The doctor will Skype you now: the value of telehealth in managing long-term conditions

by Dr Padraig Dixon
Senior Research Associate in Health Economics
Centre for Academic Primary Care

People are increasingly living with long-term health conditions. Management of these conditions is expensive, and their increased prevalence challenges health system sustainability and current service models. Can alternative models of care meet the needs of patients with long-term conditions at an acceptable cost?

One growing area of healthcare that could serve as a replacement or adjunct to traditional care models is telehealth, which is the remote provision of healthcare by a variety of communication tools. Telehealth advocates argue that the wider use of technology and a greater reliance on self-management in supporting patients with long-term conditions may produce the same or better health outcomes, but at a lower cost, than traditional care modalities. Is this optimism justified, and might telehealth be good value for the NHS?

Recent work, funded by the National Institute for Health Read more

What is the ‘3D approach’ for managing multiple long-term conditions?

by Dr Mei-See Man
Trial Manager
Centre for Academic Primary Care

The 3D study, led by researchers from the Centre for Academic Primary Care (CAPC), is examining a new approach for GP practices to manage patients with multiple long-term health problems.

Meeting a need

Existing treatment is based on guidelines for each separate condition meaning that patients often attend multiple appointments for each disease which can be repetitive, inconvenient and inefficient. They see different nurses and doctors who may give conflicting advice. These patients frequently get depressed and they also sometimes complain that no-one treats them as a ‘whole person’ or takes their views into account.

The 3D approach was developed by patients and GPs together to address these issues. Based around patient-centred care, the approach focuses on three ‘D’s: Depression, Drugs and the patient’s Dimensions of health, such as their quality of life, priorities and … Read more

How do we support GPs providing end of life care?

by Dr Lucy SelmanDr Lucy Selman
Research Fellow (Qualitative Research in Randomised Trials)
Centre for Academic Primary Care

GPs are vital to the delivery of end of life care. They coordinate care, provide generalist palliative care, help prevent unnecessary hospital admissions, and, in England, commission local health and social care services. Crucially, they help shift care from hospitals to the community, which is where most people would prefer to die.

But providing good care at the end of life is not always straightforward. There’s evidence that GPs can find it challenging, and that the quality of end of life care by GPs can be problematic. The Royal College of General Practitioners and the House of Commons Health Committee therefore recognise the urgent need for evidence-based education in end of life care for GPs. However, the evidence base for GP training in end of life care is unclear, and no rigorous evaluations … Read more

Creating a data archive of GP consultations – the motivations and challenges

One in a million logoBy Dr Rebecca Barnes
Senior Research Fellow
Centre for Academic Primary Care

Nearly 14 years ago in summer school at University of California Santa Barbara, Professor Don Zimmerman provided my introduction to the analysis of institutional, in particular medical, interaction.

Those studies set the benchmark for my own research ambitions but the main obstacle I faced was getting access to data.

For all the right reasons, medical consultations data are challenging to collect. Where ethical approval is in place for reuse it is often restricted to the original research team. Sometimes retrospective approvals for reuse of existing data are possible but even then, consultations data that has been collected without reuse in mind is often of variable quality; the process of data collection and participant characteristics are not well-documented, recordings can be incomplete and they are often audio-only.

The idea for the Primary Care Consultations Archive was born with this … Read more

Why GPs need training about domestic violence and children

Eszter Szilassy2by Eszter Szilassy
Senior Research Associate
Centre for Academic Primary Care

While violence against men continues to fall in the UK, women affected by violence and domestic abuse are bearing the brunt of a hidden rise in violent crime. This rise coincides with the austerity-led cutting of domestic violence services.

Domestic violence and abuse (DVA) damages physical and mental health resulting in increased use of health services by survivors of abuse. The prevalence of DVA among women attending general practice is higher than in the wider population. Women experiencing DVA are more likely to be in contact with GPs than with any other professionals. Reduced investment in specialist domestic violence services further increases the demand for direct general practice responses to DVA. Although victims tend not to disclose spontaneously to their GP, they have an expectation, often unfulfilled, that doctors can be trusted with disclosure, and can offer them … Read more

Who do GPs go to when they need help?

johanna-spiersBy Johanna Spiers
Research associate
Centre for Academic Primary Care

GPs often say they make the worst patients, but who do they turn to when they need help? That’s what I aim to find out on a new research project about GPs with mental health issues.

My new job is firmly at the centre of the zeitgeist. GPs are all over the news on a daily basis. Doctors are judged by journalists and picked apart by politicians for running unsafe surgeries, for closing their doors to new patients, and for long waiting lists. If you read (and believe) certain sectors of the UK press, you might be forgiven for thinking that GPs have a lot to answer for.

The reality is, of course, way more complex than the Daily Fail might have us believe. Yes, GPs are retiring early. Yes, many practices are unable to add new names … Read more

Domestic violence and abuse: how should doctors and nurses respond?

Gene FederBy Gene Feder
GP and Professor of Primary Care
Centre for Academic Primary Care

Domestic violence and abuse (DVA) is a violation of human rights with long-term health consequences, from chronic pain to mental ill-health. It is a global public health challenge, requiring political and educational intervention to drive prevention, as well as a robust criminal justice response. But what is required from front line doctors and nurses, beyond the requirement to respond with clinical competence and compassion to survivors of DVA presenting with, for example, acute injuries, pelvic pain or PTSD? What are the arguments and the evidence for an extended role for clinicians, as articulated in the NICE guidelines on DVA and the WHO guidelines on intimate partner and sexual violence, requiring specific training on DVA and the resources for referral of patients experiencing DVA to specialist DVA services?

A crucial argument and evidence source, as we … Read more

Get inspired – step out of your comfort zone

Medina Johnson_2By Medina Johnson

IRIS National Implementation Manager
Next Link Domestic Abuse Services
Research Collaborator, Centre for Academic Primary Care

Being neither an academic nor a general practitioner, I arrived feeling something like a fish out of water at the RCGP annual conference last month in Glasgow. My colleagues and I had won one of the categories of the RCGP’s Research Paper of the Year award with our paper about women’s experiences of referral to a domestic violence advocate and I was invited to give a short presentation in the wonderfully named “Winners’ Enclosure” section of the conference.

As I trotted, albeit nervously, up to the lectern (I’m going along with the “Winners’ Enclosure” analogy here!) I was reminded how easy it is for us to all stay within our own comfort zone whether that be professionally or personally. I had never presented on a paper before. I had never … Read more