Research Posters 2042 – 2050
2042 The place of third sector community groups in providing support for older people: secondary analysis of qualitative analysis
Aims/objectives To examine the barriers and facilitators to attending community groups for older people.
Content of Presentation Secondary analysis of ten transcripts which were selected at random from a larger study of 19 interviews with older people recruited from community groups in Stoke-on-Trent.
Relevance/Impact Around one million people in the UK would describe themselves as lonely. This can lead to depression. Attending a community group can reduce social isolation and loneliness and act as a ‘life-line’ for older people, and have a potential role to play in preventing depression in older people.
Outcomes Analysis of the interview data suggests that bereavement is often an event which precipitates a ‘crisis’. Respondents described physical illness, lack of support and loneliness. Participants described the need for optimism, a sense of determination, use of pre-existing skills, good support networks and established relationships with general practitioners in order to overcome the challenges associated with bereavement and loneliness, and to engage with community groups. Facilitators to older people attending community groups include: of a catalyst for change, ability to access the groups (transport).
Discussion GPs need to be more aware of services offered by the third sector and availability of community transport could facilitate older people to attend groups. This may reduce levels of social isolation, loneliness and depression.
2043 Reducing the risk of Type 2 diabetes after gestational diabetes: Exploring women’s views on behaviour change interventions incorporating mobile technology
Aims/Objectives To explore how mobile technology could be incorporated into a primary care based behaviour change intervention aimed at reducing the risk of progression from Gestational Diabetes (GD) to Type 2 Diabetes Mellitus (T2DM).
Background Women diagnosed with GD are over seven times more likely to develop T2DM, yet annual rates of long term follow up in primary care are around 20%. We are missing a critical window of opportunity to reduce the risk of progression from GD to T2DM. Previous qualitative work has noted that women in the post-natal period require flexible, longer term approaches that accommodate their family and work commitments, and new information technologies may have potential to support this.
Methods Twenty women diagnosed with GD were identified from hospital records as part of their routine antenatal care and invited to take part in the project. The semi-structured interviews were audio recorded, transcribed and analysed using NVIVO.
Outcomes Five main themes emerged: 1) Impact of GD diagnosis, 2) Knowledge about diabetes, 3) Reducing the risk of developing T2DM, 4) Support received from healthcare professionals, 5) Use of technology. Technology subthemes included types of device (e.g. mobile phone, PC, fitness trackers), barriers (e.g. data security, cost, perceived complexity) and facilitators (e.g. ease of use, familiarity, platform compatibility).
Relevance/Impact Postnatal primary care provision for women who have had gestational diabetes is unsatisfactory. This study highlights how mobile technology could compliment a primary care based intervention aimed at reducing risk of progression from GD to T2DM.
Discussion: This study builds upon previous Patient and Public Involvement (PPI) work and will inform a future bid for funding for a primary care based health behaviour change intervention.
2044 Evaluation of the feasibility of using C-reactive protein (CRP) to optimise prescribing for lower respiratory tract infections in primary care settings
Aims/Objectives The Scottish Antimicrobial Prescribing Group has developed several initiatives to promote reduction of unnecessary antibiotic use for respiratory tract infections. This study was developed to evaluate the feasibility of using CRP testing, as recommended by NICE, as an additional tool to reduce unnecessary use. A multi-professional study steering group was established to provide advice on methodology and governance issues. Ten GP Practices were recruited across four regions to use CRP testing in patients presenting with suspected lower respiratory tract infection during November 2015 – February 2016.
Content of Presentation Data collected during consultations and GP feedback will be presented to illustrate the practical aspects of how the test was used in Scottish practice and its perceived impact on GP decision making and prescribing of antibiotics.
Relevance/Impact Respiratory tract infections make up a sizeable proportion of acute consultations and although many are self-limiting they are often treated with antibiotics. In the face of globally increasing antimicrobial resistance reducing unnecessary antibiotic use is important.
Outcomes Our data suggests that CRP testing can be accommodated with the current appointments system, by either the GP or a practice nurse running the test. The test appeared to reduce the number of immediate prescriptions, increase use of delayed prescriptions and provided reassurance for both prescribers and patients when no antibiotic was used.
Discussion CRP testing is practical in the Scottish primary care context and offers an additional tool to support prescribers to reduce unnecessary use of antibiotics for respiratory infections. Study results will be used to inform future strategy for point of care testing for community infections.
2045 Co-morbidity, polypharmacy and mortality in people with stroke – a cross sectional study of 8751 UK Biobank Participants
Aims/Objectives Co-morbidity (one or more long term conditions in addition to an index condition) and polypharmacy (multiple medications) are common in stroke. Little is known about effects on health-related outcomes. We aimed to examine associations between number of morbidities / prescriptions and mortality in stroke.
Content of Presentation Cross-sectional study using UK Biobank data. Participants were 8751 adults aged 40-69 in the UK with self-reported stroke or TIA. There were 42 physical/mental health morbidities coded. Cox proportional hazards regression examined associations between number of self-report co-morbidities / medications and all-cause mortality. Hazards ratios were adjusted for age, sex, deprivation, smoking status and alcohol consumption.
Relevance/Impact This work will inform the development of primary care guidelines for stroke.
Outcomes Participants: 57.5% male; 95.6% Caucasian; mean age 60.9 years (SD 6.7); mean number of co-morbidities 2.0 (SD 1.6); mean number of medications 5.6 (SD 3.6). Compared to those with no co-morbidities, risk of all-cause mortality was significantly higher in those with 3 (HR; 95% CI: 1.72; 1.25 -2.36), 4 (1.83; 1.29-2.61) and ≥5 (2.24; 1.58-3.20) morbidities. Compared to those with no medications, risk of all-cause mortality was significantly higher in those with 1-2 (2.60; 1.05-6.44), 5-6 (2.65; 1.09-6.47), 7-8 (2.98; 1.22-7.32), 9-10 (3.86; 1.56-9.53) and ≥11 (4.57; 1.86-11.26) medications but not in those on 3-4 (1.65; 0.67 – 4.07).
Discussion Risk of all-cause mortality is higher for those with higher levels of multimorbidity. With regards polypharmacy, all-cause mortality is lowest for those on 3-4 medications. Further work will examine the relationship between types and combinations of medication with mortality and healthcare utilisation.
2046 GP Practice Cancer Screening Uptake in the Context of Their Patient Population Characteristics
Background GP Cancer Profiles published by PHE allow practitioners to view the performance of their practice on various cancer screening coverage and uptake indicators, as well as the demographic characteristics of their patient population (e.g. socio-economic deprivation, age etc.). However, GPs would benefit from identifying whether the cancer screening coverage for their practice is higher or lower that should be expected of their patient population.
Method Patient population characteristics were modelled against GP practice cancer screening coverage, to determine what proportion of variation in coverage is accounted for by patient population characteristics. Expected values for each practice’s screening coverage were then calculated using its patient population characteristics, and this figure was compared to the actual coverage.
Results Results focusing on breast cancer screening coverage in 2013-2015 suggest that practice population demographics account for a large amount of variation in coverage between GP practices (R-squared 63.6%). The analysis also identified some practices that have coverage which is higher or lower than would be expected given the demographic characteristics of their patient populations.
Conclusion Results indicate that GP practice population characteristics explain less than two thirds of the variation in cancer screening coverage. The unexplained variation could be accounted for by GP factors and the results could prompt reflection from GPs on screening uptake in their practice and help GPs to better understand their own cancer screening performance.
2047 Statistical profiling and comparison of GP practices
Background GP practice profiles published by PHE provide a wealth of cancer-related data to monitor performance and demographics of patient populations. This analysis identifies groups of practices that are broadly similar in terms of demographics using cluster analysis methods. Cancer related outcome measures were then compared between the clusters.
Methods 13 variables from 7754 English GP practices were analysed; an urban/rural index, deprivation, percentage white, percentage Asian, list size and age profiles by gender. Using k-means clustering in STATA, candidate solutions were compared by examination of cluster contents, statistical measures (Sum of squares between (SSB) and the Silhouette coefficient (SC)), graphical visualisation and qualitative characterisation.
Results We identified six clusters with SSB = 0.32 and SC = 0.36. The largest group generally consists of urban, affluent, white, large practices. The smallest corresponds to urban, relatively poor practices with a higher Asian caseload and fewer old patients. The four other groups correspond to (rural, affluent, white, older), (urban, affluent, mixed-race, large practices), (urban, poor, white) and (urban, poor, mixed-race, fewer old patients). There was significant variation between clusters in two week wait referral rates, bowel screening coverage and cervical screening coverage.
Conclusion GP practices can be grouped demographically and statistically significant variation between groups is seen for some cancer related variables. This analysis aims to support a health professional engagement programme, which helps doctors improve local cancer outcomes. Further work is planned to explore patterns of cancer outcome statistics with respect to cluster membership.
2048 What impact do patient charges for primary care services have on access to primary care and health outcomes?
Aims: A suggestion has been made to lessen the immense NHS deficit by introducing patient charges to access primary care; such charges aim to reduce “excess” demand while increasing revenue. However, this might be a false economy if people choose to evade seeing their GP to avoid charges. We aim to assess the impact of such fees on relevant health outcomes, health expenditure and utilisation.
Content of Presentation: We collected data from publicly available datasets on user fees policies and health indicators in 25 OECD member states. We will present policies implemented in various countries and their impact on health indicators. We found that countries that charge users to access primary care had significantly higher diabetes hospital admission rates (p=0.048) and lower coverage of over-65s for seasonal influenza vaccination (p=0.029). However, these associations became insignificant after correction for multiple comparisons, and no significant differences were found for other indicators.
Relevance/Impact: These results can help inform the debate on introducing user charges for primary care in the NHS. Currently, there is little evidence to base policy on.
Outcomes: Primary care quality indicators, general population health indicators, cancer survival rates, healthcare utilisation and access indicators, measures of healthcare expenditure.
Discussion: The implications of these findings are widespread. They suggest that user charges to access primary care are ineffective at reducing healthcare expenditure and “excess” demand for health services. However, there is no evidence that charges would increase costs elsewhere. We need careful evidence on the impact of user fees to devise policy.
2049 Medically unexplained symptoms (MUS): the challenges of recruiting healthcare professionals and people with MUS for research
Aims/objectives To raise awareness about the challenges of conducting research into medically unexplained symptoms (MUS).Content of presentation: Between 20-40% of new consultations in primary care relate to MUS. Annual NHS costs for MUS in adults of working age in England is estimated to be £2.89bn in 2008/9, or 11% of total NHS expenditure. The presentation describes challenges experienced by the research team recruiting healthcare professionals (GPs, Psychiatrists, Psychologists and Improving Access to Psychological Therapies, [IAPT] workers) and people with MUS for a qualitative study to explore the use of metaphors to support management of people with MUS.
Relevance/impact Understanding and managing MUS can have adverse impacts on patients, families, and healthcare staff and services in primary and secondary care. MUS research is therefore important in order to generate knowledge to improve service delivery and care management.
Outcomes The research team experienced challenges in recruitment of healthcare professionals and people with MUS. GPs, Psychologists and Psychiatrists reported having roles in management of people with MUS. IAPT workers we approached specified that MUS was not of clinical relevance to them; despite GPs reporting to have made referrals to psychological wellbeing services. People with MUS describe difficulties accessing acceptable treatment.
Discussion Reflections from this study indicate that people with MUS are difficult to identify. Moreover, a systemic problem may exist in the clinical pathway in terms of making referrals to IAPT services; which are tasked to offer psychological interventions to people with MUS.
2050 Integrative Review: Combined brief interventions to improve the physical health of patients with mental health problems
Aims/Objectives To evaluate the current evidence base for combined brief interventions in improving the physical health of patients with mental health problems. Brief interventions are a form of targeted health promotion typically using behaviour change techniques such as for smoking or physical exercise.
Content of Presentation This is an integrative review, which is a type of literature review using a detailed search strategy combining diverse (qualitative and quantitative) data. The databases used are Ebase, Medline, Cochrane, CINAHL and PsychINFO.
Relevance/Impact People with long term mental health problems have a 70% higher mortality rate than the general population, are three times more likely to have a physical illness and die 15 years younger than their peers. Combined brief interventions could potentially have a great impact and primary care is in a unique position to deliver this due to treating patient from a holistic as opposed to disease-based perspective.
Outcomes Whilst there is strong evidence for effectiveness and cost-effectiveness of utilising brief interventions to promote healthy lifestyles and behaviour change, there is little research in combined approaches within primary care to improve the physical health of this vulnerable population.
Discussion Further research is needed to assess the effectiveness a combined approach to improving the physical health of patients with mental health problems. I will conduct qualitative research into barriers and facilitators to combined brief interventions within primary care. This should lead to a more evidence-based and efficient implementation of making every contact count from a primary care perspective.