scholarly journals Barriers and facilitators to GP–patient communication about emotional concerns in UK primary care: a systematic review

2020 ◽  
Vol 37 (4) ◽  
pp. 434-444
Author(s):  
Daisy Parker ◽  
Richard Byng ◽  
Chris Dickens ◽  
Debbie Kinsey ◽  
Rose McCabe
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Treatment Guidelines ◽  
Medical Condition ◽  
Information Provision ◽  
Patient Communication ◽  
Barriers And Facilitators ◽  
Qualitative Synthesis ◽  
Social Stressors ◽  
The Uk

Abstract Background In the UK, general practitioners (GPs) are the most commonly used providers of care for emotional concerns. Objective To update and synthesize literature on barriers and facilitators to GP–patient communication about emotional concerns in UK primary care. Design Systematic review and qualitative synthesis. Method We conducted a systematic search on MEDLINE (OvidSP), PsycInfo and EMBASE, supplemented by citation chasing. Eligible papers focused on how GPs and adult patients in the UK communicated about emotional concerns. Results were synthesized using thematic analysis. Results Across 30 studies involving 342 GPs and 720 patients, four themes relating to barriers were: (i) emotional concerns are difficult to disclose; (ii) tension between understanding emotional concerns as a medical condition or arising from social stressors; (iii) unspoken assumptions about agency resulting in too little or too much involvement in decisions and (iv) providing limited care driven by little time. Three facilitative themes were: (v) a human connection improves identification of emotional concerns and is therapeutic; (vi) exploring, explaining and negotiating a shared understanding or guiding patients towards new understandings and (vii) upfront information provision and involvement manages expectations about recovery and improves engagement in treatment. Conclusion The findings suggest that treatment guidelines should acknowledge: the therapeutic value of a positive GP–patient relationship; that diagnosis is a two-way negotiated process rather than an activity strictly in the doctor’s domain of expertise; and the value of exploring and shaping new understandings about patients’ emotional concerns and their management.

scholarly journals Effectiveness of physical activity promotion and exercise referral in primary care: protocol for a systematic review and meta-analysis of randomised controlled trials

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Jean-Pierre Laake ◽  
Joanna Fleming
Keyword(s):  
Physical Activity ◽  
Systematic Review ◽  
Primary Care ◽  
Sedentary Behaviour ◽  
Physical Activity Promotion ◽  
Self Report ◽  
Activity Promotion ◽  
Randomised Controlled ◽  
The Uk ◽  
Exercise Referral

Abstract Background Physical inactivity is the fourth leading risk factor for global mortality. Reducing sedentary behaviour and increasing physical activity are efficacious for improving many physical and mental health conditions including cardiovascular disease, type 2 diabetes and depression. Reducing sedentary behaviour and increasing physical activity can also be effective at reducing obesity; however, sedentary behaviour and reduced physical activity are also associated with mortality independently. Despite this, most adults in the UK do not currently meet the UK Chief Medical Officers’ guidelines for weekly physical activity. As most adults visit their general practitioner at least once a year, the primary care consultation provides a unique opportunity to deliver exercise referral or physical activity promotion interventions. This is a protocol for a systematic review of randomised controlled trials for the effectiveness of physical activity promotion and referral in primary care. Methods A comprehensive literature search of Embase, MEDLINE (Ovid), Web of Science (Core Collection), Scopus, CINAHL, PsycINFO, and The Cochrane Library (CENTRAL) will be conducted for studies with a minimum follow-up of 12 months that report physical activity as an outcome measure (by either self-report or objective measures) including an intention to treat analysis. The authors will screen papers, first by title and abstract and then by full text, independently assess studies for inclusion, appraise risk of bias and extract data. The quality of the evidence will be assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluations) approach. The primary outcome will be participation in physical activity at 12 months. Pooled effects will be calculated using random effects models. Results will be submitted for publication in a peer-reviewed journal and for presentation at UK national primary care conferences. Discussion This systematic review and meta-analyses will summarise the evidence for the effectiveness of physical activity promotion and referral as interventions for improving physical activity, as well as whether studies using objective measures of physical activity have similar effects to those studies using self-report measures. This knowledge has importance for primary care clinicians, patients and, given the focus of the recent NHS long-term plan on preventive medicine, those making policy decisions. Systematic review registration The protocol is registered with PROSPERO the international prospective register of systematic reviews, ID CRD42019130831

scholarly journals Contribution of paramedics in primary and urgent care: a systematic review

2020 ◽  
Vol 70 (695) ◽  
pp. e421-e426 ◽  
Author(s):  
Georgette Eaton ◽  
Geoff Wong ◽  
Veronika Williams ◽  
Nia Roberts ◽  
Kamal R Mahtani
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Patient Satisfaction ◽  
Clinical Work ◽  
Ambulance Service ◽  
Urgent Care ◽  
Free Text ◽  
Clinical Role ◽  
Primary Care Workforce ◽  
The Uk

BackgroundWithin the UK, there are now opportunities for paramedics to work across a variety of healthcare settings away from their traditional ambulance service employer, with many opting to move into primary care.AimTo provide an overview of the types of clinical roles paramedics are undertaking in primary and urgent care settings within the UK.Design and settingA systematic review.MethodSearches were conducted of MEDLINE, CINAHL, Embase, the National Institute for Health and Care Excellence, the Journal of Paramedic Practice, and the Cochrane Database from January 2004 to March 2019 for papers detailing the role, scope of practice, clinician and patient satisfaction, and costs of paramedics in primary and urgent care settings. Free-text keywords and subject headings focused on two key concepts: paramedic and general practice/primary care.ResultsIn total, 6765 references were screened by title and/or abstract. After full-text review, 24 studies were included. Key findings focused on the description of the clinical role, the clinical work environment, the contribution of paramedics to the primary care workforce, the clinical activities they undertook, patient satisfaction, and education and training for paramedics moving from the ambulance service into primary care.ConclusionCurrent published research identifies that the role of the paramedic working in primary and urgent care is being advocated and implemented across the UK; however, there is insufficient detail regarding the clinical contribution of paramedics in these clinical settings. More research needs to be done to determine how, why, and in what context paramedics are now working in primary and urgent care, and what their overall contribution is to the primary care workforce.

scholarly journals Persistent barriers and facilitators to seeking help for a dementia diagnosis: a systematic review of 30 years of the perspectives of carers and people with dementia

2020 ◽  
Vol 32 (5) ◽  
pp. 611-634 ◽  
Author(s):  
Michelle Parker ◽  
Sally Barlow ◽  
Juanita Hoe ◽  
Leanne Aitken
Keyword(s):  
Systematic Review ◽  
Help Seeking ◽  
Barriers And Facilitators ◽  
Qualitative Synthesis ◽  
Dementia Diagnosis ◽  
Network Support ◽  
Informal Network ◽  
People With Dementia ◽  
Diagnosis Of Dementia ◽  
Protocol Registration

ABSTRACTObjective:To identify barriers and facilitators to help seeking for a dementia diagnosis from the perspective of carers and people with dementia.Design:A systematic review of the literature was conducted according to the PRISMA guidelines (PROSPERO protocol registration CRD42018092524). Nine electronic databases were searched for qualitative, quantitative, and mixed methods primary research studies. Two independent reviewers screened titles and abstracts, full texts of eligible studies, and conducted quality appraisal of included articles. A convergent qualitative synthesis approach was used.Results:From 7496 articles, 35 papers representing 32 studies from 1986 to 2017 were included. Studies originated from 13 countries across 4 continents. Barriers and facilitators were reported predominantly by carers. A small number of studies included people with dementia. Barriers included denial, stigma and fear, lack of knowledge, normalization of symptoms, preserving autonomy, lack of perceived need, unaware of changes, lack of informal network support, carer difficulties, and problems accessing help. Facilitators included recognition of symptoms as a problem, prior knowledge and contacts, and support from informal network.Conclusions:Studies from a 30-year period demonstrated that barriers to help seeking persist globally, despite increasing numbers of national dementia policies. Barriers and facilitators rarely existed independently demonstrating the complexity of help seeking for a diagnosis of dementia. Multiple barriers compounded the decision-making process and more than one facilitator was often required to overcome them. Multi-faceted interventions to reduce barriers are needed, one approach would be a focus on the development of dementia friendly communities to reduce stigma and empower people with dementia and carers.

scholarly journals Incidence of adult Huntington's disease in the UK: a UK-based primary care study and a systematic review

BMJ Open ◽  
2016 ◽  
Vol 6 (2) ◽  
pp. e009070 ◽  
Author(s):  
Nancy S Wexler ◽  
Laura Collett ◽  
Alice R Wexler ◽  
Michael D Rawlins ◽  
Sarah J Tabrizi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Huntington's Disease ◽  
Huntington’S Disease ◽  
The Uk ◽  
Care Study

scholarly journals Long-term condition management in adults with intellectual disability in primary care: a systematic review

BJGP Open ◽  
2018 ◽  
Vol 2 (1) ◽  
pp. bjgpopen18X101445 ◽  
Author(s):  
Peter Hanlon ◽  
Sara MacDonald ◽  
Karen Wood ◽  
Linda Allan ◽  
Sally-Ann Cooper
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Intellectual Disability ◽  
General Population ◽  
Intellectual Disabilities ◽  
Barriers And Facilitators ◽  
Long Term Conditions ◽  
Health Checks ◽  
Adults With Intellectual Disabilities

BackgroundAdults with intellectual disabilities have higher morbidity and earlier mortality than the general population. Access to primary health care is lower, despite a higher prevalence of many long-term conditions.AimTo synthesise the evidence for the management of long-term conditions in adults with intellectual disabilities and identify barriers and facilitators to management in primary care.Design & settingMixed-methods systematic review.MethodSeven electronic databases were searched to identify both quantitative and qualitative studies concerning identification and management of long-term conditions in adults with intellectual disability in primary care. Both the screening of titles, abstracts, and full texts, and the quality assessment were carried out in duplicate. Findings were combined in a narrative synthesis.ResultsFifty-two studies were identified. Adults with intellectual disabilities are less likely than the general population to receive screening and health promotion interventions. Annual health checks may improve screening, identification of health needs, and management of long-term conditions. Health checks have been implemented in various primary care contexts, but the long-term impact on outcomes has not been investigated. Qualitative findings highlighted barriers and facilitators to primary care access, communication, and disease management. Accounts of experiences of adults with intellectual disabilities reveal a dilemma between promoting self-care and ensuring access to services, while avoiding paternalistic care.ConclusionAdults with intellectual disabilities face numerous barriers to managing long-term conditions. Reasonable adjustments, based on the experience of adults with intellectual disability, in addition to intervention such as health checks, may improve access and management, but longer-term evaluation of their effectiveness is required.

scholarly journals Barriers and facilitators to deprescribing in primary care: a systematic review

BJGP Open ◽  
2020 ◽  
Vol 4 (3) ◽  
pp. bjgpopen20X101096 ◽  
Author(s):  
Alison Jayne Doherty ◽  
Paul Boland ◽  
Janet Reed ◽  
Andrew J Clegg ◽  
Anne-Marie Stephani ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Decision Making ◽  
Search Strategy ◽  
Health Management ◽  
Decision Makers ◽  
Barriers And Facilitators ◽  
Evidence Based ◽  
Individual Level ◽  
Whole Systems

BackgroundManaging polypharmacy is a challenge for healthcare systems globally. It is also a health inequality concern as it can expose some of the most vulnerable in society to unnecessary medications and adverse drug-related events. Care for most patients with multimorbidity and polypharmacy occurs in primary care. Safe deprescribing interventions can reduce exposure to inappropriate polypharmacy. However, these are not fully accepted or routinely implemented.AimTo identify barriers and facilitators to safe deprescribing interventions for adults with multimorbidity and polypharmacy in primary care.Design & settingA systematic review of studies published from 2000, examining safe deprescribing interventions for adults with multimorbidity and polypharmacy.MethodA search of electronic databases: MEDLINE, Embase, Cumulative Index of Nursing and Allied Health Literature (CINHAL), Cochrane, and Health Management Information Consortium (HMIC) from inception to 26 Feb 2019, using an agreed search strategy. This was supplemented by handsearching of relevant journals, and screening of reference lists and citations of included studies.ResultsIn total, 40 studies from 14 countries were identified. Cultural and organisational barriers included: a culture of diagnosing and prescribing; evidence-based guidance focused on single diseases; a lack of evidence-based guidance for the care of older people with multimorbidities; and a lack of shared communication, decision-making systems, tools, and resources. Interpersonal and individual-level barriers included: professional etiquette; fragmented care; prescribers’ and patients’ uncertainties; and gaps in tailored support. Facilitators included: prudent prescribing; greater availability and acceptability of non-pharmacological alternatives; resources; improved communication, collaboration, knowledge, and understanding; patient-centred care; and shared decision-making.ConclusionA whole systems, patient-centred approach to safe deprescribing interventions is required, involving key decision-makers, healthcare professionals, patients, and carers.

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