Exploring how paramedics are deployed in general practice and the perceived benefits and drawbacks: a mixed-methods scoping study

BackgroundGeneral practice in the UK faces continuing challenges to balance a workforce shortage against rising demand. The NHS England GPForward View proposes development of the multidisciplinary, integrated primary care workforce to support frontline service delivery, including the employment of paramedics. However, very little is known about the safety, clinical effectiveness, or cost-effectiveness of paramedics working in general practice. Research is needed to understand the potential benefits and drawbacks of this model of workforce organisation.AimTo understand how paramedics are deployed in general practice, and to investigate the theories and drivers that underpin this service development.Design & settingA mixed-methods study using a literature review, national survey, and qualitative interviews.MethodA three-phase study was undertaken that consisted of: a literature review and survey; meetings with key informants (KIs); and direct enquiry with relevant staff stakeholders (SHs).ResultsThere is very little evidence on the safety and cost-effectiveness of paramedics working in general practice and significant variation in the ways that paramedics are deployed, particularly in terms of the patients seen and conditions treated. Nonetheless, there is a largely positive view of this development and a perceived reduction in GP workload. However, some concerns centre on the time needed from GPs to train and supervise paramedic staff.ConclusionThe contribution of paramedics in general practice has not been fully evaluated. There is a need for research that takes account of the substantial variation between service models to fully understand the benefits and consequences for patients, the workforce, and the NHS.

Download Full-text

Self-sampling kits to increase HIV testing among black Africans in the UK: the HAUS mixed-methods study

Health Technology Assessment ◽

10.3310/hta22220 ◽

2018 ◽

Vol 22 (22) ◽

pp. 1-158 ◽

Cited By ~ 6

Author(s):

Maureen Seguin ◽

Catherine Dodds ◽

Esther Mugweni ◽

Lisa McDaid ◽

Paul Flowers ◽

...

Keyword(s):

Mixed Methods ◽

Cost Effectiveness ◽

Hiv Testing ◽

Clinical Effectiveness ◽

Phase Iii ◽

Black Africans ◽

Black African ◽

African People ◽

The Uk ◽

Stage 1

Background Timely diagnosis of human immunodeficiency virus (HIV) enables access to antiretroviral treatment, which reduces mortality, morbidity and further transmission in people living with HIV. In the UK, late diagnosis among black African people persists. Novel methods to enhance HIV testing in this population are needed. Objectives To develop a self-sampling kit (SSK) intervention to increase HIV testing among black Africans, using existing community and health-care settings (stage 1) and to assess the feasibility for a Phase III evaluation (stage 2). Design A two-stage, mixed-methods design. Stage 1 involved a systematic literature review, focus groups and interviews with key stakeholders and black Africans. Data obtained provided the theoretical base for intervention development and operationalisation. Stage 2 was a prospective, non-randomised study of a provider-initiated, HIV SSK distribution intervention targeted at black Africans. The intervention was assessed for cost-effectiveness. A process evaluation explored feasibility, acceptability and fidelity. Setting Twelve general practices and three community settings in London. Main outcome measure HIV SSK return rate. Results Stage 1 – the systematic review revealed support for HIV SSKs, but with scant evidence on their use and clinical effectiveness among black Africans. Although the qualitative findings supported SSK distribution in settings already used by black Africans, concerns were raised about the complexity of the SSK and the acceptability of targeting. These findings were used to develop a theoretically informed intervention. Stage 2 – of the 349 eligible people approached, 125 (35.8%) agreed to participate. Data from 119 were included in the analysis; 54.5% (65/119) of those who took a kit returned a sample; 83.1% of tests returned were HIV negative; and 16.9% were not processed, because of insufficient samples. Process evaluation showed the time pressures of the research process to be a significant barrier to feasibility. Other major barriers were difficulties with the SSK itself and ethnic targeting in general practice settings. The convenience and privacy associated with the SSK were described as beneficial aspects, and those who used the kit mostly found the intervention to be acceptable. Research governance delays prevented implementation in Glasgow. Limitations Owing to the study failing to recruit adequate numbers (the intended sample was 1200 participants), we were unable to evaluate the clinical effectiveness of SSKs in increasing HIV testing in black African people. No samples were reactive, so we were unable to assess pathways to confirmatory testing and linkage to care. Conclusions Our findings indicate that, although aspects of the intervention were acceptable, ethnic targeting and the SSK itself were problematic, and scale-up of the intervention to a Phase III trial was not feasible. The preliminary economic model suggests that, for the acceptance rate and test return seen in the trial, the SSK is potentially a cost-effective way to identify new infections of HIV. Future work Sexual and public health services are increasingly utilising self-sampling technologies. However, alternative, user-friendly SSKs that meet user and provider preferences and UK regulatory requirements are needed, and additional research is required to understand clinical effectiveness and cost-effectiveness for black African communities. Study registration This study is registered as PROSPERO CRD42014010698 and Integrated Research Application System project identification 184223. Funding The National Institute for Health Research Health Technology Assessment programme and the BHA for Equality in Health and Social Care.

Download Full-text

Risk of cholestatic liver disease associated with flucloxacillin and flucloxacillin prescribing habits in the UK: Cohort study using data from the UK General Practice Research Database

British Journal of Clinical Pharmacology ◽

10.1111/j.1365-2125.2005.02370.x ◽

2005 ◽

Vol 60 (1) ◽

pp. 76-82 ◽

Cited By ~ 78

Author(s):

Stefan Russmann ◽

James A. Kaye ◽

Susan S. Jick ◽

Hershel Jick

Keyword(s):

General Practice ◽

Cohort Study ◽

Liver Disease ◽

General Practice Research Database ◽

Practice Research ◽

Cholestatic Liver Disease ◽

Research Database ◽

Prescribing Habits ◽

Using Data ◽

The Uk

Download Full-text

A Review of the Use of Routine Data on CHD in General Practice Research in Scotland

Scottish Medical Journal ◽

10.1177/003693300505000307 ◽

2005 ◽

Vol 50 (3) ◽

pp. 109-113 ◽

Cited By ~ 2

Author(s):

G McLean

Keyword(s):

Risk Factors ◽

Primary Care ◽

General Practice ◽

Literature Review ◽

Research Methods ◽

Routine Data ◽

Practice Research ◽

Primary Care Research ◽

Care Research ◽

Extensive Range

Background: The primary aim of the Platform Project is to maximise the use of routine data for-primary care research in Scotland. Aims: To assess the extent to which routine data ts available and has been used in studies on CHD in General Practice research in Scotland. To assess the advantages and limitations of using routine data in this setting Methods: Literature review using a variety of databases catalogues and websites, bibliographies of articles retrieved and searching through journals by hand not available electronically. Results: This review has found that the use of routine data in CHD studies in General Practice research in Scotland remains small. There has been little work undertaken which has combined the use of routine data with other research methods. Limitations with routine data exist particularly with regard to risk factors and ethnicity. However, despite such limitations there exists an increasingly extensive range of data, which exists to help explain tends in CHD, which so far has been largely underused.

Download Full-text