRCTN.
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Affiliation(s)
- Heather Burroughs
- Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, ST5 5BG UK
| | - Bernadette Bartlam
- Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, ST5 5BG UK
| | - Mo Ray
- Department School of Health and Social Care, Lincoln University, Lincoln, UK
| | - Tom Kingstone
- Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, ST5 5BG UK
- South Staffordshire and Shropshire NHS Healthcare Foundation Trust, St Georges Hospital, Stafford, ST16 3SR UK
| | - Tom Shepherd
- Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, ST5 5BG UK
| | - Reuben Ogollah
- Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, ST5 5BG UK
| | - Janine Proctor
- Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, ST5 5BG UK
| | - Waquas Waheed
- National Institute of Health Research School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
| | - Peter Bower
- National Institute of Health Research School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
| | - Peter Bullock
- National Institute of Health Research School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, M13 9PL, Manchester, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD UK
| | - Della Bailey
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD UK
| | - Stephanie Butler-Whalley
- Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, ST5 5BG UK
| | - Carolyn Chew-Graham
- Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, ST5 5BG UK
- South Staffordshire and Shropshire NHS Healthcare Foundation Trust, St Georges Hospital, Stafford, ST16 3SR UK
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Thompson DG, O’Brien S, Kennedy A, Rogers A, Whorwell P, Lovell K, Richardson G, Reeves D, Bower P, Chew-Graham C, Harkness E, Beech P. A randomised controlled trial, cost-effectiveness and process evaluation of the implementation of self-management for chronic gastrointestinal disorders in primary care, and linked projects on identification and risk assessment. Programme Grants Appl Res 2018. [DOI: 10.3310/pgfar06010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BackgroundChronic gastrointestinal disorders are major burdens in primary care. Although there is some evidence that enhancing self-management can improve outcomes, it is not known if such models of care can be implemented at scale in routine NHS settings and whether or not it is possible to develop effective risk assessment procedures to identify patients who are likely to become chronically ill.ObjectivesWhat is the clinical effectiveness and cost-effectiveness of an intervention to enhance self-management support for patients with chronic conditions when translated from research settings into routine care? What are the barriers and facilitators that affect the implementation of an intervention to enhance self-management support among patients, clinicians and organisations? Is it possible to develop methods to identify patients at risk of long-term problems with functional gastrointestinal disorders in primary care? Data sources included professional and patient interviews, patient self-report measures and data on service utilisation.DesignA pragmatic, two-arm, practice-level cluster Phase IV randomised controlled trial evaluating outcomes and costs associated with the intervention, with associated process evaluation using interviews and other methods. Four studies around identification and risk assessment: (1) a general practitioner (GP) database study to describe how clinicians in primary care record consultations with patients who experience functional lower gastrointestinal symptoms; (2) a validation of a risk assessment tool; (3) a qualitative study to explore GPs’ views and experiences; and (4) a second GP database study to investigate patient profiles in irritable bowel syndrome, inflammatory bowel disease and abdominal pain.SettingSalford, UK.ParticipantsPeople with long-term conditions and professionals in primary care.InterventionsA practice-level intervention to train practitioners to assess patient self-management capabilities and involve them in a choice of self-management options.Main outcome measuresPatient self-management, care experience and quality of life, health-care utilisation and costs.ResultsNo statistically significant differences were found between patients attending the trained practices and those attending control practices on any of the primary or secondary outcomes. The intervention had little impact on either costs or effects within the time period of the trial. In the practices, self-management tools failed to be normalised in routine care. Full assessment of the predictive tool was not possible because of variable case definitions used in practices. There was a lack of perceived clinical benefit among GPs.LimitationsThe intervention was not implemented fully in practice. Assessment of the risk assessment tool faced barriers in terms of the quality of codting in GP databases and poor recruitment of patients.ConclusionsThe Whole system Informing Self-management Engagement self-management (WISE) model did not add value to existing care for any of the long-term conditions studied.Future workThe active components required for effective self-management support need further study. The results highlight the challenge of delivering improvements to quality of care for long-term conditions. There is a need to develop interventions that are feasible to deliver at scale, yet demonstrably clinically effective and cost-effective. This may have implications for the piloting of interventions and linking implementation more clearly to local commissioning strategies.Trial registrationCurrent Controlled Trial ISRCTN90940049.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 6, No. 1. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- David G Thompson
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
| | - Sarah O’Brien
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Anne Kennedy
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Wessex, University of Southampton, Southampton, UK
| | - Anne Rogers
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Wessex, University of Southampton, Southampton, UK
| | - Peter Whorwell
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
| | - Karina Lovell
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | | | - David Reeves
- Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester, UK
| | - Peter Bower
- Centre for Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Carolyn Chew-Graham
- Research Institute, Primary Care and Health Sciences, Faculty of Medicine and Health Sciences, Keele University, Keele, UK
| | - Elaine Harkness
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
| | - Paula Beech
- Stroke Rehabilitation Unit, Salford Royal Foundation Trust, Salford, UK
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Kenning C, Lovell K, Hann M, Agius R, Bee PE, Chew-Graham C, Coventry PA, van der Feltz-Cornelis CM, Gilbody S, Hardy G, Kellett S, Kessler D, McMillan D, Reeves D, Rick J, Sutton M, Bower P. Collaborative case management to aid return to work after long-term sickness absence: a pilot randomised controlled trial. Public Health Res 2018. [DOI: 10.3310/phr06020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BackgroundDespite high levels of employment among working-age adults in the UK, there is still a significant minority who are off work with ill health at any one time (so-called ‘sickness absence’). Long-term sickness absence results in significant costs to the individual, to the employer and to wider society.ObjectiveThe overall objective of the intervention was to improve employee well-being with a view to aiding return to work. To meet this aim, a collaborative case management intervention was adapted to the needs of UK employees who were entering or experiencing long-term sickness absence.DesignA pilot randomised controlled trial, using permuted block randomisation. Recruitment of patients with long-term conditions in settings such as primary care was achieved by screening of routine records, followed by mass mailing of invitations to participants. However, the proportion of patients responding to such invitations can be low, raising concerns about external validity. Recruitment in the Case Management to Enhance Occupational Support (CAMEOS) study used this method to test whether or not it would transfer to a population with long-term sickness absence in the context of occupational health (OH).ParticipantsEmployed people on long-term sickness absence (between 4 weeks and 12 months). The pilot was run with two different collaborators: a large organisation that provided OH services for a number of clients and a non-profit community-based organisation.InterventionCollaborative case management was delivered by specially trained case managers from the host organisations. Sessions were delivered by telephone and supported use of a self-help handbook. The comparator was usual care as provided by participants’ general practitioner (GP) or OH provider. This varied for participants according to the services available to them. Neither participants nor the research team were blind to randomisation.Main outcome measuresRecruitment rates, intervention delivery and acceptability to participants were the main outcomes. Well-being, as measured by the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), and return-to-work rates were also recorded.ResultsIn total, over 1000 potentially eligible participants were identified across the sites and invited to participate. However, responses were received from just 61 of those invited (5.5%), of whom 16 (1.5%) were randomised to the trial (seven to treatment, nine to control). Detailed information on recruitment methods, intervention delivery, engagement and acceptability is presented. No harms were reported in either group.ConclusionsThis pilot study faced a number of barriers, particularly in terms of recruitment of employers to host the research. Our ability to respond to these challenges faced several barriers related to the OH context and the study set up. The intervention seemed feasible and acceptable when delivered, although caution is required because of the small number of randomised participants. However, employees’ lack of engagement in the research might imply that they did not see the intervention as valuable.Future workDeveloping effective and acceptable ways of reducing sickness absence remains a high priority. We discuss possible ways of overcoming these challenges in the future, including incentives for employers, alternative study designs and further modifications to recruitment methods.Trial registrationCurrent Controlled Trials ISRCTN33560198.FundingThis project was funded by the NIHR Public Health Research programme and will be published in full inPublic Health Research; Vol. 6, No. 2. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Cassandra Kenning
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Karina Lovell
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Mark Hann
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Raymond Agius
- Centre for Occupational and Environmental Health, University of Manchester, Manchester, UK
| | - Penny E Bee
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | | | | | | | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
| | - Gillian Hardy
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Stephen Kellett
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - David Kessler
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Dean McMillan
- Department of Health Sciences, University of York, York, UK
| | - David Reeves
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Joanne Rick
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Matthew Sutton
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Peter Bower
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
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Kharicha K, Iliffe S, Manthorpe J, Chew-Graham C, Cattan M, Kirby-Barr M, Goodman C, Walters K. HOW DO OLDER PEOPLE MANAGE LONELINESS FOR THEMSELVES? A QUALITATIVE STUDY IN ENGLAND. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- K. Kharicha
- Centre for Ageing Population Studies, Department of Primary Care and Population Health, University College London, London, United Kingdom,
| | - S. Iliffe
- Centre for Ageing Population Studies, Department of Primary Care and Population Health, University College London, London, United Kingdom,
| | | | | | - M. Cattan
- Northumbria University, Newcastle upon Tyne, United Kingdom,
| | - M. Kirby-Barr
- Centre for Ageing Population Studies, Department of Primary Care and Population Health, University College London, London, United Kingdom,
| | - C. Goodman
- University of Hertfordshire, Hertfordshire, United Kingdom
| | - K. Walters
- Centre for Ageing Population Studies, Department of Primary Care and Population Health, University College London, London, United Kingdom,
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Guthrie E, Afzal C, Blakeley C, Blakemore A, Byford R, Camacho E, Chan T, Chew-Graham C, Davies L, de Lusignan S, Dickens C, Drinkwater J, Dunn G, Hunter C, Joy M, Kapur N, Langer S, Lovell K, Macklin J, Mackway-Jones K, Ntais D, Salmon P, Tomenson B, Watson J. CHOICE: Choosing Health Options In Chronic Care Emergencies. Programme Grants Appl Res 2017. [DOI: 10.3310/pgfar05130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BackgroundOver 70% of the health-care budget in England is spent on the care of people with long-term conditions (LTCs), and a major cost component is unscheduled health care. Psychological morbidity is high in people with LTCs and is associated with a range of adverse outcomes, including increased mortality, poorer physical health outcomes, increased health costs and service utilisation.ObjectivesThe aim of this programme of research was to examine the relationship between psychological morbidity and use of unscheduled care in people with LTCs, and to develop a psychosocial intervention that would have the potential to reduce unscheduled care use. We focused largely on emergency hospital admissions (EHAs) and attendances at emergency departments (EDs).DesignA three-phase mixed-methods study. Research methods included systematic reviews; a longitudinal prospective cohort study in primary care to identify people with LTCs at risk of EHA or ED admission; a replication study in primary care using routinely collected data; an exploratory and feasibility cluster randomised controlled trial in primary care; and qualitative studies to identify personal reasons for the use of unscheduled care and factors in routine consultations in primary care that may influence health-care use. People with lived experience of LTCs worked closely with the research team.SettingPrimary care. Manchester and London.ParticipantsPeople aged ≥ 18 years with at least one of four common LTCs: asthma, coronary heart disease, chronic obstructive pulmonary disease (COPD) and diabetes. Participants also included health-care staff.ResultsEvidence synthesis suggested that depression, but not anxiety, is a predictor of use of unscheduled care in patients with LTCs, and low-intensity complex interventions reduce unscheduled care use in people with asthma and COPD. The results of the prospective study were that depression, not having a partner and life stressors, in addition to prior use of unscheduled care, severity of illness and multimorbidity, were independent predictors of EHA and ED admission. Approximately half of the cost of health care for people with LTCs was accounted for by use of unscheduled care. The results of the replication study, carried out in London, broadly supported our findings for risk of ED attendances, but not EHAs. This was most likely due to low rates of detection of depression in general practitioner (GP) data sets. Qualitative work showed that patients were reluctant to use unscheduled care, deciding to do so when they perceived a serious and urgent need for care, and following previous experience that unscheduled care had successfully and unquestioningly met similar needs in the past. In general, emergency and primary care doctors did not regard unscheduled care as problematic. We found there are missed opportunities to identify and discuss psychosocial issues during routine consultations in primary care due to the ‘overmechanisation’ of routine health-care reviews. The feasibility trial examined two levels of an intervention for people with COPD: we tried to improve the way in which practices manage patients with COPD and developed a targeted psychosocial treatment for patients at risk of using unscheduled care. The former had low acceptability, whereas the latter had high acceptability. Exploratory health economic analyses suggested that the practice-level intervention would be unlikely to be cost-effective, limiting the value of detailed health economic modelling.LimitationsThe findings of this programme may not apply to all people with LTCs. It was conducted in an area of high social deprivation, which may limit the generalisability to more affluent areas. The response rate to the prospective longitudinal study was low. The feasibility trial focused solely on people with COPD.ConclusionsPrior use of unscheduled care is the most powerful predictor of unscheduled care use in people with LTCs. However, psychosocial factors, particularly depression, are important additional predictors of use of unscheduled care in patients with LTCs, independent of severity and multimorbidity. Patients and health-care practitioners are unaware that psychosocial factors influence health-care use, and such factors are rarely acknowledged or addressed in consultations or discussions about use of unscheduled care. A targeted patient intervention for people with LTCs and comorbid depression has shown high levels of acceptability when delivered in a primary care context. An intervention at the level of the GP practice showed little evidence of acceptability or cost-effectiveness.Future workThe potential benefits of case-finding for depression in patients with LTCs in primary care need to be evaluated, in addition to further evaluation of the targeted patient intervention.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- Elspeth Guthrie
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Cara Afzal
- Manchester Mental Health and Social Care Trust, Manchester Royal Infirmary, Manchester, UK
- Greater Manchester Academic Health Science Network (GM AHSN), Manchester, UK
| | - Claire Blakeley
- Manchester Mental Health and Social Care Trust, Manchester Royal Infirmary, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Amy Blakemore
- Manchester Academic Health Science Centre, Manchester, UK
- Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
| | - Rachel Byford
- Department of Health Care Management and Policy, University of Surrey, Guildford, UK
| | - Elizabeth Camacho
- Manchester Academic Health Science Centre, Manchester, UK
- Centre for Health Economics, Institute for Population Health, University of Manchester, Manchester, UK
| | - Tom Chan
- Department of Health Care Management and Policy, University of Surrey, Guildford, UK
| | - Carolyn Chew-Graham
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, UK
| | - Linda Davies
- Centre for Health Economics, Institute for Population Health, University of Manchester, Manchester, UK
| | - Simon de Lusignan
- Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
| | - Chris Dickens
- Institute of Health Research, Medical School, University of Exeter, Exeter, UK
- Peninsula Collaboration for Leadership in Health Research and Care (PenCLAHRC), University of Exeter, Exeter, UK
| | | | - Graham Dunn
- Manchester Academic Health Science Centre, Manchester, UK
- Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK
| | - Cheryl Hunter
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Mark Joy
- Faculty of Science, Engineering and Computing, Kingston University, London, UK
| | - Navneet Kapur
- Manchester Academic Health Science Centre, Manchester, UK
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Susanne Langer
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Karina Lovell
- Manchester Academic Health Science Centre, Manchester, UK
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | | | - Kevin Mackway-Jones
- Manchester Academic Health Science Centre, Manchester, UK
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Dionysios Ntais
- Manchester Academic Health Science Centre, Manchester, UK
- Centre for Health Economics, Institute for Population Health, University of Manchester, Manchester, UK
| | - Peter Salmon
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Barbara Tomenson
- Manchester Academic Health Science Centre, Manchester, UK
- Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK
| | - Jennifer Watson
- Manchester Mental Health and Social Care Trust, Manchester Royal Infirmary, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
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Carr MJ, Ashcroft DM, Kontopantelis E, While D, Awenat Y, Cooper J, Chew-Graham C, Kapur N, Webb RT. Premature Death Among Primary Care Patients With a History of Self-Harm. Ann Fam Med 2017; 15:246-254. [PMID: 28483890 PMCID: PMC5422086 DOI: 10.1370/afm.2054] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 12/16/2016] [Accepted: 12/30/2016] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Self-harm is a public health problem that requires a better understanding of mortality risk. We undertook a study to examine premature mortality in a nationally representative cohort of primary care patients who had harmed themselves. METHODS During 2001-2013, a total of 385 general practices in England contributed data to the Clinical Practice Research Datalink with linkage to Office for National Statistics mortality records. We identified 30,017 persons aged 15 to 64 years with a recorded episode of self-harm. We estimated the relative risks of all-cause and cause-specific natural and unnatural mortality using a comparison cohort of 600,258 individuals matched on age, sex, and general practice. RESULTS We found an elevated risk of dying prematurely from any cause among the self-harm cohort, especially in the first year of follow-up (adjusted hazard ratio for that year, 3.6; 95% CI, 3.1-4.2). In particular, suicide risk was especially high during the first year (adjusted hazard ratio, 54.4; 95% CI, 34.3-86.3); although it declined sharply, it remained much higher than that in the comparison cohort. Large elevations of risk throughout the follow-up period were also observed for accidental, alcohol-related, and drug poisoning deaths. At 10 years of follow-up, cumulative incidence values were 6.5% (95% CI, 6.0%-7.1%) for all-cause mortality and 1.3% (95% CI, 1.2%-1.5%) for suicide. CONCLUSIONS Primary care patients who have harmed themselves are at greatly increased risk of dying prematurely by natural and unnatural causes, and especially within a year of a first episode. These individuals visit clinicians at a relatively high frequency, which presents a clear opportunity for preventive action. Primary care patients with myriad comorbidities, including self-harming behavior, mental disorder, addictions, and physical illnesses, will require concerted, multipronged, multidisciplinary collaborative care approaches.
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Affiliation(s)
- Matthew J Carr
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Carr, While, Awenat, Cooper, Kapur, Webb); Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Ashcroft); NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester M13 9PL, UK (Ashcroft); Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Kontopantelis); Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire ST5 5BG, UK (Chew-Graham); West Midlands NIHR Collaborative Leadership in Applied Health Research and Care (CLAHRC), Birmingham, UK (Chew-Graham).
| | - Darren M Ashcroft
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Carr, While, Awenat, Cooper, Kapur, Webb); Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Ashcroft); NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester M13 9PL, UK (Ashcroft); Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Kontopantelis); Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire ST5 5BG, UK (Chew-Graham); West Midlands NIHR Collaborative Leadership in Applied Health Research and Care (CLAHRC), Birmingham, UK (Chew-Graham)
| | - Evangelos Kontopantelis
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Carr, While, Awenat, Cooper, Kapur, Webb); Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Ashcroft); NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester M13 9PL, UK (Ashcroft); Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Kontopantelis); Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire ST5 5BG, UK (Chew-Graham); West Midlands NIHR Collaborative Leadership in Applied Health Research and Care (CLAHRC), Birmingham, UK (Chew-Graham)
| | - David While
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Carr, While, Awenat, Cooper, Kapur, Webb); Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Ashcroft); NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester M13 9PL, UK (Ashcroft); Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Kontopantelis); Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire ST5 5BG, UK (Chew-Graham); West Midlands NIHR Collaborative Leadership in Applied Health Research and Care (CLAHRC), Birmingham, UK (Chew-Graham)
| | - Yvonne Awenat
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Carr, While, Awenat, Cooper, Kapur, Webb); Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Ashcroft); NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester M13 9PL, UK (Ashcroft); Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Kontopantelis); Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire ST5 5BG, UK (Chew-Graham); West Midlands NIHR Collaborative Leadership in Applied Health Research and Care (CLAHRC), Birmingham, UK (Chew-Graham)
| | - Jayne Cooper
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Carr, While, Awenat, Cooper, Kapur, Webb); Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Ashcroft); NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester M13 9PL, UK (Ashcroft); Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Kontopantelis); Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire ST5 5BG, UK (Chew-Graham); West Midlands NIHR Collaborative Leadership in Applied Health Research and Care (CLAHRC), Birmingham, UK (Chew-Graham)
| | - Carolyn Chew-Graham
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Carr, While, Awenat, Cooper, Kapur, Webb); Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Ashcroft); NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester M13 9PL, UK (Ashcroft); Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Kontopantelis); Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire ST5 5BG, UK (Chew-Graham); West Midlands NIHR Collaborative Leadership in Applied Health Research and Care (CLAHRC), Birmingham, UK (Chew-Graham)
| | - Nav Kapur
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Carr, While, Awenat, Cooper, Kapur, Webb); Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Ashcroft); NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester M13 9PL, UK (Ashcroft); Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Kontopantelis); Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire ST5 5BG, UK (Chew-Graham); West Midlands NIHR Collaborative Leadership in Applied Health Research and Care (CLAHRC), Birmingham, UK (Chew-Graham)
| | - Roger T Webb
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Carr, While, Awenat, Cooper, Kapur, Webb); Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Ashcroft); NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester M13 9PL, UK (Ashcroft); Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Kontopantelis); Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire ST5 5BG, UK (Chew-Graham); West Midlands NIHR Collaborative Leadership in Applied Health Research and Care (CLAHRC), Birmingham, UK (Chew-Graham)
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Panagioti M, Panagopoulou E, Bower P, Lewith G, Kontopantelis E, Chew-Graham C, Dawson S, van Marwijk H, Geraghty K, Esmail A. Controlled Interventions to Reduce Burnout in Physicians: A Systematic Review and Meta-analysis. JAMA Intern Med 2017; 177:195-205. [PMID: 27918798 DOI: 10.1001/jamainternmed.2016.7674] [Citation(s) in RCA: 680] [Impact Index Per Article: 97.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Burnout is prevalent in physicians and can have a negative influence on performance, career continuation, and patient care. Existing evidence does not allow clear recommendations for the management of burnout in physicians. OBJECTIVE To evaluate the effectiveness of interventions to reduce burnout in physicians and whether different types of interventions (physician-directed or organization-directed interventions), physician characteristics (length of experience), and health care setting characteristics (primary or secondary care) were associated with improved effects. DATA SOURCES MEDLINE, Embase, PsycINFO, CINAHL, and Cochrane Register of Controlled Trials were searched from inception to May 31, 2016. The reference lists of eligible studies and other relevant systematic reviews were hand searched. STUDY SELECTION Randomized clinical trials and controlled before-after studies of interventions targeting burnout in physicians. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data and assessed the risk of bias. The main meta-analysis was followed by a number of prespecified subgroup and sensitivity analyses. All analyses were performed using random-effects models and heterogeneity was quantified. MAIN OUTCOMES AND MEASURES The core outcome was burnout scores focused on emotional exhaustion, reported as standardized mean differences and their 95% confidence intervals. RESULTS Twenty independent comparisons from 19 studies were included in the meta-analysis (n = 1550 physicians; mean [SD] age, 40.3 [9.5] years; 49% male). Interventions were associated with small significant reductions in burnout (standardized mean difference [SMD] = -0.29; 95% CI, -0.42 to -0.16; equal to a drop of 3 points on the emotional exhaustion domain of the Maslach Burnout Inventory above change in the controls). Subgroup analyses suggested significantly improved effects for organization-directed interventions (SMD = -0.45; 95% CI, -0.62 to -0.28) compared with physician-directed interventions (SMD = -0.18; 95% CI, -0.32 to -0.03). Interventions delivered in experienced physicians and in primary care were associated with higher effects compared with interventions delivered in inexperienced physicians and in secondary care, but these differences were not significant. The results were not influenced by the risk of bias ratings. CONCLUSIONS AND RELEVANCE Evidence from this meta-analysis suggests that recent intervention programs for burnout in physicians were associated with small benefits that may be boosted by adoption of organization-directed approaches. This finding provides support for the view that burnout is a problem of the whole health care organization, rather than individuals.
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Affiliation(s)
- Maria Panagioti
- National Institute of Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, England
| | - Efharis Panagopoulou
- Laboratory of Hygiene, Aristotle Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Peter Bower
- National Institute of Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, England
| | - George Lewith
- Complementary and Integrated Medicine Research Unit, Primary Medical Care Aldermoor Health Centre, Southampton, England
| | - Evangelos Kontopantelis
- National Institute of Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, England4Farr Institute for Health Informatics Research, Vaughan House, University of Manchester, Manchester, England
| | - Carolyn Chew-Graham
- Research Institute, Primary Care and Health Sciences, Keele University, Staffordshire, England
| | - Shoba Dawson
- National Institute of Health Research Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, England
| | - Harm van Marwijk
- National Institute of Health Research Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, England
| | - Keith Geraghty
- National Institute of Health Research School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, England
| | - Aneez Esmail
- National Institute of Health Research Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, England
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Richards DA, Bower P, Chew-Graham C, Gask L, Lovell K, Cape J, Pilling S, Araya R, Kessler D, Barkham M, Bland JM, Gilbody S, Green C, Lewis G, Manning C, Kontopantelis E, Hill JJ, Hughes-Morley A, Russell A. Clinical effectiveness and cost-effectiveness of collaborative care for depression in UK primary care (CADET): a cluster randomised controlled trial. Health Technol Assess 2016; 20:1-192. [PMID: 26910256 DOI: 10.3310/hta20140] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Collaborative care is effective for depression management in the USA. There is little UK evidence on its clinical effectiveness and cost-effectiveness. OBJECTIVE To determine the clinical effectiveness and cost-effectiveness of collaborative care compared with usual care in the management of patients with moderate to severe depression. DESIGN Cluster randomised controlled trial. SETTING UK primary care practices (n = 51) in three UK primary care districts. PARTICIPANTS A total of 581 adults aged ≥ 18 years in general practice with a current International Classification of Diseases, Tenth Edition depressive episode, excluding acutely suicidal people, those with psychosis, bipolar disorder or low mood associated with bereavement, those whose primary presentation was substance abuse and those receiving psychological treatment. INTERVENTIONS Collaborative care: 14 weeks of 6-12 telephone contacts by care managers; mental health specialist supervision, including depression education, medication management, behavioural activation, relapse prevention and primary care liaison. Usual care was general practitioner standard practice. MAIN OUTCOME MEASURES Blinded researchers collected depression [Patient Health Questionnaire-9 (PHQ-9)], anxiety (General Anxiety Disorder-7) and quality of life (European Quality of Life-5 Dimensions three-level version), Short Form questionnaire-36 items) outcomes at 4, 12 and 36 months, satisfaction (Client Satisfaction Questionnaire-8) outcomes at 4 months and treatment and service use costs at 12 months. RESULTS In total, 276 and 305 participants were randomised to collaborative care and usual care respectively. Collaborative care participants had a mean depression score that was 1.33 PHQ-9 points lower [n = 230; 95% confidence interval (CI) 0.35 to 2.31; p = 0.009] than that of participants in usual care at 4 months and 1.36 PHQ-9 points lower (n = 275; 95% CI 0.07 to 2.64; p = 0.04) at 12 months after adjustment for baseline depression (effect size 0.28, 95% CI 0.01 to 0.52; odds ratio for recovery 1.88, 95% CI 1.28 to 2.75; number needed to treat 6.5). Quality of mental health but not physical health was significantly better for collaborative care at 4 months but not at 12 months. There was no difference for anxiety. Participants receiving collaborative care were significantly more satisfied with treatment. Differences between groups had disappeared at 36 months. Collaborative care had a mean cost of £272.50 per participant with similar health and social care service use between collaborative care and usual care. Collaborative care offered a mean incremental gain of 0.02 (95% CI -0.02 to 0.06) quality-adjusted life-years (QALYs) over 12 months at a mean incremental cost of £270.72 (95% CI -£202.98 to £886.04) and had an estimated mean cost per QALY of £14,248, which is below current UK willingness-to-pay thresholds. Sensitivity analyses including informal care costs indicated that collaborative care is expected to be less costly and more effective. The amount of participant behavioural activation was the only effect mediator. CONCLUSIONS Collaborative care improves depression up to 12 months after initiation of the intervention, is preferred by patients over usual care, offers health gains at a relatively low cost, is cost-effective compared with usual care and is mediated by patient activation. Supervision was by expert clinicians and of short duration and more intensive therapy may have improved outcomes. In addition, one participant requiring inpatient treatment incurred very significant costs and substantially inflated our cost per QALY estimate. Future work should test enhanced intervention content not collaborative care per se. TRIAL REGISTRATION Current Controlled Trials ISRCTN32829227. FUNDING This project was funded by the Medical Research Council (MRC) (G0701013) and managed by the National Institute for Health Research (NIHR) on behalf of the MRC-NIHR partnership.
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Affiliation(s)
| | - Peter Bower
- Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
| | | | - Linda Gask
- Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
| | - Karina Lovell
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - John Cape
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Stephen Pilling
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Ricardo Araya
- London School of Hygiene and Tropical Medicine, London, UK
| | - David Kessler
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Michael Barkham
- Centre for Psychological Services Research, Department of Psychology, University of Sheffield, Sheffield, UK
| | - J Martin Bland
- Department of Health Sciences, University of York, York, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
| | - Colin Green
- University of Exeter Medical School, Exeter, UK
| | - Glyn Lewis
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Chris Manning
- Public and Patient Advocate, Upstream Healthcare, Teddington, UK
| | - Evangelos Kontopantelis
- Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
| | | | - Adwoa Hughes-Morley
- Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
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Camacho EM, Ntais D, Coventry P, Bower P, Lovell K, Chew-Graham C, Baguley C, Gask L, Dickens C, Davies LM. Long-term cost-effectiveness of collaborative care (vs usual care) for people with depression and comorbid diabetes or cardiovascular disease: a Markov model informed by the COINCIDE randomised controlled trial. BMJ Open 2016; 6:e012514. [PMID: 27855101 PMCID: PMC5073527 DOI: 10.1136/bmjopen-2016-012514] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 12/05/2022] Open
Abstract
OBJECTIVES To evaluate the long-term cost-effectiveness of collaborative care (vs usual care) for treating depression in patients with diabetes and/or coronary heart disease (CHD). SETTING 36 primary care general practices in North West England. PARTICIPANTS 387 participants completed baseline assessment (collaborative care: 191; usual care: 196) and full or partial 4-month follow-up data were captured for 350 (collaborative care: 170; usual care: 180). 62% of participants were male, 14% were non-white. Participants were aged ≥18 years, listed on a Quality and Outcomes Framework register for CHD and/or type 1 or 2 diabetes mellitus, with persistent depressive symptoms. Patients with psychosis or type I/II bipolar disorder, actively suicidal, in receipt of services for substance misuse, or already in receipt of psychological therapy for depression were excluded. INTERVENTION Collaborative care consisted of evidence-based low-intensity psychological treatments, delivered over 3 months and case management by a practice nurse and a Psychological Well Being Practitioner. OUTCOME MEASURES As planned, the primary measure of cost-effectiveness was the incremental cost-effectiveness ratio (cost per quality-adjusted life year (QALY)). A Markov model was constructed to extrapolate the trial results from short-term to long-term (24 months). RESULTS The mean cost per participant of collaborative care was £317 (95% CI 284 to 350). Over 24 months, it was estimated that collaborative care was associated with greater healthcare usage costs (net cost £674 (95% CI -30 953 to 38 853)) and QALYs (net QALY gain 0.04 (95% CI -0.46 to 0.54)) than usual care, resulting in a cost per QALY gained of £16 123, and a likelihood of being cost-effective of 0.54 (willingness to pay threshold of £20 000). CONCLUSIONS Collaborative care is a potentially cost-effective long-term treatment for depression in patients with comorbid physical and mental illness. The estimated cost per QALY gained was below the threshold recommended by English decision-makers. Further, long-term primary research is needed to address uncertainty associated with estimates of cost-effectiveness. TRIAL REGISTRATION NUMBER ISRCTN80309252; Post-results.
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Affiliation(s)
- Elizabeth M Camacho
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Dionysios Ntais
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Peter Coventry
- Mental Health and Addiction Research Group, University of York, York, UK
| | - Peter Bower
- Centre for Primary Care, University of Manchester, Manchester, UK
| | - Karina Lovell
- The School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Carolyn Chew-Graham
- Centre for Primary Care, University of Manchester, Manchester, UK
- Primary Care & Health Sciences, University of Keele, Staffordshire, UK
| | | | - Linda Gask
- Centre for Primary Care, University of Manchester, Manchester, UK
| | - Chris Dickens
- Mental Health Research Group, University of Exeter, Exeter, UK
| | - Linda M Davies
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
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Wilkie R, Blagojevic-Bucknall M, Belcher J, Chew-Graham C, Lacey RJ, McBeth J. Widespread pain and depression are key modifiable risk factors associated with reduced social participation in older adults: A prospective cohort study in primary care. Medicine (Baltimore) 2016; 95:e4111. [PMID: 27495019 PMCID: PMC4979773 DOI: 10.1097/md.0000000000004111] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 11/26/2022] Open
Abstract
In older adults, reduced social participation increases the risk of poor health-related quality of life, increased levels of inflammatory markers and cardiovascular disease, and increased mortality. Older adults frequently present to primary care, which offers the potential to deliver interventions at the point of care to increase social participation. The aim of this prospective study was to identify the key modifiable exposures that were associated with reduced social participation in a primary care population of older adults.The study was a population-based prospective cohort study. Participants (n = 1991) were those aged ≥65 years who had completed questionnaires at baseline, and 3 and 6-year follow-ups. Generalized linear mixed modeling framework was used to test for associations between exposures and decreasing social participation over 6 years.At baseline, 44% of participants reported reduced social participation, increasing to 49% and 55% at 3 and 6-year follow-up. Widespread pain and depression had the strongest independent association with reduced social participation over the 6-year follow-up period. The prevalence of reduced social participation for those with widespread pain was 106% (adjusted incidence rate ratio 2.06, 95% confidence interval 1.72, 2.46), higher than for those with no pain. Those with depression had an increased prevalence of 82% (adjusted incidence rate ratio 1.82, 95% confidence interval 1.62, 2.06). These associations persisted in multivariate analysis.Population ageing will be accompanied by increasing numbers of older adults with pain and depression. Future trials should assess whether screening for widespread pain and depression, and targeting appropriate treatment in primary care, increase social participation in older people.
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Affiliation(s)
- Ross Wilkie
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, UK
- Correspondence: Dr Ross Wilkie, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK (e-mail: )
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Methley A, Campbell S, Cheraghi-Sohi S, Chew-Graham C. Meeting the mental health needs of people with multiple sclerosis: a qualitative study of patients and professionals. Disabil Rehabil 2016; 39:1097-1105. [DOI: 10.1080/09638288.2016.1180547] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Abigail Methley
- Section for Clinical and Health Psychology, School of Psychological Sciences, University of Manchester, Manchester, UK
- Manchester Mental Health and Social Care Trust, NHS, Manchester, UK
| | - Stephen Campbell
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Institute of Population Health, University of Manchester, Manchester, UK
| | - Sudeh Cheraghi-Sohi
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Institute of Population Health, University of Manchester, Manchester, UK
| | - Carolyn Chew-Graham
- Primary Care and Health Sciences, Keele University, Keele, UK
- Collaboration for Leadership in Health Research and Care, West Midlands, UK
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46
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Carr MJ, Ashcroft DM, Kontopantelis E, While D, Awenat Y, Cooper J, Chew-Graham C, Kapur N, Webb RT. Clinical management following self-harm in a UK-wide primary care cohort. J Affect Disord 2016; 197:182-8. [PMID: 26994436 PMCID: PMC4870375 DOI: 10.1016/j.jad.2016.03.013] [Citation(s) in RCA: 24] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 02/19/2016] [Accepted: 03/07/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Little is known about the clinical management of patients in primary care following self-harm. METHODS A descriptive cohort study using data from 684 UK general practices that contributed to the Clinical Practice Research Datalink (CPRD) during 2001-2013. We identified 49,970 patients with a self-harm episode, 41,500 of whom had one complete year of follow-up. RESULTS Among those with complete follow-up, 26,065 (62.8%, 62.3-63.3) were prescribed psychotropic medication and 6318 (15.2%, 14.9-15.6) were referred to mental health services; 4105 (9.9%, CI 9.6-10.2) were medicated without an antecedent psychiatric diagnosis or referral, and 4,506 (10.9%, CI 10.6-11.2) had a diagnosis but were not subsequently medicated or referred. Patients registered at practices in the most deprived localities were 27.1% (CI 21.5-32.2) less likely to be referred than those in the least deprived. Despite a specifically flagged NICE 'Do not do' recommendation in 2011 against prescribing tricyclic antidepressants following self-harm because of their potentially lethal toxicity in overdose, 8.8% (CI 7.8-9.8) of individuals were issued a prescription in the subsequent year. The percentage prescribed Citalopram, an SSRI antidepressant with higher toxicity in overdose, fell sharply during 2012/2013 in the aftermath of a Medicines and Healthcare products Regulatory Agency (MHRA) safety alert issued in 2011. CONCLUSIONS A relatively small percentage of these vulnerable patients are referred to mental health services, and reduced likelihood of referral in more deprived localities reflects a marked health inequality. National clinical guidelines have not yet been effective in reducing rates of tricyclic antidepressant prescribing for this high-risk group.
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Affiliation(s)
- Matthew J Carr
- Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK.
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, University of Manchester, UK; NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, UK
| | - Evangelos Kontopantelis
- Centre for Health Informatics, Institute of Population Health, University of Manchester, UK; NIHR School for Primary Care Research, University of Manchester, UK
| | - David While
- Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK
| | - Yvonne Awenat
- School of Psychological Sciences, University of Manchester, UK
| | - Jayne Cooper
- Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK
| | - Carolyn Chew-Graham
- Research Institute of Primary Care and Health Sciences, Keele University, UK
| | - Nav Kapur
- Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Manchester Mental Health and Social Care Trust, UK
| | - Roger T Webb
- Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK
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Iliffe S, Waugh A, Poole M, Bamford C, Brittain K, Chew-Graham C, Fox C, Katona C, Livingston G, Manthorpe J, Steen N, Stephens B, Hogan V, Robinson L. The effectiveness of collaborative care for people with memory problems in primary care: results of the CAREDEM case management modelling and feasibility study. Health Technol Assess 2016; 18:1-148. [PMID: 25138151 DOI: 10.3310/hta18520] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND People with dementia and their families need support in different forms, but currently services are often fragmented with variable quality of care. Case management offers a way of co-ordinating services along the care pathway and therefore could provide individualised support; however, evidence of the effectiveness of case management for dementia is inconclusive. OBJECTIVE To adapt the intervention used in a promising case management project in the USA and test its feasibility and acceptability in English general practice. DESIGN In work package 1, a design group of varied professionals, with a carer and staff from the voluntary sector, met six times over a year to identify the skills and personal characteristics required for case management; protocols from the US study were adapted for use in the UK. The feasibility of recruiting general practices and patient-carer dyads and of delivering case management were tested in a pilot study (work package 2). An embedded qualitative study explored stakeholder views on study procedures and case management. SETTING Four general practices, two in the north-east of England (Newcastle) one in London and one in Norfolk, took part in a feasibility pilot study of case management. PARTICIPANTS Community-dwelling people with dementia and their carers who were not already being case managed by other services. INTERVENTION A social worker shared by the two practices in the north-east and practice nurses in the other two practices were trained to deliver case management. We aimed to recruit 11 people with dementia from each practice who were not already being case managed. MAIN OUTCOME MEASURES Numbers of people with dementia and their carers recruited, numbers and content of contacts, needs identified and perceptions of case management among stakeholders. RESULTS Recruitment of practices and patients was slow and none of the practices achieved its recruitment target. It took more than 6 months to recruit a total of 28 people with dementia. Practice Quality and Outcome Framework registers for dementia contained only 60% of the expected number of people, most living in care homes. All stakeholders were positive about the potential of case management; however, only one of the four practices achieved a level of case management activity that might have influenced patient and carer outcomes. Case managers' activity levels were not related solely to time available for case management. Delivery of case management was hindered by limited clarity about the role, poor integration with existing services and a lack of embeddedness within primary care. There were discrepancies between case manager and researcher judgements about need, and evidence of a high threshold for acting on unmet need. The practice nurses experienced difficulties in ring-fencing case management time. CONCLUSIONS The model of case management developed and evaluated in this feasibility study is unlikely to be sustainable in general practice under current conditions and in our view it would not be appropriate to attempt a definitive trial of this model. This study could inform the development of a case management role with a greater likelihood of impact. Different approaches to recruiting and training case managers, and identifying people with dementia who might benefit from case management, are needed, as is exploration of the scale of need for this type of working. TRIAL REGISTRATION Current Controlled Trials ISRCTN74015152. 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. 18, No. 52. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Steve Iliffe
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Amy Waugh
- Mental Health Sciences, University College London, London, UK
| | - Marie Poole
- Institute for Ageing, University of Newcastle, Newcastle upon Tyne, UK
| | - Claire Bamford
- Institute for Ageing, University of Newcastle, Newcastle upon Tyne, UK
| | - Katie Brittain
- Institute for Ageing, University of Newcastle, Newcastle upon Tyne, UK
| | | | - Chris Fox
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Gill Livingston
- Mental Health Sciences, University College London, London, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King's College London, London, UK
| | - Nick Steen
- Clinical Trials Unit, Institute of Health and Society, University of Newcastle, Newcastle upon Tyne, UK
| | | | - Vanessa Hogan
- Clinical Trials Unit, Institute of Health and Society, University of Newcastle, Newcastle upon Tyne, UK
| | - Louise Robinson
- Institute for Ageing, University of Newcastle, Newcastle upon Tyne, UK
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Affiliation(s)
- Carolyn Chew-Graham
- Research Institute, Primary Care and Health Sciences, Keele University, Staffordshire, UK.,South Staffordshire and Shropshire Healthcare NHS Foundation Trust, Staffordshire, UK
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Overend K, Lewis H, Bailey D, Bosanquet K, Chew-Graham C, Ekers D, Gascoyne S, Hems D, Holmes J, Keding A, McMillan D, Meer S, Meredith J, Mitchell N, Nutbrown S, Parrott S, Richards D, Traviss G, Trépel D, Woodhouse R, Gilbody S. Erratum to: CASPER plus (CollAborative care in screen-positive EldeRs with major depressive disorder): study protocol for a randomised controlled trial. Trials 2016; 17:217. [PMID: 27121377 PMCID: PMC4848845 DOI: 10.1186/s13063-016-1361-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 04/22/2016] [Indexed: 11/10/2022] Open
Affiliation(s)
- Karen Overend
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - Helen Lewis
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - Della Bailey
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - Kate Bosanquet
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - Carolyn Chew-Graham
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, ST5 5BG, UK
| | - David Ekers
- Centre for Mental Health Research, University of Durham, Durham, TS17 6BH, UK
| | - Samantha Gascoyne
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - Deborah Hems
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - John Holmes
- Leeds Institute of Health Sciences, University of Leeds, Charles Thackrah, Building, 101 Clarendon Road, Leeds, LS2 9LJ, UK
| | - Ada Keding
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - Dean McMillan
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - Shaista Meer
- Leeds Institute of Health Sciences, University of Leeds, Charles Thackrah, Building, 101 Clarendon Road, Leeds, LS2 9LJ, UK
| | - Jodi Meredith
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - Natasha Mitchell
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - Sarah Nutbrown
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - David Richards
- Washington Singer Laboratories, School of Psychology, University of Exeter, Perry Road, Exeter, EX4 4QG, UK
| | - Gemma Traviss
- Leeds Institute of Health Sciences, University of Leeds, Charles Thackrah, Building, 101 Clarendon Road, Leeds, LS2 9LJ, UK
| | - Dominic Trépel
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - Rebecca Woodhouse
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK.
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Guthrie EA, Dickens C, Blakemore A, Watson J, Chew-Graham C, Lovell K, Afzal C, Kapur N, Tomenson B. Depression predicts future emergency hospital admissions in primary care patients with chronic physical illness. J Psychosom Res 2016; 82:54-61. [PMID: 26919799 PMCID: PMC4796037 DOI: 10.1016/j.jpsychores.2014.10.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 09/12/2014] [Accepted: 10/03/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE More than 15 million people currently suffer from a chronic physical illness in England. The objective of this study was to determine whether depression is independently associated with prospective emergency hospital admission in patients with chronic physical illness. METHOD 1860 primary care patients in socially deprived areas of Manchester with at least one of four exemplar chronic physical conditions completed a questionnaire about physical and mental health, including a measure of depression. Emergency hospital admissions were recorded using GP records for the year before and the year following completion of the questionnaire. RESULTS The numbers of patients who had at least one emergency admission in the year before and the year after completion of the questionnaire were 221/1411 (15.7%) and 234/1398 (16.7%) respectively. The following factors were independently associated with an increased risk of prospective emergency admission to hospital: having no partner (OR 1.49, 95% CI 1.04 to 2.15); having ischaemic heart disease (OR 1.60, 95% CI 1.04 to 2.46); having a threatening experience (OR 1.16, 95% CI 1.04 to 1.29); depression (OR 1.58, 95% CI 1.04 to 2.40); and emergency hospital admission in the year prior to questionnaire completion (OR 3.41, 95% CI 1.98 to 5.86). CONCLUSION To prevent potentially avoidable emergency hospital admissions, greater efforts should be made to detect and treat co-morbid depression in people with chronic physical illness in primary care, with a particular focus on patients who have no partner, have experienced threatening life events, and have had a recent emergency hospital admission.
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Affiliation(s)
- Elspeth A Guthrie
- Manchester Mental Health and Social Care Trust, Rawnsley Building, Manchester Royal Infirmary, Manchester, UK.
| | - Chris Dickens
- Institute of Health Service Research, University of Exeter Medical School, Exeter, UK; Peninsula Collaboration for Leadership in Health Research and Care (PenCLAHRC), University of Exeter, Veysey Building, Room 007, Salmon Pool Lane, Exeter, UK.
| | - Amy Blakemore
- Manchester Mental Health and Social Care Trust, Rawnsley Building, Manchester Royal Infirmary, Manchester, UK; National Institute for Health Research School for Primary Care Research, Centre for Primary Care, Institute of Population Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
| | - Jennifer Watson
- Manchester Mental Health and Social Care Trust, Rawnsley Building, Manchester Royal Infirmary, Manchester, UK.
| | - Carolyn Chew-Graham
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, Staffordshire, UK.
| | - Karina Lovell
- School of Nursing, Midwifery and Social Work, The University of Manchester, Room 6.322a, Jean McFarlane Building, University Place, Oxford Road, Manchester, UK.
| | - Cara Afzal
- Manchester Mental Health and Social Care Trust, Rawnsley Building, Manchester Royal Infirmary, Manchester, UK.
| | - Navneet Kapur
- Centre for Suicide Prevention, University Place, The University of Manchester, Oxford Road, Manchester, UK.
| | - Barbara Tomenson
- Biostatistics Unit, Institute of Population Health, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, UK.
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