scholarly journals Nationwide evaluation of the advanced clinical practitioner role in England: a cross-sectional survey

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e055475
Author(s):  
Lauren Jade Fothergill ◽  
Amani Al-Oraibi ◽  
Jonathan Houdmont ◽  
Joy Conway ◽  
Catrin Evans ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Workforce Development ◽  
Continuing Professional Development ◽  
Free Text ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Study Objective ◽  
Levels Of Care ◽  
The Uk

Background and study objectiveIn response to growing pressures on healthcare systems, the advanced clinical practice (ACP) role has been implemented widely in the UK and internationally. In England, ACP is a level of practice applicable across various healthcare professions, who exercise a level of autonomy across four domains, referred to as the four pillars of practice (education, leadership, research and clinical practice). A national framework for ACP was established in 2017 to ensure consistency across the ACP role, however current ACP governance, education and support is yet to be evaluated. This study aimed to analyse data from a national survey of the ACP role to inform the development and improvement of policies relating to ACP in the National Health Service (NHS) in England.DesignA cross-sectional survey with free-text comments.SettingThe survey was distributed across primary and secondary levels of care to three distinct groups in England, including individual ACPs, NHS provider organisations and Trusts and primary care settings.ParticipantsA total of 4365 surveys were returned, from ACP staff (n=4013), NHS provider organisations and Trusts (n=166) and primary care organisations (n=186).ResultsConsiderable variation was found in role titles, scope of practice, job descriptions and educational backgrounds of ACPs. Differing approaches to governance were noted, which led to inconsistent ACP frameworks in some organisations. A further challenge highlighted included committing time to work across the four pillars of advanced practice, particularly the research pillar. ACPs called for improvements in supervision and continuing professional development alongside further support in navigating career pathways.ConclusionsA standardised approach may support ACP workforce development in England and enable ACPs to work across the four pillars of practice. Due to the wide uptake of ACP roles internationally, this study has relevance across professions for global healthcare workforce transformation

scholarly journals Self-Monitoring of Blood Pressure in Hypertension: A UK Primary Care Survey

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
S. Baral-Grant ◽  
M. S. Haque ◽  
A. Nouwen ◽  
S. M. Greenfield ◽  
R. J. McManus
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Clinical Practice ◽  
Blood Glucose ◽  
Diabetic Patients ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Self Monitoring ◽  
Care Survey ◽  
The Uk

This study aimed to determine the prevalence of Self-Monitoring Blood Pressure amongst people with hypertension using a cross-sectional survey. Of the 955 who replied (53%), 293 (31%) reported that they self-monitored blood pressure. Nearly 60% (198/331) self-monitored at least monthly. Diabetic patients monitoring their blood glucose were five times more likely than those not monitoring to monitor their blood pressure. Self-monitoring is less common in the UK than internationally, but is practiced by enough people to warrant greater integration into clinical practice.

Benefits and Challenges of Using Virtual Primary Care During the COVID-19 Pandemic: An International Cross-sectional Survey Study (Preprint)

2021 ◽  
Author(s):  
Edmond Li ◽  
Rosy Tsopra ◽  
Geronimo Jimenez ◽  
Alice Serafini ◽  
Gustavo Gusso ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Delivery ◽  
Lessons Learned ◽  
Survey Study ◽  
Free Text ◽  
Cross Sectional Survey ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Face To Face ◽  
Remote Care

BACKGROUND With the onset of COVID-19, general practitioners (GPs) and patients worldwide swiftly transitioned from face-to-face to digital remote consultations. There is a need to evaluate how this global shift has impacted patient care, healthcare providers, patient and carer experience, and health systems. OBJECTIVE We explored GPs’ perspectives on the main benefits and challenges of using digital remote care. METHODS GPs across 20 countries completed an online questionnaire between June – September 2020. GPs’ perceptions on main barriers and challenges were explored using free-text questions. Thematic analysis was used to analyse the data. RESULTS A total of 1,605 respondents participated in our survey. The benefits identified included reducing COVID-19 transmission risks, guaranteeing access and continuity of care, improved efficiency, faster access to care, improved convenience and communication with patients, greater work flexibility for providers, and hastening the digital transformation of primary care and accompanying legal frameworks. Main challenges included patient’s preference for face-to-face consultations, digital exclusion, lack of physical examinations, clinical uncertainty, delays in diagnosis and treatment, overuse and misuse of digital remote care, and unsuitability for certain types of consultations. Other challenges include the lack of formal guidance, higher workloads, remuneration issues, organisational culture, technical difficulties, implementation and financial issues, and regulatory weaknesses. CONCLUSIONS At the frontline of care delivery, GPs can provide important insights on what worked well, why, and how during the pandemic. Lessons learned can be used to inform the adoption of improved virtual care solutions, and support the long-term development of platforms that are more technologically robust, secure. INTERNATIONAL REGISTERED REPORT RR2-10.2196/30099

Dentists’ preferences for diagnosis, management and referral of chronic oro-facial pain: Results from a national survey

2011 ◽  
Vol 71 (6) ◽  
pp. 662-669 ◽  
Author(s):  
Vishal R Aggarwal ◽  
Amy Joughin ◽  
Joanna Zakrzewska ◽  
Priscilla Appelbe ◽  
Martin Tickle
Keyword(s):  
Primary Care ◽  
Facial Pain ◽  
Temporomandibular Disorder ◽  
Postal Questionnaire ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Specialist Services ◽  
Primary Care Practitioners ◽  
Pain Symptoms ◽  
The Uk

Aim: To explore the diagnosis, treatment and referral patterns of chronic oro-facial pain patients by generalist primary care dentists (GDPs) in the UK. Methods: A cross-sectional survey was conducted using a non-stratified random sample of 500 GDPs who were selected from the General Dental Council register. A self-complete postal questionnaire with four hypothetical clinical case scenarios describing sub-types of chronic oro-facial pain (COFP) was used to investigate diagnosis, treatment and referral options of GDPs. Results: Two hundred and twenty (44%) GDPs responded. The majority correctly diagnosed temporomandibular disorder (TMD; 88%) and burning mouth syndrome (BMS; 92%). There was more variation in the diagnosis of the other cases related to persistent oro-facial pain. For TMD there was a clear preference for treatment with occlusal splint therapy, and referral to a temporomandibular joint (TMJ) specialist. The BMS scenario showed drug therapy and referral to an oral medicine specialist to be most popular. The chronic oro-facial pain cases had greater variation in management and choice of psychotherapy was related to duration of pain symptoms. Conclusions: The greater variation in responses to scenarios based on patients with chronic oro-facial pain may reflect the difficulty clinicians face in diagnosing and treating this condition. Management appears to follow a biomedical model and most clinicians chose to refer patients for treatment. There are few specialist services to cater for such referrals, indicating a need to train primary care practitioners in management of chronic COFP, along with the establishment of evidence-based guidelines.

scholarly journals Patient-Reported Use of the After Visit Summary in a Primary Care Internal Medicine Practice

2019 ◽  
Vol 7 (5) ◽  
pp. 703-707
Author(s):  
Sarita Pathak ◽  
Gregory Summerville ◽  
Celia P Kaplan ◽  
Sarah S Nouri ◽  
Leah S Karliner
Keyword(s):  
Primary Care ◽  
Multivariable Analysis ◽  
Free Text ◽  
Primary Care Visit ◽  
Communication Tool ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Care Visit ◽  
Patient Reported ◽  
Communication Errors

Participants completed a cross-sectional survey about their use of the after visit summary (AVS) at a previous primary care visit. Of 355 participants, 294 (82.8%) recalled receiving it, 67.4% consulted it, 45.9% consulted it more than once, and 31.6% shared the AVS. In multivariable analysis, higher education and older age were associated with AVS consultation. Among the subset of 133 patients recalling personalized free-text instructions, 96% found them easy to understand and 94.4% found them useful. Our findings suggest that the AVS is a useful communication tool and improvement efforts should emphasize clarity for those most vulnerable to communication errors.

scholarly journals Diagnostic radiographer advanced clinical practice in the United Kingdom – A national cross-sectional survey

BJR|Open ◽  
2021 ◽  
Vol 3 (1) ◽  
pp. 20210003
Author(s):  
Nick Woznitza ◽  
Lisa Pittock ◽  
James Elliott ◽  
Bev Snaith
Keyword(s):  
United Kingdom ◽  
Clinical Practice ◽  
Breast Imaging ◽  
Advanced Practice ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Advanced Level ◽  
The United Kingdom ◽  
Computed Tomography Fluoroscopy ◽  
The Uk

Objectives: To survey the diagnostic radiography workforce in the United Kingdom (UK) at an organisational level to ascertain the scope of advanced practice and compliance with Health Education England standards for multiprofessional advanced clinical practice (ACP). Methods: 174 diagnostic imaging departments were invited to participate in a cross-sectional electronic survey focused upon advanced level practice and their educational and accreditation expectations (October–December 2019). Breast imaging, computed tomography, fluoroscopy, interventional radiology, lithotripsy, magnetic resonance imaging and projectional radiography were included. Results: A total of 97 responses were received, of which 79 were eligible for inclusion (45%). Respondents reported advanced-level practice roles across all imaging modalities, which included clinical reporting, procedural-based and combined roles. Radiograph and mammogram reporting were most prevalent (95 and 67% of Trusts), with fluoroscopy the most frequent procedure-only role (25%). Only 39% of trusts required adherence to the four pillars of ACP within job descriptions, and only 12% requiring a full Masters qualification. Conclusions: Diagnostic radiographer reporting and procedure-based roles in the NHS are varied and widespread. However, inconsistencies in fulfilment against the expected standards for advanced practice exist. Realignment of advanced-level roles to delineate enhanced and advanced clinical practice may ensure consistency between roles and professions. A requirement for accreditation as an advanced (clinical) practitioner with adherence to advanced practice requirements could therefore provide value to accreditation for both individual practitioners and Trusts. Advances in knowledge: Within the UK, diagnostic radiographer roles previously self-identified as advanced-level practice may be termed enhanced practice when not adhering to expected ACP standards.

scholarly journals Engagement with community liver disease management across the UK: a cross-sectional survey

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0085
Author(s):  
Helen Jarvis ◽  
Jonathan Worsfold ◽  
Vanessa Hebditch ◽  
Stephen Ryder
Keyword(s):  
Primary Care ◽  
Liver Disease ◽  
Disease Management ◽  
Chronic Liver Disease ◽  
Chronic Liver ◽  
Health Board ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Health Authorities ◽  
The Uk

BackgroundLiver disease is an increasing cause of premature mortality in the UK. Its management in primary care is not well understood. It is unclear what role commissioning bodies are playing in liver disease in the UK.AimThe aim of this study was to assess the level of engagement with community chronic liver disease management amongst CCGs and health authorities across the UK.Design & settingA cross-sectional survey to all UK CCGs and health authorities.MethodSurvey questions were developed by the British Liver Trust, in collaboration with topic experts, and evaluated structures in place relating to liver disease management at commissioning/health board level.ResultsThere were 159 responses representing 99% UK coverage of CCGs/health boards. 20% reported an individual responsible for liver disease within their organisation with 40% and 29% reporting having pathways in place to respond to abnormal liver blood tests and liver disease more generally respectively. All those reporting use of pathways reported using national guidelines to guide content. 25% made use of transient elastography (Fibroscan) and 16% of direct serum fibrosis markers (eg, ELF score) which are both part of current NICE guidelines. There was marked regional variation in all areas of engagement surveyed, with Wales having exceptionally high levels of engagement in all areas in contrast to the other nations.ConclusionThe results of this survey should be used as a catalyst to highlight necessary regional improvements to the primary care management of chronic liver disease across the UK.

scholarly journals The Frequency and Content of Discussions About Alcohol Use in Primary Care and Application of the Chief Medical Officer’s Low-Risk Drinking Guidelines: A Cross-Sectional Survey of General Practitioners and Practice Nurses in the UK

2020 ◽  
Author(s):  
Jack M Birch ◽  
Nathan Critchlow ◽  
Lynn Calman ◽  
Robert Petty ◽  
Gillian Rosenberg ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Low Risk ◽  
Screening Tools ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Practice Nurses ◽  
Patient Reported ◽  
The Uk ◽  
Do So

Abstract Aims To examine how often general practitioners (GPs) and practice nurses (PNs) working in primary care discuss alcohol with patients, what factors prompt discussions, how they approach patient discussions and whether the Chief Medical Officers’ (CMO) revised low-risk drinking guidelines are appropriately advised. Methods Cross-sectional survey with GPs and PNs working in primary care in the UK, conducted January–March 2017 (n = 2020). A vignette exercise examined what factors would prompt a discussion about alcohol, whether they would discuss before or after a patient reported exceeded the revised CMO guidelines (14 units per week) and whether the CMO drinking guidelines were appropriately advised. For all patients, participants were asked how often they discussed alcohol and how they approached the discussion (e.g. used screening tool). Results The most common prompts to discuss alcohol in the vignette exercise were physical cues (44.7% of participants) or alcohol-related symptoms (23.8%). Most practitioners (70.1%) said they would wait until a patient was exceeding CMO guidelines before instigating discussion. Two-fifths (38.1%) appropriately advised the CMO guidelines in the vignette exercise, with PNs less likely to do so than GPs (odds ratio [OR] = 0.77, P = 0.03). Less than half (44.7%) reportedly asked about alcohol always/often with all patients, with PNs more likely to ask always/often than GPs (OR = 2.22, P < 0.001). Almost three-quarters said they would enquire by asking about units (70.3%), compared to using screening tools. Conclusion Further research is required to identify mechanisms to increase the frequency of discussions about alcohol and appropriate recommendation of the CMO drinking guidelines to patients.

scholarly journals Stroke and TIA Survivors’ Perceptions of The COVID-19 Vaccine: Cross Sectional Survey

2021 ◽  
Author(s):  
Grace Turner ◽  
Neil Heron ◽  
Jennifer Crow ◽  
Eirini Kontou ◽  
Sally Hughes
Keyword(s):  
Information Needs ◽  
Healthcare Services ◽  
Vaccine Uptake ◽  
Vaccine Hesitancy ◽  
Free Text ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Lack Of Information ◽  
Ischaemic Attack ◽  
The Uk

Abstract BackgroundPeople who experience a stroke or transient ischaemic attack (TIA) have greater risks of complications from contracting COVID-19. Vaccine uptake in this vulnerable population is important to reduce the burden of COVID-19 on healthcare services and society. To prevent vaccine hesitancy and maximise compliance, we need to better understand individuals’ views on the vaccine. We aimed to explore perspectives of people with stroke/TIA on the COVID-19 vaccine and influences on its uptake.MethodWe conducted a cross-sectional, electronic open survey comprising multiple choice and free text questions. Convenience sampling was used to recruit people who have experienced a stroke and/or TIA, and were residents in the UK or Ireland.ResultsThe survey was completed by 377 stroke/TIA survivors. 87% (328/377) had either received the first vaccine or were booked to have it. The vaccine was declined by 2% (7/377) and 3% (11/377) had been offered the vaccine but not yet taken it up. 8% (30/377) had not been offered the vaccine despite being eligible.Many people expressed concerns around the safety of the vaccine (particularly risk of blood clots and stroke) and some were hesitant to have the second vaccine. Most people had no difficulty accessing the vaccine appointment. Societal and personal benefits were motivations for vaccine uptake. There was uncertainty and lack of information about risk of COVID-19 related complications specifically for people who had a stroke/TIA.ConclusionFor people with stroke and TIA, confidence in the vaccine’s safety is the overriding behavioural influence on vaccine uptake. Despite high uptake of the first vaccine, many have legitimate concerns and information needs that should be addressed. Our findings can be used to identify targets for behaviour change to improve vaccine uptake specific to stroke/TIA patients, in particular, increase trust in the vaccine’s safety (confidence) and improve understanding of the greater risks of complications from contracting COVID-19 (complacency).

scholarly journals Emergency admission risk stratification tools in UK primary care: a cross-sectional survey of availability and use

2020 ◽  
Vol 70 (699) ◽  
pp. e740-e748
Author(s):  
Mark Kingston ◽  
Rhiannon Griffiths ◽  
Hayley Hutchings ◽  
Alison Porter ◽  
Ian Russell ◽  
...  
Keyword(s):  
Primary Care ◽  
Risk Stratification ◽  
Online Survey ◽  
Emergency Admission ◽  
Service Evaluation ◽  
Service Planning ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
The Uk ◽  
Health Boards

BackgroundStratifying patient populations by risk of adverse events was believed to support preventive care for those identified, but recent evidence does not support this. Emergency admission risk stratification (EARS) tools have been widely promoted in UK policy and GP contracts.AimTo describe availability and use of EARS tools across the UK, and identify factors perceived to influence implementation.Design and settingCross-sectional survey in UK.MethodOnline survey of 235 organisations responsible for UK primary care: 209 clinical commissioning groups (CCGs) in England; 14 health boards in Scotland; seven health boards in Wales; and five local commissioning groups (LCGs) in Northern Ireland. Analysis results are presented using descriptive statistics for closed questions and by theme for open questions.ResultsResponses were analysed from 171 (72.8%) organisations, of which 148 (86.5%) reported that risk tools were available in their areas. Organisations identified 39 different EARS tools in use. Promotion by NHS commissioners, involvement of clinical leaders, and engagement of practice managers were identified as the most important factors in encouraging use of tools by general practices. High staff workloads and information governance were identified as important barriers. Tools were most frequently used to identify individual patients, but also for service planning. Nearly 40% of areas using EARS tools reported introducing or realigning services as a result, but relatively few reported use for service evaluation.ConclusionEARS tools are widely available across the UK, although there is variation by region. There remains a need to align policy and practice with research evidence.

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