scholarly journals Supporting social prescribing in primary care by linking people to local assets: a realist review

BMC Medicine ◽  
2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Stephanie Tierney ◽  
Geoff Wong ◽  
Nia Roberts ◽  
Anne-Marie Boylan ◽  
Sophie Park ◽  
...  
Keyword(s):  
Primary Care ◽  
Realist Review ◽  
Social Prescribing

scholarly journals Tensions and opportunities in social prescribing. developing a framework to facilitate its implementation and evaluation in primary care: a realist review

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0017
Author(s):  
Sara Calderón-Larrañaga ◽  
Yasmin Milner ◽  
Megan Clinch ◽  
Trisha Greenhalgh ◽  
Sarah Finer
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Best Practice ◽  
Grey Literature ◽  
Good Practice ◽  
Realist Review ◽  
Individual Characteristics ◽  
Quantitative Evidence ◽  
Social Prescribing ◽  
Community Sector

BackgroundSocial prescribing (SP) involves linking patients in primary care with services provided by the voluntary and community sector. Despite growing interest within NHS primary care, it remains unclear how and under what circumstances SP might contribute to good practice.AimTo define ‘good’ practice in SP by identifying context-specific enablers and tensions. To contribute to the development of an evidence-based framework for theorizing and evaluating SP within primary care.Design and settingRealist review of secondary data from primary care-based SP schemes.MethodWe searched for qualitative and quantitative evidence from academic articles and grey literature following the Realist and Meta-narrative Evidence Syntheses-Evolving Standards (RAMESES). We characterised common SP practices in three settings (general practice, link workers and community sector) using archetypes which ranged from best to worst practice.ResultsA total of 140 studies were included for analysis. We characterised common SP practices in three settings (general practice, link workers and community sector) using archetypes which ranged from best to worst practice. We identified resources influencing the type and potential impact of SP practices and outlined four dimensions in which opportunities for good practice arise: 1) individual characteristics (stakeholder’s buy-in, vocation, knowledge); 2) interpersonal relations (trustful, bidirectional, informed, supportive, transparent and convenient interactions within and across sectors); 3) organisational contingencies (the availability of a predisposed practice culture, leadership, training opportunities, supervision, information governance, resource adequacy and continuity and accessibility of care within organisations); and 4) policy structures (bottom-up and coherent policymaking, stable funding and suitable monitoring strategies). Findings where synthesised in a multi-level, dynamic and usable SP Framework.ConclusionOur realist review and resulting framework revealed that SP is not inherently advantageous. Specific individual, interpersonal, organisational and policy resources are needed to ensure SP best practice in primary care.

scholarly journals Conversations about FGM in primary care: a realist review on how, why and under what circumstances FGM is discussed in general practice consultations

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e039809
Author(s):  
Sharon Dixon ◽  
Claire Duddy ◽  
Gabrielle Harrison ◽  
Chrysanthi Papoutsi ◽  
Sue Ziebland ◽  
...  
Keyword(s):  
Primary Care ◽  
Grey Literature ◽  
Relevant Literature ◽  
Theory Development ◽  
Realist Review ◽  
Primary Outcome Measure ◽  
Mandatory Reporting ◽  
Programme Theory ◽  
Genital Mutilation ◽  
The Impact

ObjectivesLittle is known about the management of female genital mutilation (FGM) in primary care. There have been significant recent statutory changes relevant to general practitioners (GPs) in England, including a mandatory reporting duty. We undertook a realist synthesis to explore what influences how and when GPs discuss FGM with their patients.SettingPrimary care in England.Data sourcesRealist literature synthesis searching 10 databases with terms: GPs, primary care, obstetrics, gynaecology, midwifery and FGM (UK and worldwide). Citation chasing was used, and relevant grey literature was included, including searching FGM advocacy organisation websites for relevant data. Other potentially relevant literature fields were searched for evidence to inform programme theory development. We included all study designs and papers that presented evidence about factors potentially relevant to considering how, why and in what circumstances GPs feel able to discuss FGM with their patients.Primary outcome measureThis realist review developed programme theory, tested against existing evidence, on what influences GPs actions and reactions to FGM in primary care consultations and where, when and why these influences are activated.Results124 documents were included in the synthesis. Our analysis found that GPs need knowledge and training to help them support their patients with FGM, including who may be affected, what needs they may have and how to talk sensitively about FGM. Access to specialist services and guidance may help them with this role. Reporting requirements may complicate these conversations.ConclusionsThere is a pressing need to develop (and evaluate) training to help GPs meet FGM-affected communities’ health needs and to promote the accessibility of primary care. Education and resources should be developed in partnership with community members. The impact of the mandatory reporting requirement and the Enhanced Dataset on healthcare interactions in primary care warrants evaluation.PROSPERO registration numberCRD42018091996.

scholarly journals Efficiency over thoroughness in laboratory testing decision-making in primary care: findings from a realist review

BJGP Open ◽  
2020 ◽  
pp. bjgpopen20X101146
Author(s):  
Claire Duddy ◽  
Geoff Wong
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Laboratory Testing ◽  
Laboratory Tests ◽  
Secondary Data ◽  
Realist Review ◽  
Future Research ◽  
Underlying Causes ◽  
Important Means ◽  
Test Ordering

Background: Existing research demonstrates significant variation in test-ordering practice, and growth in the use of laboratory tests in primary care. Reviews of interventions designed to change test-ordering practice report heterogeneity in design and effectiveness. Improving understanding of clinicians’ decision making in relation to laboratory testing is an important means of understanding practice patterns and developing theory-informed interventions. Aim: To develop explanations for the underlying causes of patterns of variation and increasing use of laboratory tests in primary care and make recommendations for future research and intervention design. Design and setting: Realist review of secondary data from primary care. Method: Diverse evidence including data from qualitative and quantitative studies was gathered via systematic and iterative searching processes. Data was synthesised according to realist principles to develop explanations accounting for clinicians’ decision-making in relation to laboratory tests. Results: 145 documents contributed data to the synthesis. Laboratory test ordering can fulfil many roles in primary care. Decisions about tests are incorporated into practice heuristics and tests are deployed as a tool to manage patient interactions. Ordering tests may be easier than not ordering tests in existing systems. Alongside high workloads and limited time to devote to decision-making, there is a common perception that laboratory tests are relatively inconsequential interventions. Clinicians prioritise efficiency over thoroughness in decision-making about laboratory tests. Conclusions: Interventions to change test-ordering practice can be understood as aiming to preserve efficiency or encourage thoroughness in decision-making. Intervention designs and evaluations should consider how testing decisions are made in real-world clinical practice.

scholarly journals Supporting bereavement and complicated grief in primary care: a realist review

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0008
Author(s):  
Caroline Pearce ◽  
Geoff Wong ◽  
Isla Kuhn ◽  
Stephen Barclay
Keyword(s):  
Primary Care ◽  
Complicated Grief ◽  
Realist Review ◽  
Physical And Mental Health ◽  
Prolonged Grief ◽  
Causal Explanations ◽  
Primary Care Settings ◽  
Grief Responses ◽  
Bereavement Care

BackgroundBereavement can have significant impacts on physical and mental health, and a minority of people experience complicated and prolonged grief responses. Primary care is ideally situated to offer bereavement care, yet UK provision remains variable and practitioners feel uncertain how best to support bereaved patients.AimTo identify what works, how, and for whom, in the management of complicated grief (CG) in primary care.Design & settingA review of evidence on the management of CG and bereavement in UK primary care settings.MethodA realist approach was taken that aims to provide causal explanations through the generation and articulation of contexts, mechanisms, and outcomes.ResultsForty-two articles were included. Evidence on the primary care management of complicated or prolonged grief was limited. GPs and nurses view bereavement support as part of their role, yet experience uncertainty over the appropriate extent of their involvement. Patients and clinicians often have differing views on the role of primary care in bereavement. Training in bereavement, local systems for reporting deaths, practitioner time, and resources can assist or hinder bereavement care provision. Practitioners find bereavement care can be emotionally challenging. Understanding patients’ needs can encourage a proactive response and help identify appropriate support.ConclusionBereavement care in primary care remains variable and practitioners feel unprepared to provide appropriate bereavement care. Patients at higher risk of complicated or prolonged grief may fail to receive the support they need from primary care. Further research is required to address the potential unmet needs of bereaved patients.

Developing programme theories to understand’first contact physiotherapy’ in primary care: a rapid realist review (FRONTIER)

Physiotherapy ◽  
2020 ◽  
Vol 107 ◽  
pp. e12
Author(s):  
H. Stott ◽  
S. Halls ◽  
F. Cramp ◽  
R. Thomas ◽  
J. Jagosh ◽  
...  
Keyword(s):  
Primary Care ◽  
Realist Review ◽  
Rapid Realist Review

scholarly journals COVID-19 at the Deep End: A Qualitative Interview Study of Primary Care Staff Working in the Most Deprived Areas of England during the COVID-19 Pandemic

2021 ◽  
Vol 18 (16) ◽  
pp. 8689
Author(s):  
Claire Norman ◽  
Josephine M. Wildman ◽  
Sarah Sowden
Keyword(s):  
Primary Care ◽  
Low Income ◽  
Care Staff ◽  
Snowball Sampling ◽  
Structured Interviews ◽  
Social Prescribing ◽  
Qualitative Interview Study ◽  
The Impact ◽  
Primary Care Staff ◽  
Deprived Areas

COVID-19 is disproportionately impacting people in low-income communities. Primary care staff in deprived areas have unique insights into the challenges posed by the pandemic. This study explores the impact of COVID-19 from the perspective of primary care practitioners in the most deprived region of England. Deep End general practices serve communities in the region’s most socioeconomically disadvantaged areas. This study used semi-structured interviews followed by thematic analysis. In total, 15 participants were interviewed (11 General Practitioners (GPs), 2 social prescribing link workers and 2 nurses) with Deep End careers ranging from 3 months to 31 years. Participants were recruited via purposive and snowball sampling. Interviews were conducted using video-conferencing software. Data were analysed using thematic content analysis through a social determinants of health lens. Our results are categorised into four themes: the immediate health risks of COVID-19 on patients and practices; factors likely to exacerbate existing deprivation; the role of social prescribing during COVID-19; wider implications for remote consulting. We add qualitative understanding to existing quantitative data, showing patients from low socioeconomic backgrounds have worse outcomes from COVID-19. Deep End practitioners have valuable insights into the impact of social distancing restrictions and remote consulting on patients’ health and wellbeing. Their experiences should guide future pandemic response measures and any move to “digital first” primary care to ensure that existing inequalities are not worsened.

scholarly journals The Role of Trust and Hope in Antipsychotic Medication Reviews in Primary Care Settings: A Realist Review. 

2021 ◽  
Author(s):  
Lisa Marie Grünwald ◽  
Claire Duddy ◽  
Richard Byng ◽  
Nadia Crellin ◽  
Joanna Moncrieff
Keyword(s):  
Primary Care ◽  
Antipsychotic Medication ◽  
Perceived Risk ◽  
Secondary Care ◽  
Realist Review ◽  
Service Users ◽  
Programme Theory ◽  
Primary Care Settings ◽  
Low Expectations ◽  
Medication Reviews

Abstract Background: Increasing number of service users diagnosed with schizophrenia and psychosis are being discharged from specialist secondary care services to primary care, many of whom are prescribed long-term antipsychotics. It is unclear if General Practitioners have the confidence and experience to appropriately review and adjust doses of antipsychotic medication without secondary care support.Aim: To explore barriers and facilitators of conducting antipsychotic medication reviews in primary care for individuals with no specialist mental health inputDesign & Setting: Realist review in general practice settings. Method: A realist review has been conducted to synthesise evidence on antipsychotic medication reviews conducted in primary care with service users diagnosed with schizophrenia and/or psychosis. Following initial scoping searches and discussions with stakeholders, a systematic search and iterative secondary searches were conducted. Articles were systematically screened and analysed to develop a realist programme theory explaining the contexts (C) and mechanisms (M) which facilitate or prevent antipsychotic medication reviews (O) in primary care settings, and the potential outcomes of medication reviews.Results: Antipsychotic medication reviews may not occur for individuals with only primary care medical input. Several, often mutually reinforcing, mechanisms have been identified as potential barriers to carrying out meaningful reviews, including low expectations of recovery for people with severe mental illness, a perceived lack of capability to understand and participate in medication reviews, linked with a lack of information shared in appointments between GPs and Service Users, and perceived risk and uncertainty regarding antipsychotic medication and illness trajectory. Conclusions: The review identified reciprocal and reinforcing stereotypes affecting both GPs and service users. Possible mechanisms to counteract these barriers are discussed, including realistic expectations of medication, and the need for increased information sharing and trust between GPs and service users.

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