Clinical Posters 407 – 413

Clinical Posters 407 – 413

407 Disparities in seasonal influenza vaccine uptake in primary care

Ana Correa

Aims The aim of this research is to identify the demographic factors associated with being vaccinated against seasonal influenza in primary care.

Relevance At the beginning of the 2015-2016 influenza season, the RCGP Research and Surveillance Centre (RSC) reported that GPs in England were vaccinating over 100 fewer patients per practice than the same time the previous year. Whilst GPs are actively trying to ensure uptake among their registered population, coverage in England and Wales for over 65 year olds remains under the 75% target to achieve herd immunity.

Outcomes Seasonal influenza vaccine uptake among patients over 65 years old was 67.5% during the vaccination season from August 2015 to January 2016. We produced a logistic regression model to assess the impact of sex, ethnicity, and socio-economic deprivation on the probability of being vaccinated, for a subset of people over 65 years old. Black, mixed, and other ethnicities were significantly less likely to have been vaccinated (p<0.001).

Discussion Seasonal influenza vaccine uptake in England has not reached recommended targets, especially for older age groups, and there are also disparities between ethnic groups. Influenza vaccination has been shown to be safe and effective in reducing the potential of influenza epidemics. GPs need to generally encourage increased uptake, but also reduce current disparities in influenza vaccination.

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408 Yorkshire and Humber GPs at the Deep End: Primary care tackling health inequity

Elizabeth Walton

Aim Inspired by the Scottish GPs at the Deep End group, our aim is to create a network of GPs caring for Yorkshire and Humber’s most deprived communities and vulnerable patients.

Objectives Help practices tackle workforce and recruitment issues; Support and provide educational sessions relevant to deep end work; Provide a forum to share ideas on planning services and strategy; Act as an advocate for communities and develop networks for deep end practitioners; Link with the academic community to evaluate the effects of interventions on health inequalities.

Content We will describe how the Deep End Yorkshire and Humber group is evolving and our plans for education, workforce, advocacy and research.

Relevance/Impact: The impact of the social determinants on health, are generally accepted. The difficult questions now are around how health care professionals can reduce health inequity. The Deep End Yorkshire and Humber Group aims to provide a network and forum where GPs can innovate and advocate for more equitable health care access, provision and outcomes.

Outcomes We will present a summary of our first 2 meetings and future plans.

Discussion We are hopeful that the Deep End Yorkshire and Humber Group will act as a catalyst for innovation; supporting and inspiring GPs working with the most vulnerable and socially excluded patients in our region.

411 Evaluation of asthma control in primary care using asthma control test and peak expiratory flow rate

Clement Perera

Aims Asthma is considered a major health problem in Sri Lanka as well as globally.Objectives: This study has comparatively evaluated disease control with Asthma Control Test (ACT) and peak expiratory flow rate (PEFR).

Content of Presentation Asthma control was examined in a cross-section of 449 asthmatics above 5 and below 70 years of age using the ACT, and on the PEFR % predicted.Simultaneously, patients were clinically evaluated. Asthmatics were again evaluated fortnight after treatment according to GINA guidelines in two primary care clinics.

Outcomes Asthma control numbers were 344(76.6%) according to ACT and 345(76.8%) according to PEFR. Performance of Asthma control of ACT and PEFR were basically considered for pediatrics (Age <= 12) and adults (Age >12) groups separately. Kappa statistic indicated substantial agreement of the ACT for paediatrics 0.6099 (CI 95% 0.4506, 0.7692) as well as for adults 0.6345 (CI 95% 0.5212, 0.7478), While PEFR shows moderate agreement for pediatrics 0.5314 (CI 95% 0.3723, 0.6906) as well as for adults 0.4318 (CI 95% 0.3195, 0.5441) when compared with the clinical judgment. Paediatric and Adult status was associated with control on the PEFR (p<0.05) but not with the ACT.

Discussion Asthma control evaluation is stable and independent with ACT for both paediatrics and adults age groups and it shows good agreement when compared with clinical evaluation. PEFR constitute poor agreement as compared with ACT and dependent with paediatrics and adults groups. This proves PEFR is unstable in evaluating asthma control but ACT is recommended for all ages.

412 Frequency and the nature of headache in children attending a primary care physician

Clement Perera

Aims Childhood headache is considered one of a major disabling health problem in Sri Lanka as well as globally.

Objectives To describe the socio demographic profile, causes and precipitating factors of childhood headache in Ja-ela area.

Methods A cross sectional survey of 332 children between 5-12 years of age whose primary complaint was of headache, attending a primary care practice in Ja-ela. An interviewer administered questionnaire, prepared according to the International Classification of Headache Disorders (2 nd edition) was used to collect data.

Outcomes Prevalence of headache among children of 5-12 years visiting the primary care practice was 4.2%The majority of the children in the study sample were 11 years old (75, 23.3%) and were female (177, 55%). The prevalence of headache observed to rise with increasing age. The most frequent type of headache was migraine without aura (53, 16.5%) followed by frequent episodic tension type headaches (49, 15.2%), headaches attributed to undifferentiated somatoform disorder (35, 10.9%) and rhinosinusitis (28, 8.7%). The rarest were headache due to attributed to bacterial meningitis (1, 0.3%) and probable neoplasm (1, 0.3%). The most commonly identified precipitating factor was stress (143, 44.4%) followed by bright light (108, 33.5%), routine physical activities (56, 17.3%) skipping meals (48, 14.9%) and sleep deprivation (48, 14.9%).

Discussion Children attending a primary care practice with headache as primary complaint was low. Majority were 11 years old and females. Migraine without aura was the commonest cause while stress was the commonest precipitating factor.

412 Self-referral physiotherapy for musculoskeletal complaints: A one-year evaluation of a true first point of contact service

Rob Goodwin

Aims/Objectives Self-referral to physiotherapy, for patients with musculoskeletal complaints in a primary care settings, is not new but true first point of contact physiotherapy is, as most patients continue to initially consult their GP. Outcomes for over 500 patients who see a physiotherapist, as a true first point of contact are reported in a 1-year evaluation.

Content of Presentation The presentation will report a one-year evaluation of the service. The evaluation included patient satisfaction as well as objective clinical outcome measures (EQ-5D-5L and Global Rating of Change Questionnaire). In addition, the evaluation also included an ‘average cost per case’ financial evaluation.

Relevance/Impact This presentation is significantly relevant with the acknowledged increase in burden faced by primary care services associated with the ageing population, associated age related health conditions and the concomitant issues with GP training, recruitment and retention. As a consequence, the impact is potentially highly significant, with conservative estimates reporting the musculoskeletal proportion of primary care workload at 20%.

Outcomes The evaluation demonstrated excellent patient satisfaction with the physiotherapy service. Furthermore, there was clinical efficacy demonstrated through both clinical outcome measures. In addition, there was a statistically different average cost per case between the physiotherapy cohort and a retrospective GP cohort of patients

Discussion A genuine, first point of contact physiotherapy service appears to be clinically efficacious and well received by patients. Furthermore, there appears to be potential financial savings which could contribute to the sustainability of primary care services at an acknowledged time of increasing demand.

413 Managing emergencies in the community: Learning through simulation

Emer Forde

Aims Life threatening emergencies in the community are rare and can therefore provide a challenge for GPs in keeping up-to-date and maintaining confidence. Emergencies are currently best taught through role play or classroom based simulation. This innovative project brought simulation out of the classroom and into community environments where emergencies actually occur, creating ‘real-life’ situations.

Summary of Work Simulation based workshops led by a GP and Consultant in Intensive Care Medicine were offered in GP surgeries. Scenarios included the practical management of meningitis, anaphylaxis, hypoglycaemia, convulsions and cardiac arrest. Doctors had to find and utilise equipment in their surgery and were asked to physically draw up the appropriate medication.

Outcomes Participants’ self rated confidence in managing emergencies increased after attending the workshop. Experienced doctors struggled to draw up life saving medication such as benzyl penicillin and adrenaline. Others took several minutes to find and turn on the oxygen cylinder in their surgery. Qualitative feedback illustrated the need for more realistic simulation based learning: “I hope this can be done regularly as it will make a huge difference to patient care”, “Excellent – life like to make more memorable”, “good to use the actual surgery equipment”.

Discussion and Impact Many of the GPs knew the theory of what to do but lacked practical skills to efficiently manage emergency scenarios. Training needs to be practical and take place in real-life environments. This is particularly important for ‘time critical illnesses’ where delays can have a direct impact on morbidity and mortality.