scholarly journals Contribution of paramedics in primary and urgent care: a systematic review

2020 ◽  
Vol 70 (695) ◽  
pp. e421-e426 ◽  
Author(s):  
Georgette Eaton ◽  
Geoff Wong ◽  
Veronika Williams ◽  
Nia Roberts ◽  
Kamal R Mahtani
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Patient Satisfaction ◽  
Clinical Work ◽  
Ambulance Service ◽  
Urgent Care ◽  
Free Text ◽  
Clinical Role ◽  
Primary Care Workforce ◽  
The Uk

BackgroundWithin the UK, there are now opportunities for paramedics to work across a variety of healthcare settings away from their traditional ambulance service employer, with many opting to move into primary care.AimTo provide an overview of the types of clinical roles paramedics are undertaking in primary and urgent care settings within the UK.Design and settingA systematic review.MethodSearches were conducted of MEDLINE, CINAHL, Embase, the National Institute for Health and Care Excellence, the Journal of Paramedic Practice, and the Cochrane Database from January 2004 to March 2019 for papers detailing the role, scope of practice, clinician and patient satisfaction, and costs of paramedics in primary and urgent care settings. Free-text keywords and subject headings focused on two key concepts: paramedic and general practice/primary care.ResultsIn total, 6765 references were screened by title and/or abstract. After full-text review, 24 studies were included. Key findings focused on the description of the clinical role, the clinical work environment, the contribution of paramedics to the primary care workforce, the clinical activities they undertook, patient satisfaction, and education and training for paramedics moving from the ambulance service into primary care.ConclusionCurrent published research identifies that the role of the paramedic working in primary and urgent care is being advocated and implemented across the UK; however, there is insufficient detail regarding the clinical contribution of paramedics in these clinical settings. More research needs to be done to determine how, why, and in what context paramedics are now working in primary and urgent care, and what their overall contribution is to the primary care workforce.

scholarly journals Effectiveness of physical activity promotion and exercise referral in primary care: protocol for a systematic review and meta-analysis of randomised controlled trials

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Jean-Pierre Laake ◽  
Joanna Fleming
Keyword(s):  
Physical Activity ◽  
Systematic Review ◽  
Primary Care ◽  
Sedentary Behaviour ◽  
Physical Activity Promotion ◽  
Self Report ◽  
Activity Promotion ◽  
Randomised Controlled ◽  
The Uk ◽  
Exercise Referral

Abstract Background Physical inactivity is the fourth leading risk factor for global mortality. Reducing sedentary behaviour and increasing physical activity are efficacious for improving many physical and mental health conditions including cardiovascular disease, type 2 diabetes and depression. Reducing sedentary behaviour and increasing physical activity can also be effective at reducing obesity; however, sedentary behaviour and reduced physical activity are also associated with mortality independently. Despite this, most adults in the UK do not currently meet the UK Chief Medical Officers’ guidelines for weekly physical activity. As most adults visit their general practitioner at least once a year, the primary care consultation provides a unique opportunity to deliver exercise referral or physical activity promotion interventions. This is a protocol for a systematic review of randomised controlled trials for the effectiveness of physical activity promotion and referral in primary care. Methods A comprehensive literature search of Embase, MEDLINE (Ovid), Web of Science (Core Collection), Scopus, CINAHL, PsycINFO, and The Cochrane Library (CENTRAL) will be conducted for studies with a minimum follow-up of 12 months that report physical activity as an outcome measure (by either self-report or objective measures) including an intention to treat analysis. The authors will screen papers, first by title and abstract and then by full text, independently assess studies for inclusion, appraise risk of bias and extract data. The quality of the evidence will be assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluations) approach. The primary outcome will be participation in physical activity at 12 months. Pooled effects will be calculated using random effects models. Results will be submitted for publication in a peer-reviewed journal and for presentation at UK national primary care conferences. Discussion This systematic review and meta-analyses will summarise the evidence for the effectiveness of physical activity promotion and referral as interventions for improving physical activity, as well as whether studies using objective measures of physical activity have similar effects to those studies using self-report measures. This knowledge has importance for primary care clinicians, patients and, given the focus of the recent NHS long-term plan on preventive medicine, those making policy decisions. Systematic review registration The protocol is registered with PROSPERO the international prospective register of systematic reviews, ID CRD42019130831

THUR 121 Identifying participants with parkinson’s disease in uk biobank

2018 ◽  
Vol 89 (10) ◽  
pp. A13.2-A13
Author(s):  
Bush Kathryn ◽  
Rannikmae Kristiina ◽  
Schnier Christian ◽  
Wilkinson Timothy ◽  
Nolan John ◽  
...  
Keyword(s):  
Primary Care ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Secondary Care ◽  
Large Population ◽  
Free Text ◽  
Uk Biobank ◽  
Predictive Values ◽  
Diagnostic Codes ◽  
The Uk

BackgroundLinkage to routinely collected NHS data from primary, secondary care and death certificates enables identification of participants with Parkinson’s Disease (PD) within the UK Biobank cohort of 5 00 000 adults. Validation of the accuracy of this data is required prior to their use in research studies.MethodIn this validation study participants (n=125) with a code indicating PD were identified from a sample of 17 000 participants in the cohort. Diagnoses were validated by expert adjudicators, based on free text electronic medical records. Positive predictive values (PPV,% of cases identified that are true cases) were calculated.ResultsPrimary care diagnostic codes identified 93% of PD cases, with a PPV of 95%. Combined secondary care and death data identified 42% of PD cases with a PPV of 84%.Combining diagnostic and medication codes identified more participants, but did not increase the PPV.ConclusionsThis study suggests that linkage to routinely collected healthcare data is a reliable method for identifying participants with PD in the UK Biobank cohort.Primary care diagnostic codes identified the highest proportion of participants and had the highest PPV, demonstrating the value of using primary care data to identify cases of disease in large population based cohort studies.

scholarly journals Patient satisfaction and experience of primary care in Saudi Arabia: a systematic review

2018 ◽  
Vol 30 (10) ◽  
pp. 751-759 ◽  
Author(s):  
Mohammed Senitan ◽  
Ali Hassan Alhaiti ◽  
James Gillespie
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Saudi Arabia ◽  
Patient Satisfaction

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

Paramedic independent prescribing: a qualitative study of early adopters in the UK

2021 ◽  
Vol 6 (1) ◽  
pp. 30-37
Author(s):  
Karen Stenner ◽  
Suzanne van Even ◽  
Andy Collen
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
High Volume ◽  
Urgent Care ◽  
Multidisciplinary Teams ◽  
Framework Analysis ◽  
Early Adopters ◽  
Independent Prescribing ◽  
Controlled Drugs ◽  
The Uk

Background: Paramedics working in advanced practice roles in the UK can now train to prescribe medicine. This is anticipated to benefit patient access to medicines and quality of care where there is a national shortage of doctors, particularly in primary care.Aim: To explore the experience of paramedics who are early adopters of independent prescribing in a range of healthcare settings in the UK.Design and setting: A qualitative study involving interviews between May and August 2019, with paramedics in the UK who had completed a prescribing programme.Methods: Individual interviews with a purposive sample of paramedics recruited via social media and regional paramedic networks. Interviews covered experiences, benefits and challenges of the prescribing role. A framework analysis approach was used to identify key themes.Results: Participants were 18 advanced paramedics working in primary care, emergency departments, urgent care centres and rapid response units. All participants reported being adequately prepared to prescribe. Key benefits of prescribing included improving service capacity, efficiency and safety, and facilitating advanced clinical roles. Challenges included technological problems, inability to prescribe controlled drugs and managing expectations about the prescribing role. Concerns were raised about support and role expectations, particularly in general practice.Conclusion: Paramedic prescribing is most successful in settings with a high volume of same-day presentations and urgent and emergency care. It facilitated advanced roles within multidisciplinary teams. Concerns indicate that greater consideration for support infrastructure and workforce planning is required within primary care to ensure paramedics meet the entry criteria for a prescribing role.

scholarly journals Sustaining primary care teams in the midst of a pandemic

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Erin E. Sullivan ◽  
Russell S. Phillips
Keyword(s):  
Primary Care ◽  
Patient Satisfaction ◽  
Virtual Work ◽  
Care Delivery ◽  
Preventative Care ◽  
Interprofessional Teams ◽  
Primary Care Workforce ◽  
Primary Care Teams ◽  
Important Solution ◽  
Primary Care Clinicians

AbstractThe challenges wrought by the COVID-19 pandemic on health systems have tested primary care clinicians, who are on the front lines of care delivery. To ensure the longevity of the primary care workforce, strong interprofessional teams are one important solution to alleviating burnout and increasing clinician and patient satisfaction, but the pandemic has demonstrated that the operating manual needs to be adapted for virtual work. Essential principles of primary care, including preventative care, communication and collaboration, and building strong relationships, can be applied to strengthen virtual primary care teams.

scholarly journals Evidence-Based Medicine in Daily Surgical Decision Making: A Survey-Based Comparison between the UK and Germany

2014 ◽  
Vol 54 (1-2) ◽  
pp. 14-23 ◽  
Author(s):  
Andreas A. Schnitzbauer ◽  
Andrea Proneth ◽  
Liset Pengel ◽  
Jörg Ansorg ◽  
Matthias Anthuber ◽  
...  
Keyword(s):  
Decision Making ◽  
Health System ◽  
Evidence Based Medicine ◽  
Clinical Work ◽  
Free Text ◽  
Evidence Based ◽  
Mailing Lists ◽  
Interdisciplinary Approaches ◽  
The Uk ◽  
Based Medicine

Background: Evidence-based medicine (EbM) is a vital part of reasonable and conclusive decision making for clinicians in daily clinical work. To analyze the knowledge and the attitude of surgeons towards EbM, a survey was performed in the UK and Germany. Methods: A web-based questionnaire was distributed via mailing lists from the Royal College of Surgeons of England (RCSE) and the Berufsverband Deutscher Chirurgen (BDC). Our primary aim was to get information about knowledge of EbM amongst German and British surgeons. Results: A total of 549 individuals opened the questionnaire, but only 198 questionnaires were complete and valid for analysis. In total, 40,000 recipients were approached via the mailing lists of the BDC and RCSE. The response rate was equally low in both countries. On a scale from 1 (unimportant) to 10 (very important), all participants rated EbM as very important for daily clinical decision making (7.3 ± 1.9) as well as for patients (7.8 ± 1.9) and the national health system (7.8 ± 1.9). On a scale from 1 (unimportant) to 5 (very important), systematic reviews (4.6 ± 0.6) and randomized controlled trials (4.6 ± 0.6) were identified as the highest levels of study designs to enhance evidence in medicine. British surgeons considered EbM to be more important in daily clinical work when compared to data from German surgeons (7.9 ± 1.6 vs. 6.7 ± 2.1, p < 0.001). Subgroup analysis showed different results in some categories; however, a pattern to explain the differences was not evident. Personal requirements expressed in a free text field emphasized the results and reflected concerns such as broad unwillingness and lack of interdisciplinary approaches for patients (n = 59: 25 in the UK and 34 in Germany). Conclusion: The overall results show that EbM is believed to be important by surgeons in the UK and Germany. However, perception of EbM in the respective health system (UK vs. Germany) may be different. Nonetheless, EbM is an important tool to navigate through daily clinical problems although a discrepancy between the knowledge of theoretical abstract terms and difficulties in implementing EbM in daily clinical work has been detected. The provision of infrastructure, courses and structured education as a permanent instrument will advance the knowledge, application and improvement of EbM in the future.

scholarly journals Application of normalisation process theory in understanding implementation processes in primary care settings in the UK: a systematic review

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Lisa Huddlestone ◽  
Jessica Turner ◽  
Helen Eborall ◽  
Nicky Hudson ◽  
Melanie Davies ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Process Theory ◽  
Normalisation Process Theory ◽  
Implementation Processes ◽  
Primary Care Settings ◽  
The Uk

scholarly journals Incidence of adult Huntington's disease in the UK: a UK-based primary care study and a systematic review

BMJ Open ◽  
2016 ◽  
Vol 6 (2) ◽  
pp. e009070 ◽  
Author(s):  
Nancy S Wexler ◽  
Laura Collett ◽  
Alice R Wexler ◽  
Michael D Rawlins ◽  
Sarah J Tabrizi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Huntington's Disease ◽  
Huntington’S Disease ◽  
The Uk ◽  
Care Study
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