Research Posters 2021 – 2027
2021 Patient participation in undergraduate medical education: development of an informative patient resource
Aims / Objectives: Medical students spend up to 15% of their undergraduate curriculum in general practice. This project explores what information patients need when considering involvement in general practice-based teaching.
Content of Presentation: We conducted focus groups with patients which were audio-recorded and transcribed verbatim,. These were analysed iteratively and coded thematically. We present focus group findings and recommendations from this project.
Relevance / Impact: There are few resources for patients participating in medical education. This study will inform development of a national resource for patients considering involvement in undergraduate general practice teaching.
Outcomes: Patients want to be included in teaching and feel their involvement (in addition to their disease) matters. Patients want information about students (e.g. seniority) and their learning focus. Patients value prior trusting relationships with their GP, maximising their engagement and positive teaching experiences. Patients would like their practices to explicitly share their teaching role with patients (e.g. information about teaching participation and how patients can help).
Discussion: We will use these findings and existing literature to inform design of resources for patients and GPs. We hope these will improve the quality, relevance and utility of consent processes for teaching involvement, and the teaching interactions between students, patients and GPs.
2022 The RCGP Patient Safety Toolkit
The RCGP patient safety toolkit (PSTK) The online resource hosted by the RCGP is a go-to point for general practices interested in developing the patient safety of their organisation (http://www.rcgp.org.uk/clinical-and-research/toolkits/patient-safety.aspx). The website contains patient safety resources across a broad spectrum of patient safety issues such as safety climate measures, checklists, prescribing indicators, trigger tools and patient questionnaires.
The PSTK is the result of a multi-centre NIHR SPCR project. Herein we describe the development of the PSTK from literature review via consensus processes to testing phases in general practice. We describe the new tools created during the project process to address gaps in the existing literature and discuss the problems associated with poorly understood areas of patient safety such as diagnostic and clerical error.
We aim to introduce potential users to the range of tools on offer in the toolkit and explain how these can be used in your practice to facilitate change. We also describe early usage data for the website and user feedback which indicates that the toolkit is being positively received.The PSTK can be used for CPD purposes, practice innovation and development and is a useful training resource. The toolkit is a platform from which to raise awareness of the importance of patient safety in general practice.
We would like to promote this issue among the many demands of busy general practice as it can make a real difference to patients and ultimately save practices time dealing with complaints arising from patient safety issues.
2023 “I went off sick in a crisis” – Exploring the barriers and facilitators to help-seeking by GPs living with mental health problems: a qualitative study
Aims/Objectives: General Practitioners (GPs) experience high levels of anxiety, depression, stress and/or burnout, which can impact on their own well-being and on patient care. This study aims to explore the barriers GPs experience when seeking help for mental health problems.
Content of Presentation: We report a qualitative study using semi-structured interviews which explored GPs’ experiences of illness, impact on work and seeking and obtaining help.
Relevance/Impact: Our results will provide much-needed evidence of GPs’ experiences of mental health problems and how this impacts on their work. Information on barriers to help-seeking and sources of support will inform the development of appropriate services for GPs living with mental health problems.
Outcomes: Initial analysis of 34 interviews suggests that sources of distress include personal circumstances and background, and importantly pressures experienced in work, at the level of the patient, practice, and political systems. Respondents report remaining in work even when unwell, and only taking time off as an extreme measure, or at the point of a crisis. Barriers to help-seeking include perceived stigma, worries about privacy and confidentiality, lack of time to look after self, feelings of isolation, lack of support, and ‘presenteeism’ associated with guilt.
Discussion: GPs may be especially vulnerable to the effects of mental health problems, due to their unique set of sources of distress and barriers to help-seeking. We would advocate the introduction of specialist services to support and care for GPs living with mental health problems, and will discuss how our findings complement developments in this area.
2024 How long do patients with chronic disease expect to live? A systematic review of the literature
Personal survival expectations can affect healthcare decisions, but patients can misunderstand the aims and chance of success of treatment. A systematic review of self-estimated life expectancy in non-cancer chronic disease was conducted.
Methods The published and grey scientific literature from 1985 to 2015 was systematically searched for terms relating to ‘life expectancy’ and ‘self-estimation’. Studies of adults with non-cancer chronic disease who estimated their own life expectancy were included. Study quality was assessed using a bespoke tool.
Results 2,356 titles were reviewed. Seven papers met criteria for inclusion. Amongst patients with heart failure, self-estimated life expectancy was 40% longer than predicted by a validated model. Outpatients receiving haemodialysis overestimated their chances of surviving five years. Patients with heart failure and COPD were approximately three times more likely to die in the next year than they predicted. No data on hepatic, neurological or non-COPD lung disease were found.
DiscussionThere is little published evidence examining self-estimated life expectancy in non-cancer disease. Available evidence suggests patients tend to overestimate life expectancy. Data from diseases other than COPD, heart and kidney failure is limited.
Conclusion Individuals with chronic disease may have unrealistically optimistic expectations of their prognosis. More research is needed to understand how expectations of life-expectancy affect behaviour. Meanwhile, clinicians should attempt to identify each patient’s prognostic preferences and provide information that they can understand and use to inform their decisions.
2025 Engagement of general practitioners with clinical commissioning group
Background: Clinical commissioning is the centre piece of the new health reforms by the government. General practitioners have been given the crucial role of leading commissioning in order to improve healthcare outcomes. This study draws on available data to explore the experiences and extent of involvement of general practitioners with clinical commissioning.
Aim: The aim of this research is to explore experiences of general practitioners in their engagement with clinical commissioning.
Methods: In-depth and semi-structured interviews were conducted, using a purposive sample of GPs with a formal role with CCG. The questions asked aimed to explore (1) roles of GPs in clinical commissioning, (2) positive factors in GP engagement with clinical commissioning, (3) limitations in GP engagement with clinical commissioning and (4) recommendations for practice.
Results: The results demonstrate GPs understood their roles in commissioning, and are enthusiastic to improve healthcare outcomes, despite the limitations encountered.
Conclusion: The findings highlighted that GPs are enthusiastic about improving healthcare outcomes in clinical commissioning; however, there is lack of training support required for their commissioning development.Keywords: clinical commissioning, clinical engagement, general practitioners (GPs).
2027 Improving risk factor management for patients with poorly controlled type 2 diabetes: a systematic review of non-pharmaceutical interventions in primary care
Background: Poorly-controlled type 2 diabetes mellitus (T2DM) is a major international health problem. Our aim was to assess the effectiveness of non-pharmaceutical interventions, targeting poorly-controlled T2DM and seeking to improve glycaemic control and cardiovascular risk in primary care.
Methods: A systematic review of randomised controlled trials (RCTs) was untaken, which targeted patients with poor glycaemic control, defined as HbA1c over 7.5% (68 mmol/ mol). Primary outcomes were HbA1c, blood pressure and lipids. Meta-analysis was performed with subgroups exploring the effects of duration of study follow-up, the predominant intervention type and baseline HbA1c. Meta-regression analyses were undertaken to further examine the impact of different study and population characteristics on HbA1c and SBP.
Results: Thirty-eight RCTs were identified, including 10,407 patients with most undertaken in the USA. In general there was low risk of bias across studies. The main intervention-types were patient-directed (48%) and organisational (48%). Overall, interventions reduced HbA1c by -0.35% (95% CI; -0.5%, -0.2%) but meta-analyses had high heterogeneity. Meta-regression confirmed that organisational interventions were more likely to improve HbA1c compared to patient-orientated interventions (β-Coefficient -0.44, p=0.015) for longer follow up studies (≥ 12 months). Interventions on populations with a higher baseline HbA1c (> 9.5%) also were more likely to improve HbA1c. Interventions did not improve bloods pressure overall.
Conclusions: Interventions for T2DM in community settings targeting patients with poor control show modest but positive effects on HbA1c. This review suggests that interventions are more effective if they target patients with very poor control and enhance organisational elements of care.