scholarly journals Developing a digital intervention for primary care practitioners to support antidepressant discontinuation (Preprint)

2021 ◽  
Author(s):  
Hannah Bowers ◽  
Tony Kendrick ◽  
Nadja van Ginneken ◽  
Marta Glowacka ◽  
Samantha Williams ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Professionals ◽  
Controlled Trial ◽  
Qualitative Interviews ◽  
Think Aloud ◽  
Design Elements ◽  
Digital Intervention ◽  
Long Term Treatment ◽  
Antidepressant Use

BACKGROUND The number of people on antidepressants has increased in the past three decades, mainly due to people staying on them longer, but in many cases long-term treatment is not evidence-based and risks increasing side effects. Prompting GPs to review medication does not improve rates of appropriate discontinuation. GPs and other health professionals may need help to support patients discontinuing antidepressants in primary care. OBJECTIVE To develop a digital intervention to support practitioners to help patients discontinue inappropriate long-term antidepressants, as part of a wider intervention package including a patient digital intervention and patient telephone support. METHODS A prototype digital intervention (called ‘ADvisor for Health Professionals’) was planned and developed using a theory, evidence and person-based approach. The following elements informed development: a literature review and qualitative synthesis, an in-depth qualitative study, development of guiding principles for design elements, and theoretical behavioural analyses. The intervention was then optimised through think-aloud qualitative interviews with health professionals while using the prototype intervention. RESULTS Think-aloud qualitative interviews with 19 health professionals suggested that the digital intervention contained useful information and was readily accessible for practitioners. The development work highlighted a need for further guidance on drug tapering schedules for practitioners, as well as clarity around who is responsible for broaching the subject of discontinuation. Practitioners highlighted the need to have information in easily and quickly accessible formats due to time constraints in day-to-day practice. Some GPs felt that some information was already known to them but understood why this was included. Practitioners differed in their ideas about how it would be used in practice, with some preferring to read the resource in its entirety and others wanting to ‘dip in and out’ as needed. Changes were made to the wording and structure of the intervention in response to the feedback provided. CONCLUSIONS ADvisor for Health Professionals is a digital intervention which has been developed using theory, evidence and a person-based approach. The optimisation work suggests that practitioners may find this tool useful in supporting reduction of long-term antidepressant use. Further quantitative and qualitative evaluation through a randomised controlled trial is needed to examine the feasibility, effectiveness and cost-effectiveness of the intervention.

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.

Long-term treatment with probiotics in primary care patients with irritable bowel syndrome – a randomised, double-blind, placebo controlled trial

2013 ◽  
Vol 48 (10) ◽  
pp. 1127-1135 ◽  
Author(s):  
Luise Mølenberg Begtrup ◽  
Ove B Schaffalitzky de Muckadell ◽  
Jens Kjeldsen ◽  
René dePont Christensen ◽  
Dorte Ejg Jarbøl
Keyword(s):  
Primary Care ◽  
Irritable Bowel Syndrome ◽  
Controlled Trial ◽  
Term Treatment ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Long Term Treatment ◽  
Primary Care Patients ◽  
Irritable Bowel

scholarly journals General practitioners’ views and experiences in caring for patients after sepsis: a qualitative interview study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e040533
Author(s):  
Sabine Gehrke-Beck ◽  
Jochen Gensichen ◽  
Katrina M Turner ◽  
Christoph Heintze ◽  
Konrad FR Schmidt
Keyword(s):  
Primary Care ◽  
Critical Illness ◽  
General Practitioners ◽  
Continuity Of Care ◽  
Controlled Trial ◽  
Qualitative Interviews ◽  
Daily Practice ◽  
Training Programme ◽  
Qualitative Interview Study

BackgroundPatients surviving critical illnesses, such as sepsis, often suffer from long-term complications. After discharge from hospital, most patients are treated in primary care. Little is known how general practitioners (GPs) perform critical illness aftercare and how it can be improved. Within a randomised controlled trial, an outreach training programme has been developed and applied.ObjectivesThe aim of this study is to describe GPs’ views and experiences of caring for postsepsis patients and of participating a specific outreach training.DesignSemistructured qualitative interviews.Setting14 primary care practices in the metropolitan area of Berlin, Germany.Participants14 GPs who had participated in a structured sepsis aftercare programme in primary care.ResultsThemes identified in sepsis aftercare were: continuity of care and good relationship with patients, GP’s experiences during their patient’s critical illness and impact of persisting symptoms. An outreach education as part of the intervention was considered by the GPs to be acceptable, helpful to improve knowledge of the management of postintensive care complications and useful for sepsis aftercare in daily practice.ConclusionsGPs provide continuity of care to patients surviving sepsis. Better communication at the intensive care unit–GP interface and training in management of long-term complications of sepsis may be helpful to improve sepsis aftercare.Trial registration numberISRCTN61744782.

scholarly journals Withdrawal of unnecessary antidepressant medication: a randomised controlled trial in primary care

BJGP Open ◽  
2017 ◽  
Vol 1 (4) ◽  
pp. bjgpopen17X101265 ◽  
Author(s):  
Rhona Eveleigh ◽  
Esther Muskens ◽  
Peter Lucassen ◽  
Peter Verhaak ◽  
Jan Spijker ◽  
...  
Keyword(s):  
Primary Care ◽  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Intervention Group ◽  
Antidepressant Medication ◽  
Treatment Recommendation ◽  
Control Group ◽  
Antidepressant Use ◽  
Randomised Controlled

BackgroundAntidepressant use has increased exponentially in recent decades, mostly due to long continuation.AimTo assess the effectiveness of a tailored recommendation to withdraw antidepressant treatment.Design & settingRandomised controlled trial in primary care (PANDA study) in the Netherlands.MethodLong-term antidepressant users (≥9 months) were selected from GPs prescription databases. Patients were diagnosed with the Composite International Diagnostic Interview (CIDI). Long-term users without indication for maintenance treatment (overtreatment) were selected. The intervention consisted of disclosure of the current psychiatric diagnosis combined with a tailored treatment recommendation. Patients were followed for 12 months.ResultsThe study included 146 participants from 45 family practices. Of the 70 patients in the intervention group, 34 (49%) did not comply with the advice to stop their antidepressant medication. Of the 36 (51%) patients who agreed to try, only 4 (6%) succeeded. These figures were consistent with the control group, where 6 (8%) of the 76 patients discontinued antidepressant use successfully. Patients who were recommended to discontinue their antidepressant medication reported a higher relapse rate than the control group (26% versus 13%, P = 0.05).ConclusionChanging inappropriate long-term antidepressant use is difficult.

Experiences in physical activity promotion in health care settings for primary prevention in the UK

2014 ◽  
Vol 62 (2) ◽  
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Health Professionals ◽  
Controlled Trial ◽  
Full Range ◽  
Tertiary Care ◽  
Physical Activity Promotion ◽  
Community Based ◽  
Activity Promotion ◽  
Randomised Controlled

In addition to the delivery of primary care services, recent changes to the NHS in the United Kingdom have placed increasing responsibility on GPs for the commissioning of the full range of health services from prevention through to clinical interventions and rehabilitation. Whilst historically there has always been an expectation that primary care professionals were ideally placed to provide support for prevention as well as treatment, their active engagement in the promotion of physical activity has remained largely superficial. With notable exceptions where individuals have a personal interest or commitment, the majority of health professionals tend to limit themselves to peremptory non-specific advice at best, or frequently don’t broach the subject at all. There are a number of reasons for this including increasing time pressures, a general lack of knowledge, limited evidence and concerns about litigation in the event of an adverse exercise induced event. However in the 1990s there was a surge of interest in the emerging “Exercise on Prescription” model where patients could be referred to community based exercise instructors for a structured “prescription” of exercise in community leisure centres. Despite the continuing popularity of the model there remain problems particularly in getting the active support of health professionals who generally cite the same barriers as previously identified. In an attempt to overcome some of these problems Wales established a national exercise referral scheme with an associated randomised controlled trial. The scheme evaluated well and had subsequently evolved with new developments including integration with secondary and tertiary care pathways, accredited training for exercise instructors and exit routes into alternative community based exercise opportunities.

The Development of Balance Retraining: An Online Intervention for Dizziness in Adults Aged 50 Years and Older

2015 ◽  
Vol 24 (3) ◽  
pp. 276-279 ◽  
Author(s):  
Rosie Essery ◽  
Sarah Kirby ◽  
Adam W. A. Geraghty ◽  
Gerhard Andersson ◽  
Per Carlbring ◽  
...  
Keyword(s):  
Primary Care ◽  
Development Process ◽  
Controlled Trial ◽  
Online Intervention ◽  
Intervention Design ◽  
Development Phase ◽  
Think Aloud ◽  
Valuable Data ◽  
Randomized Controlled ◽  
Phase Data

Purpose This article outlines the rationale and development process for an online intervention based on vestibular rehabilitation therapy (VRT). The intervention aims to assist adults aged 50 years and older to self-manage and reduce dizziness symptoms. Method The intervention was developed according to the person-based approach to digital intervention design focused on accommodating perspectives of target users. A prototype version of the intervention was provided to 18 adults (11 women, 7 men) aged 50 years and older with dizziness. These adults were invited to use the intervention over a 6-week period and, during this time, took part in a think-aloud session. This session sought to understand users' perceptions of how acceptable, engaging, and easy to use they found the online intervention. Results Users were extremely positive regarding how easy to navigate, visually appealing, and informative they found the intervention. Think-aloud sessions provided valuable data for informing small amendments to further enhance acceptability of the intervention for target users. Conclusions Informed by these development-phase data, a finalized version of the intervention is now being investigated in a primary care–based randomized controlled trial. Results should provide an understanding of whether VRT can be effectively—especially, cost-effectively—delivered via an online intervention to adults aged 50 years and older.

scholarly journals Acceptability of a vocational advice service for patients consulting in primary care with musculoskeletal pain: A qualitative exploration of the experiences of general practitioners, vocational advisers and patients

2017 ◽  
Vol 47 (1) ◽  
pp. 78-85 ◽  
Author(s):  
Tom Sanders ◽  
Gwenllian Wynne-Jones ◽  
Bie Nio Ong ◽  
Majid Artus ◽  
Nadine Foster
Keyword(s):  
Primary Care ◽  
Controlled Trial ◽  
Comparative Method ◽  
Qualitative Interviews ◽  
Cluster Randomised Controlled Trial ◽  
Key Factors ◽  
Constant Comparative Method ◽  
General Practices ◽  
Randomised Controlled ◽  
Qualitative Exploration

Aims: Using qualitative interviews, this study explored the experiences of GPs, vocational advisers and patients towards a new vocational advice (VA) service in primary care. Methods: This study was nested within the Study of Work and Pain (SWAP) cluster randomised controlled trial. The SWAP trial located a VA service within three general practices in Staffordshire. Interviews took place with 10 GPs 12 months after the introduction of the VA service, four vocational advisers whilst the VA service was running and 20 patients on discharge from the VA service. The data were analysed using the constant comparative method, which is a variation of grounded theory. Results: The key factors determining the acceptability and perceived effectiveness of the VA service from the perspective of the three groups of stakeholders were (1) the timing of referrals to the VA, (2) the perceived lack of patient demand for the service and (3) role uncertainty experienced by VAs. Conclusions: Early vocational intervention may not be appropriate for all musculoskeletal patients with work difficulties. Indeed, many patients felt they did not require the support of a VA, either because they had self-limiting work difficulties and/or already had support mechanisms in place to return to work. Future VA interventions may be better implemented in a targeted way so that appropriate patients are identified with characteristics which can best be addressed by the VA service.

scholarly journals Development and implementation of a nurse-led allergy clinic model in primary care: feasibility trial protocol

2019 ◽  
Vol 29 (1) ◽  
Author(s):  
Margaret Kelman ◽  
Victoria Hammersley ◽  
Marilyn Kendall ◽  
Mome Mukherjee ◽  
Lynn Morrice ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Healthcare Professionals ◽  
Controlled Trial ◽  
Qualitative Interviews ◽  
Retention Rates ◽  
Feasibility Trial ◽  
Allergy Clinic ◽  
Randomised Controlled

AbstractIn the United Kingdom, there are acknowledged short comings in allergy care provision for patients seen in primary care. There is a lack of allergy training for healthcare professionals and this leads to inappropriate referrals to the limited number of allergy specialists. The primary aims of this study are to assess the feasibility of delivering and evaluating a new nurse-led allergy service in primary care, measured by recruitment, retention and quality of life. This is a single arm feasibility trial in which up to 250 participants referred to the nurse-led allergy clinic will receive the intervention and complete 6–12 weeks follow-up before being referred back to their usual care. Primary outcomes for this study will be establishment of clinics, recruitment and retention rates, and estimates of change in disease-specific quality of life measures. Secondary outcomes will be acceptability of the new service to participants/carers and healthcare professionals. A sample of participants and professional stakeholders will take part in more in-depth semi-structured qualitative interviews. Data from this feasibility trial will be used to inform plans for a pilot randomised controlled trial of nurse-led allergy clinics.

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