scholarly journals Predicting pain and function outcomes in people consulting with shoulder pain: the PANDA-S clinical cohort and qualitative study protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e052758
Author(s):  
Gwenllian Wynne-Jones ◽  
Helen Myers ◽  
Alison Hall ◽  
Chris Littlewood ◽  
S Hennings ◽  
...  
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Shoulder Pain ◽  
Prognostic Model ◽  
Latent Class ◽  
Qualitative Interviews ◽  
Short Term ◽  
Clinical Cohort ◽  
Costs Of Care

IntroductionPeople presenting with shoulder pain considered to be of musculoskeletal origin is common in primary care but diagnosing the cause of the pain is contentious, leading to uncertainty in management. To inform optimal primary care for patients with shoulder pain, the study aims to (1) to investigate the short-term and long-term outcomes (overall prognosis) of shoulder pain, (2) estimate costs of care, (3) develop a prognostic model for predicting individuals’ level and risk of pain and disability at 6 months and (4) investigate experiences and opinions of patients and healthcare professionals regarding diagnosis, prognosis and management of shoulder pain.Methods and analysisThe Prognostic And Diagnostic Assessment of the Shoulder (PANDA-S) study is a longitudinal clinical cohort with linked qualitative study. At least 400 people presenting to general practice and physiotherapy services in the UK will be recruited. Participants will complete questionnaires at baseline, 3, 6, 12, 24 and 36 months. Short-term data will be collected weekly between baseline and 12 weeks via Short Message Serevice (SMS) text or software application. Participants will be offered clinical (physiotherapist) and ultrasound (sonographer) assessments at baseline. Qualitative interviews with ≈15 dyads of patients and their healthcare professional (general practitioner or physiotherapist).Short-term and long-term trajectories of Shoulder Pain and Disability Index (using SPADI) will be described, using latent class growth analysis. Health economic analysis will estimate direct costs of care and indirect costs related to work absence and productivity losses. Multivariable regression analysis will be used to develop a prognostic model predicting future levels of pain and disability at 6 months using penalisation methods to adjust for overfitting. The added predictive value of prespecified physical examination tests and ultrasound findings will be examined. For the qualitative interviews an inductive, exploratory framework will be adopted using thematic analysis to investigate decision making, perspectives of patients and clinicians on the importance of diagnostic and prognostic information when negotiating treatment and referral options.Ethics and disseminationThe PANDA-S study has ethical approval from Yorkshire and The Humber-Sheffield Research Ethics Committee, UK (18/YH/0346, IRAS Number: 242750). Results will be disseminated through peer-reviewed publications, social and mainstream media, professional conferences, and the patient and public involvement and engagement group supporting this study, and through newsletters, leaflets and posters in participating sites.Trial registration numberISRCTN46948079.

scholarly journals Predicting pain and function outcomes in people consulting with shoulder pain: The PANDA-S clinical cohort and qualitative study protocol (ISRCTN 46948079)

2021 ◽  
Author(s):  
Gwenllian Wynne-Jones ◽  
Helen Myers ◽  
Alison Hall ◽  
Chris Littlewood ◽  
Susie Hennings ◽  
...  
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Shoulder Pain ◽  
Prognostic Model ◽  
Latent Class ◽  
Qualitative Interviews ◽  
Clinical Cohort ◽  
Costs Of Care ◽  
Short And Long Term

Introduction Shoulder pain is common in primary care but achieving definitive diagnosis is contentious leading to uncertainty in management. To inform optimal primary care for patients with shoulder pain, the study aims to (i) to investigate the short- and long-term outcomes (overall prognosis) of shoulder pain, (ii) estimate costs of care, (iii) develop a prognostic model for predicting individuals level and risk of pain and disability at 6 months, (iv) investigate experiences and opinions of patients and healthcare professionals regarding diagnosis, prognosis, and management of shoulder pain. Methods and analysis PANDA-S is a longitudinal clinical cohort with linked qualitative study. At least 400 people presenting to general practice and physiotherapy services in the UK will be recruited. Participants will complete questionnaires at baseline, 3, 6, 12, 24 and 36 months. Short-term data will be collected weekly between baseline and 12 weeks via SMS text or software application (App). Participants will be offered clinical (physiotherapist) and ultrasound (sonographer) assessments at baseline. Qualitative interviews with 15 dyads of patients and their healthcare professional (GP or physiotherapist). Short and long-term trajectories of shoulder pain and disability (using SPADI) will be described, using latent class growth analysis. Health economic analysis will estimate direct costs of care and indirect costs related to work absence and productivity losses. Multivariable regression analysis will be used to develop a prognostic model predicting future levels of pain and disability at 6-months using penalisation methods to adjust for overfitting. The added predictive value of pre-specified physical examination tests and ultrasound findings will be examined. For the qualitative interviews an inductive, exploratory framework will be adopted using thematic analysis to investigate decision making and perspectives of patients and clinicians on the importance of diagnostic and prognostic information when negotiating treatment and referral options.

scholarly journals Spatio-temporal associations of air pollutant concentrations, GP respiratory consultations and respiratory inhaler prescriptions: a 5-year study of primary care in the borough of Lambeth, South London

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Mark Ashworth ◽  
◽  
Antonis Analitis ◽  
David Whitney ◽  
Evangelia Samoli ◽  
...  
Keyword(s):  
Primary Care ◽  
Negative Binomial ◽  
Hospital Admissions ◽  
Air Pollutant ◽  
Respiratory Morbidity ◽  
Short Term ◽  
Short Term Exposure ◽  
Short And Long Term ◽  
Spatio Temporal

Abstract Background Although the associations of outdoor air pollution exposure with mortality and hospital admissions are well established, few previous studies have reported on primary care clinical and prescribing data. We assessed the associations of short and long-term pollutant exposures with General Practitioner respiratory consultations and inhaler prescriptions. Methods Daily primary care data, for 2009–2013, were obtained from Lambeth DataNet (LDN), an anonymised dataset containing coded data from all patients (1.2 million) registered at general practices in Lambeth, an inner-city south London borough. Counts of respiratory consultations and inhaler prescriptions by day and Lower Super Output Area (LSOA) of residence were constructed. We developed models for predicting daily PM2.5, PM10, NO2 and O3 per LSOA. We used spatio-temporal mixed effects zero inflated negative binomial models to investigate the simultaneous short- and long-term effects of exposure to pollutants on the number of events. Results The mean concentrations of NO2, PM10, PM2.5 and O3 over the study period were 50.7, 21.2, 15.6, and 49.9 μg/m3 respectively, with all pollutants except NO2 having much larger temporal rather than spatial variability. Following short-term exposure increases to PM10, NO2 and PM2.5 the number of consultations and inhaler prescriptions were found to increase, especially for PM10 exposure in children which was associated with increases in daily respiratory consultations of 3.4% and inhaler prescriptions of 0.8%, per PM10 interquartile range (IQR) increase. Associations further increased after adjustment for weekly average exposures, rising to 6.1 and 1.2%, respectively, for weekly average PM10 exposure. In contrast, a short-term increase in O3 exposure was associated with decreased number of respiratory consultations. No association was found between long-term exposures to PM10, PM2.5 and NO2 and number of respiratory consultations. Long-term exposure to NO2 was associated with an increase (8%) in preventer inhaler prescriptions only. Conclusions We found increases in the daily number of GP respiratory consultations and inhaler prescriptions following short-term increases in exposure to NO2, PM10 and PM2.5. These associations are more pronounced in children and persist for at least a week. The association with long term exposure to NO2 and preventer inhaler prescriptions indicates likely increased chronic respiratory morbidity.

scholarly journals Controlled trial of the short- and long-term effect of psychological treatment of post-partum depression

2003 ◽  
Vol 182 (5) ◽  
pp. 412-419 ◽  
Author(s):  
Peter J. Cooper ◽  
Lynne Murray ◽  
Anji Wilson ◽  
Helena Romaniuk
Keyword(s):  
Primary Care ◽  
Postnatal Depression ◽  
Post Partum ◽  
Psychodynamic Therapy ◽  
Term Effect ◽  
Short Term ◽  
Post Partum Depression ◽  
Maternal Mood ◽  
Long Term Effect

BackgroundPsychological interventions for postnatal depression can be beneficial in the short term but their longer-term impact is unknown.AimsTo evaluate the long-term effect on maternal mood of three psychological treatments in relation to routine primary care.MethodWomen with post-partum depression (n=193) were assigned randomly to one of four conditions: routine primary care, non-directive counselling, cognitive–behavioural therapy or psychodynamic therapy. They were assessed immediately after the treatment phase (at 4.5 months) and at 9, 18 and 60 months post-partum.ResultsCompared with the control, all three treatments had a significant impact at 4.5 months on maternal mood (Edinburgh Postnatal Depression Scale, EPDS). Only psychodynamic therapy produced a rate of reduction in depression (Structured Clinical Interview for DSM–III–R) significantly superior to that of the control. The benefit of treatment was no longer apparent by 9 months post-partum. Treatment did not reduce subsequent episodes of post-partum depression.ConclusionsPsychological intervention for post-partum depression improves maternal mood (EPDS) in the short term. However, this benefit is not superior to spontaneous remission in the long term.

scholarly journals Improving the Care of People with Long-Term Conditions in Primary Care: Protocol for the Enhance Pilot Trial

2015 ◽  
Vol 5 (1) ◽  
pp. 135-149 ◽  
Author(s):  
Emma L. Healey ◽  
Clare Jinks ◽  
Valerie A. Tan ◽  
Carolyn A. Chew-Graham ◽  
Sarah A. Lawton ◽  
...  
Keyword(s):  
Primary Care ◽  
Controlled Trial ◽  
Qualitative Interviews ◽  
Pilot Trial ◽  
Integrated Approach ◽  
Long Term Conditions ◽  
Delivery Of Care ◽  
Care Protocol ◽  
Engagement Assessment

Background Long-term conditions (LTCs) are important determinants of quality of life and healthcare expenditure worldwide. Whilst multimorbidity is increasingly the norm in primary care, clinical guidelines and the delivery of care remain focused on single diseases, resulting in poorer clinical outcomes. Osteoarthritis, and anxiety and/or depression frequently co-occur with other LTCs, yet are seldom prioritized by the patient or clinician, resulting in higher levels of disability, poorer prognosis, and increased healthcare costs. Objective To examine the feasibility and acceptability of an integrated approach to LTC management, tackling the under-diagnosis and under-management of osteoarthritis-related pain and anxiety and/or depression in older adults with other LTCs in primary care. Design The ENHANCE study is a pilot stepped-wedge cluster randomized controlled trial to test the feasibility and acceptability of a nurse-led ENAHNCE LTC review consultation for identifying, assessing, and managing joint pain, and anxiety and/or depression in patients attending LTC reviews. Specific objectives (process evaluation and research outcomes) will be achieved through a theoretically informed mixed-methods approach using participant self-reported questionnaires, a medical record review, an ENHANCE EMIS template, qualitative interviews, and audio recordings of the ENHANCE LTC review. Discussion Success of the pilot trial will be measured against the level of the primary care team engagement, assessment of training delivery, and degree of patient recruitment and retention. Patient satisfaction and treatment fidelity will also be explored. ISRCTN registry number: 12154418.

scholarly journals Long-term antidepressant use: a qualitative study on perspectives of patients and GPs in primary care

2016 ◽  
Vol 66 (651) ◽  
pp. e708-e719 ◽  
Author(s):  
Renske C Bosman ◽  
Klaas M Huijbregts ◽  
Peter FM Verhaak ◽  
Henricus G Ruhé ◽  
Harm WJ van Marwijk ◽  
...  
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Antidepressant Use

scholarly journals Physicians’ experiences of SBIRT training and implementation for SUD management in primary care in the UAE: a qualitative study

2017 ◽  
Vol 19 (04) ◽  
pp. 344-354
Author(s):  
Christiane Pflanz-Sinclair ◽  
Catriona Matheson ◽  
Christine M. Bond ◽  
Amna Almarzouqi ◽  
Amanda J. Lee ◽  
...  
Keyword(s):  
Primary Care ◽  
Substance Use ◽  
Qualitative Study ◽  
Primary Care Physicians ◽  
Substance Misuse ◽  
Care Pathway ◽  
Controlled Trial ◽  
Qualitative Interviews ◽  
Successful Implementation ◽  
Cultural Issues

AimThe objective of this paper is to present a qualitative study of introducing substance misuse screening using the Screening Brief Intervention and Referral to Treatment (SBIRT) model, in primary care in Abu Dhabi.BackgroundSubstance misuse in the UAE is an increasing problem. However religious beliefs and fear of legal consequences have prevented this topic from being openly discussed, risk levels identified through screening and treatment options offered.MethodsA controlled trial was undertaken which included a qualitative process study which is reported here. Qualitative interviews with primary care physicians from two intervention clinics were undertaken to explore their views, experiences and attitudes towards substance misuse management in their clinic. Physicians were trained on SBIRT and on the research project process and documentation. At completion of the project, 10 months after the training, physicians (n=17) were invited to participate in an interview to explore their experiences of training and implementation of SBIRT. Interviews were recorded and transcribed. Inductive thematic coding was applied.FindingsIn total, 11 physicians were interviewed and three main themes emerged: (1) The SBIRT screening project, (2) cultural issues and (3) patient follow-up. Findings revealed a general willingness toward the concept of screening and delivering brief interventions in primary care although increased workload and uncertainties about remuneration for the service may be a barrier to future implementation. There was a perceived problem of substance misuse that was not currently being met and a strong perception that patients were not willing to reveal substance use due cultural barriers and fear of police involvement. In conclusion this qualitative process evaluation provided essential insight into implementing SBIRT in the Middle East. In conclusion, despite physician willingness and a clinical need for a substance misuse care pathway, the reluctance among patients to admit to substance use in this culture needs to be addressed to enable successful implementation.

scholarly journals Patient's experience of asthma exacerbation and management: a qualitative study of severe asthma

2020 ◽  
pp. 00528-2020
Author(s):  
Woo-Jung Song ◽  
Ha-Kyeong Won ◽  
Suh Young Lee ◽  
Han-Ki Park ◽  
You Sook Cho ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Severe Asthma ◽  
Asthma Exacerbation ◽  
Qualitative Interviews ◽  
Health Consequences ◽  
Patient’S Experience ◽  
Oral Corticosteroids ◽  
Tertiary Hospitals ◽  
Systematic Education

BackgroundExacerbation is a defining feature of severe asthma, and oral corticosteroids (OCSs) are frequently prescribed to manage exacerbations. This qualitative study was conducted to examine the experience of patients with severe asthma, with a focus on asthma exacerbation and OCS treatment.MethodsAdults with severe asthma were recruited from three tertiary hospitals in South Korea. Data were collected through in-depth qualitative interviews. Verbatim transcripts were analysed using Colaizzi's phenomenological method to uncover the meaning of the participants’ experience. Recruitment of participants continued until thematic saturation.ResultsFourteen patients with severe asthma were recruited. Four theme clusters emerged: 1) experience of asthma exacerbation, 2) impact on life, 3) OCS treatments, and 4) disease perception. The patients experienced severe physical and psychosocial distress from asthma exacerbations, felt helpless due to failed efforts to prevent exacerbation, and were living a restricted life due to fear of exacerbation. They feared OCS side effects but had no other choice but to rely on OCS because other interventions were ineffective. Most had poor knowledge and understanding of severe asthma and the longterm health consequences.ConclusionAsthma exacerbation affects wide aspects of life in patients with severe asthma. Several components may underlie OCS reliance, including experience of distress during exacerbation, fear of future exacerbation, and lack of proper knowledge about long-term health consequences of severe asthma and OCS treatments. Multi-disciplinary approach is warranted to support the patients and to provide systematic education about long-term health implications of severe asthma.

scholarly journals ‘I wouldn't push that further because I don't want to lose her’: a multiperspective qualitative study of behaviour change for long‐term conditions in primary care

2014 ◽  
Vol 18 (6) ◽  
pp. 1995-2010 ◽  
Author(s):  
Cheryl Hunter ◽  
Carolyn A. Chew‐Graham ◽  
Susanne Langer ◽  
Jessica Drinkwater ◽  
Alexandra Stenhoff ◽  
...  
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Behaviour Change ◽  
Long Term Conditions

scholarly journals Are corticosteroid injections more beneficial than anaesthetic injections alone in the management of rotator cuff-related shoulder pain? A systematic review

2018 ◽  
Vol 52 (8) ◽  
pp. 497-504 ◽  
Author(s):  
Tim Cook ◽  
Catherine Minns Lowe ◽  
Mark Maybury ◽  
Jeremy S Lewis
Keyword(s):  
Systematic Review ◽  
Rotator Cuff ◽  
Shoulder Pain ◽  
Local Anaesthetic ◽  
Risk Of Bias ◽  
Long Term Outcomes ◽  
Short Term ◽  
Significant Difference ◽  
Corticosteroid Injections

ObjectiveTo compare the effectiveness of corticosteroid injections to local anaesthetic injections in the management of rotator cuff-related shoulder pain (RCRSP).DesignSystematic review with best evidence synthesis.Data sourcesThe Cochrane, PubMed, CINAHL Plus, PEDro and EMBASE electronic databases were searched (inception until 8 June 2017). Reference lists of included articles were also hand searched.Eligibility criteriaTwo reviewers independently evaluated eligibility. Randomised controlled trials (RCTs) were included if they compared subacromial injections of corticosteroid with anaesthetic injections. Two reviewers independently extracted data regarding short-term, midterm and long-term outcomes for pain, self-reported function, range of motion and patient-perceived improvement.ResultsThirteen RCTs (n=1013) were included. Four trials (n=475) were judged as being at low risk of bias. Three studies of low risk of bias favoured the use of corticosteroid over anaesthetic-only injections in the short term (up to 8 weeks). There was strong evidence of no significant difference between injection types in midterm outcomes (12–26 weeks). There was limited evidence of no significant difference between injection types in long-term outcomes.ConclusionCorticosteroid injections may have a short-term benefit (up to 8 weeks) over local anaesthetic injections alone in the management of RCRSP. Beyond 8 weeks, there was no evidence to suggest a benefit of corticosteroid over local anaesthetic injections.Trial registration numberPROSPERO CRD42016033161.

scholarly journals Understanding Clinicians’ Decisions to Assume Prescriptions for Inherited Patients on Long-term Opioid Therapy: A Qualitative Study

Pain Medicine ◽  
2020 ◽  
Vol 21 (11) ◽  
pp. 3187-3198 ◽  
Author(s):  
Michelle S Keller ◽  
Alma Jusufagic ◽  
Teryl K Nuckols ◽  
Jack Needleman ◽  
MarySue Heilemann
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Primary Care Physicians ◽  
Quality Care ◽  
Opioid Therapy ◽  
Outpatient Setting ◽  
Specialized Training ◽  
Primary Care Clinicians ◽  
Opioid Medications

Abstract Objective Given the changing political and social climate around opioids, we examined how clinicians in the outpatient setting made decisions about managing opioid prescriptions for new patients already on long-term opioid therapy. Methods We conducted in-depth interviews with 32 clinicians in Southern California who prescribed opioid medications in the outpatient setting for chronic pain. The study design, interview guides, and coding for this qualitative study were guided by constructivist grounded theory methodology. Results We identified three approaches to assuming a new patient’s opioid prescriptions. Staunch Opposers, mostly clinicians with specialized training in pain medicine, were averse to continuing opioid prescriptions for new patients and often screened outpatients seeking opioids. Cautious and Conflicted Prescribers were wary about prescribing opioids but were willing to refill prescriptions if they perceived the patient as trustworthy and the medication fell within their comfort zone. Clinicians in the first two groups felt resentful about other clinicians “dumping” patients on opioids on them. Rapport Builders, mostly primary care physicians, were the most willing to assume opioid prescriptions and were strategic in their approach to transitioning patients to safer doses. Conclusions Clinicians with the most training in pain management were the least willing to assume responsibility for opioid prescriptions for patients already on long-term opioid therapy. In contrast, primary care clinicians were the most willing to assume this responsibility. However, primary care clinicians face barriers to providing high-quality care for patients with complex pain conditions, such as short visit times and less specialized training.

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