O2 Assessing medication adherence in paediatric cystic fibrosis patients

BackgroundCystic fibrosis (CF) is a life-threatening, autosomal recessive disease, caused by a mutation in the CFTR gene. It affects over 10,800 people in the UK. There is currently no cure for CF with treatment aimed at controlling infections and preventing complications. Paucity of research exists in assessing adherence of long-term medications in paediatric CF patients, in the UK. This is a continuation of a small proof of concept study established in 2015 at Southampton Children’s Hospital.AimTo calculate the medication adherence of Creon, d-nase alfa and vitamins over a 12- month study period. To gain a better insight into impact of CF treatment in patient and their family’s daily life.MethodThis study was approved by the local research ethics committee. A mixed- method approach was taken. Medicines possession ratio (MPR) was calculated using SPSS software from data collected via hospital, homecare and community services, this was used to estimate medication adherence. Semi-structured telephone interviews were conducted with patients’ parents. Thematic analysis was used to study the qualitative data.ResultsTwenty nine parents/patients were consented to take part in the study. Fifteen of these had to be excluded from the MPR calculation due to lack of prescription information from primary care; n=14, mean age 8.4 years (1–14 y), males/female 8/6. Calculated MPR: Creon 72.44% (36.4–100), d-nase 85.27% (57.4–100), vitamins 86.51% (41–100) The themes identified from the qualitative interviews (n=9, all were parents) were time, routine, relationships and psychological impact.ConclusionHaving a set daily routine was felt to be important; adherence was described as more difficult on ‘non- typical days’. Many parents prepared the medication for their children (at all ages), but left it for them to take when they were older; they also helped afterwards by washing nebulisers for example. Finding the time for prolonged time-consuming treatment was described as tricky when trying to balance it with other daily activities. The relationships between parents and their children, especially as the children reached secondary school age; between parents and their healthcare team (in both hospital and community) were described as important factors to aid adherence. CF treatment was described as a ‘chore’, with no break or respite. Adherence, estimated via MPR was lower for oral treatments rather than inhaled, but higher overall than has been shown in other studies.1 Obtaining data from primary care was problematic; this will need to be overcome for further studies. The complex nature of medicines prescribing for this patient cohort led to difficulties with data collection, the loss of 15 patients due to incomplete data from primary care highlights this problem. The increased availability of shared electronic prescription data will make this type of study much more feasible in the future. The overall MPR was higher than expected, but this might be related to the role of parents, we would like to continue this work with more of our adolescent patients and those who have recently transitioned to adult services.ReferenceModi AC, Lim CS, Yu N, et al. A multi-method assessment of treatment adherence for children with cystic fibrosis. J Cyst Fibros 2006;5:177–185.

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A novel income security intervention to address poverty in a primary care setting: a retrospective chart review

BMJ Open ◽

10.1136/bmjopen-2016-014270 ◽

2017 ◽

Vol 7 (8) ◽

pp. e014270 ◽

Cited By ~ 7

Author(s):

Marcella K Jones ◽

Gary Bloch ◽

Andrew D Pinto

Keyword(s):

Primary Care ◽

Health Promotion ◽

Financial Literacy ◽

Chart Review ◽

Community Services ◽

Expert Advice ◽

Advisory Group ◽

Healthcare Team ◽

Income Security ◽

The Impact

ObjectiveTo examine the development and implementation of a novel income security intervention in primary care.DesignA retrospective, descriptive chart review of all patients referred to the Income Security Heath Promotion service during the first year of the service (December 2013–December 2014).SettingA multisite interdisciplinary primary care organisation in inner city Toronto, Canada, serving over 40 000 patients.ParticipantsThe study population included 181 patients (53% female, mean age 48 years) who were referred to the Income Security Health Promotion service and engaged in care.InterventionThe Income Security Health Promotion service consists of a trained health promoter who provides a mixture of expert advice and case management to patients to improve income security. An advisory group, made up of physicians, social workers, a community engagement specialist and a clinical manager, supports the service.Outcome measuresSociodemographic information, health status, referral information and encounter details were collected from patient charts.ResultsEncounters focused on helping patients with increasing their income (77.4%), reducing their expenses (58.6%) and improving their financial literacy (26.5%). The health promoter provided an array of services to patients, including assistance with taxes, connecting to community services, budgeting and accessing free services. The service could be improved with more specific goal setting, better links to other members of the healthcare team and implementing routine follow-up with each patient after discharge.ConclusionsIncome Security Health Promotion is a novel service within primary care to assist vulnerable patients with a key social determinant of health. This study is a preliminary look at understanding the functioning of the service. Future research will examine the impact of the Income Security Health Promotion service on income security, financial literacy, engagement with health services and health outcomes.

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Educational inequalities in statin treatment for preventing cardiovascular disease: cross-sectional analysis of UK Biobank

10.1101/2020.06.11.20128116 ◽

2020 ◽

Author(s):

Alice R Carter ◽

Dipender Gill ◽

Richard Morris ◽

George Davey Smith ◽

Amy E Taylor ◽

...

Keyword(s):

Cardiovascular Disease ◽

Primary Care ◽

Cardiovascular Risk ◽

Educational Attainment ◽

Prescription Data ◽

List Type ◽

Uk Biobank ◽

Cross Sectional ◽

Statin Use ◽

Years Of Schooling

AbstractImportanceThe most socioeconomically deprived individuals remain at the greatest risk of cardiovascular disease. Differences in risk adjusted use of statins between educational groups may contribute to these inequalities.ObjectiveTo identify whether people with lower levels of educational attainment are less likely to take statins for a given level of cardiovascular risk.DesignCross-sectional analysis of a population-based cohort study and linked longitudinal primary care records.SettingUK Biobank data from baseline assessment centres, linked primary care data and hospital episode statisticsParticipantsUK Biobank participants (N = 489 679, mean age = 56, 54% female) with complete data on educational attainment and self-reported medication use. Secondary analyses were carried out on a subsample of participants with linked primary care data (N = 217 675).Main outcome measuresStatin use self-reported to clinic nurses at baseline assessment centres, validated with linked prescription data in a subsample of participants in secondary analyses.ResultsGreater education was associated with lower statin use, whilst higher cardiovascular risk (assessed by QRISK3 score) was associated with higher statin use in both females and males. There was evidence of an interaction between QRISK3 and education, such that for the same QRISK3 score, people with more education were more likely to report taking statins. For example, in women with 7 years of schooling, equivalent to leaving school with no formal qualifications, a one unit increase in QRISK3 score was associated with a 6% higher odds of statin use (odds ratio (OR) 1.06, 95% CI 1.05, 1.06). In contrast, in women with 20 years of schooling, equivalent to obtaining a degree, a one unit increase in QRISK3 score was associated with an 11% higher odds of statin use (OR 1.11, 95% CI 1.10, 1.11). Comparable ORs in men were 1.04 (95% CI 1.04, 1.05) for men with 7 years of schooling and (95% CI 1.07, 1.07) for men with 20 years of schooling.ConclusionsFor the same level of cardiovascular risk, individuals with lower educational attainment are less likely to receive statins, likely contributing to health inequalities.SummaryWhat is already known on this topic?Despite reductions in the rates of cardiovascular disease in high income countries, individuals who are the most socioeconomically deprived remain at the highest risk.Although intermediate lifestyle and behavioural risk factors explain some of this, much of the effect remains unexplained.What does this study add?For the same increase in QRISK3 score, the likelihood of statin use increased more in individuals with high educational attainment compared with individuals with lower educational attainment.These results were similar when using UK Biobank to derive QRISK3 scores and when using QRISK scores recorded in primary care records, and when using self-reported statin prescription data or prescription data from linked primary care records.The mechanisms leading to these differences are unknown, but both health seeking behaviours and clinical factors may contribute.

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Feasibility study for supporting medication adherence for adults with cystic fibrosis: mixed-methods process evaluation

BMJ Open ◽

10.1136/bmjopen-2020-039089 ◽

2020 ◽

Vol 10 (10) ◽

pp. e039089

Author(s):

Daniel Hind ◽

Sarah J Drabble ◽

Madelynne A Arden ◽

Laura Mandefield ◽

Simon Waterhouse ◽

...

Keyword(s):

Cystic Fibrosis ◽

Medication Adherence ◽

Process Evaluation ◽

Working Hours ◽

Prescription Data ◽

Team Members ◽

Treatment Regimens ◽

Adherence Support ◽

Adherence Data ◽

Registration Number

ObjectivesTo undertake a process evaluation of an adherence support intervention for people with cystic fibrosis (PWCF), to assess its feasibility and acceptability.SettingTwo UK cystic fibrosis (CF) units.ParticipantsFourteen adult PWCF; three professionals delivering adherence support (‘interventionists’); five multi-disciplinary CF team members.InterventionsNebuliser with data recording and transfer capability, linked to a software platform, and strategies to support adherence to nebulised treatments facilitated by interventionists over 5 months (± 1 month).Primary and secondary measuresFeasibility and acceptability of the intervention, assessed through semistructured interviews, questionnaires, fidelity assessments and click analytics.ResultsInterventionists were complimentary about the intervention and training. Key barriers to intervention feasibility and acceptability were identified. Interventionists had difficulty finding clinic space and time in normal working hours to conduct review visits. As a result, fewer than expected intervention visits were conducted and interviews indicated this may explain low adherence in some intervention arm participants. Adherence levels appeared to be >100% for some patients, due to inaccurate prescription data, particularly in patients with complex treatment regimens. Flatlines in adherence data at the start of the study were linked to device connectivity problems. Content and delivery quality fidelity were 100% and 60%–92%, respectively, indicating that interventionists needed to focus more on intervention ‘active ingredients’ during sessions.ConclusionsThe process evaluation led to 14 key changes to intervention procedures to overcome barriers to intervention success. With the identified changes, it is feasible and acceptable to support medication adherence with this intervention.Trial registration numberISRCTN13076797; Results.

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SAT0653-HPR COMMUNITY RHEUMATOLOGY SERVICE IN THE UK – WHO BENEFITS THE MOST?

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.6550 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1285.2-1286

Author(s):

K. Szabo-Kocsis ◽

M. Dare

Keyword(s):

Primary Care ◽

Connective Tissue ◽

Waiting Time ◽

Secondary Care ◽

List Type ◽

Ehlers Danlos Syndrome ◽

Specialist Services ◽

Wide Range ◽

Set Up ◽

The Uk

Background:Community rheumatology (CR) in the UK is a new form of rheumatologic service provision established in the last few years and run by few organisations such as Connect Health Ltd.CR is based on the principle of sharing the management of rheumatologic patients between community service and secondary care aiming to reduce the unreasonable referral flow from primary care to secondary care and to share the care of stable inflammatory patients between the services.In the traditional service model patients are referred by General Practitioners (GP) to the secondary care with a wide spectrum of conditions: from fibromyalgia through soft tissues rheumatisms to inflammatory or connective tissue diseases. Many of these patients will be discharged from the specialist service after their first visit with fibromyalgia, osteoarthritis, chronic pain syndrome or MSK diagnoses. The proportion of these patients versus those who have an inflammatory rheumatologic condition or connective tissue disease (CTD) varies significantly and can contribute to oversaturated specialist rheumatologic services with long waiting time where specialists deal with less relevant cases.Objectives:To determine how CR can improve quality of care and decrease the waiting time for appointment in secondary care rheumatology services. To set standards for referral pathways and measured outcomes of effectiveness in patient care.In the UK the regional Clinical Commissioning Groups would accept a maximum waiting time from the referral until patient treatment of up to 18 weeks and specialist services often breach that limit. This long interval may have a significant negative impact for the care of patients with rheumatological condition, reducing patient satisfaction and/or jeopardize patient safety. The solution to the above problem is the creation of CR service.Methods:Extensive search about the available resources within UK NHS system in regards CR service creation and set up. Web search, literature review in relation to CR in the UKResults:From the research different models of CR can be identified and one of these will be presented in details based on the experience of one of the largest organisation running CR services in the UK (Connect Health Ltd). This service is organised within community care set up and can accept patients referred by the primary care physicians with non-inflammatory symptoms (e.g. osteoarthritis, Ehlers - Danlos Syndrome, fibromyalgia) or PMR or gout. The service also can review stable inflammatory patients who are treated with DMARDs and are transferred from the secondary care service by their consultant. This presentation will demonstrate how CR provides safer, faster and more accessible services to the patients assisting the specialist services and allowing them to concentrate on the inflammatory and CTD patients who need faster access to these services than it is possible now. Particularly the presentation will emphasise on:Patient population coverTeam structure, their experience and trainingReferral criteria and IT set up for multidisciplinary connectionTime interval for appointment and patient feedbackImpact on the secondary care rheumatology serviceCases of misdiagnosis and inappropriate referralsCost effectiveness of the CRChallenges in the CR serviceConclusion:The CR service can be a safe addition to the specialist services taking over significant workload and provide new career opportunities for a wide range of Allied Health Professionals (AHP) for the bigger satisfaction of the patients who can access rheumatology service earlier and easier.Disclosure of Interests:None declared

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PP29 The paramedic will see you now: understanding new roles in primary care

Emergency Medicine Journal ◽

10.1136/emermed-2020-999abs.29 ◽

2020 ◽

Vol 37 (10) ◽

pp. e13.2-e13

Author(s):

Alison Porter ◽

Timothy Driscoll ◽

Adrian Edwards ◽

Bridie Evans ◽

Lesley Griffiths ◽

...

Keyword(s):

Primary Care ◽

Clinical Supervision ◽

Feasibility Study ◽

Clinical Skills ◽

Evidence Base ◽

Logic Model ◽

Health Board ◽

List Type ◽

Model Training ◽

The Uk

BackgroundIn response to rising healthcare demand and shortages of general practitioners (GPs), policy across the UK supports paramedics joining the clinical team in primary care. Numbers of paramedics in primary care (PPC) are increasing in England and Wales through a range of local initiatives. As the first stage in the ARRIVE feasibility study evaluating PPC, we conducted preliminary qualitative research to:Understand the key components of the PPC intervention and its potential impactsIdentify sites with PPC and describe the range of existing interventionsDevelop a logic model to describe PPC.MethodsWe interviewed a total of 19 stakeholders from across Wales, including Health Board managers, GPs, practice managers and paramedics. Interviews were recorded and transcribed in full, then analysed thematically. We held a stakeholder event, bringing together 21 people involved in commissioning, planning and delivering PPC to discuss the key components of a logic model, including outcome measures for evaluation.ResultsWe developed a logic model describing how paramedics provide direct clinical contact with patients in a primary care setting. Potential positive impacts include better patient experience, reductions in emergency admissions through better proactive care, increased sustainability of primary care, and increased levels of clinical skills and satisfaction for paramedics. Components of the intervention which varied across sites included type of patient contact (home visit or surgery); approaches to patient selection and triage; employment model; training and induction; and clinical supervision and support from GPs.ImplicationsPPC is a rapidly developing area of provision in primary care, but there is great variation in the nature of models which have been implemented, and there is still uncertainty about the risks and benefits of PPC, and about how best to deliver it. Our logic model underpins the ARRIVE feasibility study, which will help to build the evidence base urgently needed on the PPC innovation.

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Real-world evaluation of digital CBT for insomnia in the primary care setting – many should not log on to doze off

The Cognitive Behaviour Therapist ◽

10.1017/s1754470x19000242 ◽

2019 ◽

Vol 12 ◽

Author(s):

Zheyu Xu ◽

Kirstie N. Anderson

Keyword(s):

Primary Care ◽

Clinical Trials ◽

Sleep Disorders ◽

Care Setting ◽

Primary Care Setting ◽

Case Series ◽

Stepped Care ◽

List Type ◽

Cognitive Behaviour ◽

The Uk

Abstract Cognitive behaviour therapy for insomnia (CBTi) has emerged as the first-line treatment for insomnia where available. Clinical trials of digital CBTi (dCBTi) have demonstrated similar efficacy and drop-out rates to face-to-face CBTi. Most patients entering clinical trials are carefully screened to exclude other sleep disorders. This is a case series review of all those referred to a dCBTi within an 18-month time period. Those initially screened, accepted after exclusion of other sleep disorders, commencing and completing therapy were assessed to understand patient population referred from general practice in the UK. 390 patient referrals were analysed. 135 were suitable for dCBTi with a high rate of other sleep disorders detected in screening. 78 completed therapy (20.0%) and 44.9% had significant improvement in sleep outcomes, achieving ≥20% improvement in final sleep efficiency. dCBTi can be used within the UK NHS with good benefit for those who are selected as having insomnia and who then complete therapy. Many referrals are made with those likely to have distinct primary sleep disorders highlighting the need for education regarding sleep and sleep disorders prior to dCBTi therapy. Key learning aims (1) The use of unsupported digital cognitive behavioural therapy for insomnia (dCBTi) requires proper patient selection. (2) There are many insomnia mimics and also previously unrecognized sleep and psychiatric disturbances that are under-diagnosed in the primary care setting that are contraindications for unsupported dCBTi. (3) The use of a stepped care approach similar to the UK’s Improving Access to Psychological Therapies (IAPT) model using dCBTi could be feasible in the public health setting.

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Patients’ Experiences of “Long COVID” in the Community and Recommendations for Improving Services: A Quality Improvement Survey

Journal of Primary Care & Community Health ◽

10.1177/21501327211041846 ◽

2021 ◽

Vol 12 ◽

pp. 215013272110418

Author(s):

Mohammad Sharif Razai ◽

Roaa Al-Bedaery ◽

Laxmi Anand ◽

Katherine Fitch ◽

Hannah Okechukwu ◽

...

Keyword(s):

Primary Care ◽

Quality Improvement ◽

Community Services ◽

Multisystem Disease ◽

Phone Calls ◽

Initial Symptoms ◽

Or Practice ◽

Important Approach ◽

The Uk ◽

Primary Care Practices

Introduction: “Long COVID” is a multisystem disease that lasts for 4 or more weeks following initial symptoms of COVID-19. In the UK, at least 10% of patient report symptoms at 12 weeks following a positive COVID-19 test. The aims of this quality improvement survey were to explore patients’ acute and post-acute “long” COVID-19 symptoms, their experiences of community services and their recommendations for improving these services. Methods: Seventy patients diagnosed with COVID were randomly selected from 2 large socially and ethnically diverse primary care practices. Of those contactable by telephone, 85% (41/48) agreed to participate in the quality improvement survey. They were interviewed by telephone using a semi-structured questionnaire about community services for COVID-19 patients. Interviews lasted 10 to 15 minutes. Results: Forty-nine percent of patients reported at least 1 post-acute COVID-19 symptom. The most common were severe fatigue (45%), breathlessness (30%), neurocognitive difficulties (such as poor memory), poor concentration and “brain fog” (30%), headaches (20%), and joint pain (20%). Many patients felt isolated and fearful, with scant information about community resources and little safety netting advice. Patients also expected more from primary care with over half (56%) recommending regular phone calls and follow up from healthcare staff as the most important approach in their recovery. Conclusions: In line with patients’ requests for more support, the practices now routinely refer patients with long COVID to an on-site social prescriber who explores how they are getting on, refers them to the GP or practice nurse when required, and sign posts them to support services in the community.

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Management of deradicalisation in the UK: reflections of a clinical psychologist

Journal of Psychological Therapies ◽

10.33212/jpt.v4n1.2019.59 ◽

2019 ◽

Vol 4 (1) ◽

Cited By ~ 1

Author(s):

Feryad A. Hussain

Keyword(s):

Clinical Psychologist ◽

Healthcare Team ◽

Psychosocial Issues ◽

Muslim Community ◽

Home Office ◽

Terrorist Groups ◽

Violent Action ◽

Clinical Counselling ◽

The Uk

Radicalisation to violent action is not just a problem in foreign lands. Research has identified numerous politico–psychosocial factors to explain why young people from the UK are now joining terrorist groups such as ISIS. Our understanding has been expanded by the accounts of “returnees” who have subsequently either self-deradicalised or joined a government deradicalisation programme in the role of an Intervention Provider (IP). These individuals are now key to the deradicalisation programme. This article presents the reflections of a clinical psychologist who worked within a social healthcare team managing psychosocial issues related to radicalisation, in conjunction with an allocated IP. The project involved individuals from the Muslim community and, as such, issues discussed are specific to this group. It is acknowledged that the process in general is universally applicable to all groups though specifics may vary (under Trust agreement, details may not be discussed). This article also aims to share basic information on the current Home Office deradicalisation programme and raises questions about the current intervention. It also offers reflections on how the work of IPs may be facilitated and supported by clinical/counselling psychologists and psychotherapists.

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