Most clinical trials are pragmatic in nature and aim to assess the effectiveness of a new treatment against ‘treatment as usual’. When interpreting trial results, researchers tend to focus primarily on what treatment participants in different trial arms received. This may be difficult in the usual care arm, as this arm is often poorly defined, whereas the intervention arm is often clearly defined prior to the trial starting. In addition, this focus is very narrow. Treatment is a process and patients’ experiences of accessing and receiving care could also influence their treatment outcomes, and thus the trial’s results.
A paper recently published in Trials highlights that differences do exist between the experiences of participants randomised to usual care and intervention arms. These differences relate not only to what treatment participants receive, but also how they access and engage with … Read more
I know this from working in both general practice and as a hospital doctor in A&E.
During the early stages of an illness it can be difficult for even the most experienced healthcare professionals to determine whether a patient has a minor self-limiting illness or is harbouring a more serious condition. In addition, growing problems such as antibiotic resistance and multimorbidity mean that sometimes even when a doctor makes a correct diagnosis, patients do not always get better with the first round of treatment and may require further medical help.
We cannot, and it is not clinically appropriate, to admit everyone to hospital to observe them until they feel 100% better.
That is why it is important that healthcare professionals provide patients with safety-netting advice. Safety-netting … Read more
With ninety percent of patient interaction with health services going through primary care, it’s not surprising that primary care clinicians and researchers try to figure out ways to improve primary care services. Interventions are many and varied, and result in important questions about their effectiveness. Do electronic consultations offer a good service to patients? If GPs introduce advice on healthy lifestyles into the consultation, does it make patients healthier? What about increasing the duration of GP appointments to ten minutes – does this improve outcomes for patients? Or ensuring that patients always see the same named doctor? Or painting the waiting room green?
Questions like these are normally answered by administration of a generic patient-reported questionnaire. By comparing the responses of groups of patients (say those with eight minute consultations and those with ten minute consultations), researchers can … Read more
I was recently invited to address the annual general meeting of PROSPECT, a local prostate cancer support group. The brief I was given was to discuss the GP’s role in diagnosing prostate cancer and the latest research in this area; a daunting task to tackle in a room full of men with prostate cancer at various stages on their cancer journey.
I spoke of the GP’s role across the continuum of cancer, from prevention and early diagnosis through to survivorship support and palliative care. I tried to discuss some of the latest studies in the field, such as the PROMIS study and the CAP trial, in a digestible form for these men. I also mused with them about the potential role new genetic technologies will have in the future in guiding GPs in determining cancer risk … Read more
I have a problem with gambling. There’s not enough of it.
That was the admission from billionaire Steve Wynn, a major figure in the casino industry, speaking at a recent gambling research conference in (where else?) Las Vegas. And sure, it made for a good quote. But it’s also a rather glib dismissal of a serious issue that affects many thousands of people across the world.
The UK certainly has a problem with gambling. At least it has since 2007, when laws were changed to allow for huge growth in gambling opportunities and exposure. It has been hard to ignore the subsequent explosion in industry advertising, which increased by around 500% between 2007 and 2013. By contrast, you may have missed the increased numbers of high intensity electronic gambling … Read more
I have been a researcher for over two decades. In that time, lamentations about the limited influence of research evidence have grown. But I think we researchers are largely to blame. We steadfastly insist on disseminating our knowledge in ways that we know don’t work.
Researchers usually write scientific papers, because publication is a key career performance metric. But scientific papers are read and digested by other scientists, not those who can act on our findings. Our ethnographic study showed how and why research doesn’t reach policymakers, like healthcare commissioners.
We found that local healthcare commissioners cannot retrieve papers from many scientific journals, as they often do not have passwords or subscriptions. Although open access publication helps, commissioners usually use Google, where scientific papers often do not appear – even if open access. If a … Read more
There has been a transformation in social and scientific attitudes to depression in my working lifetime. It is no longer acceptable to stigmatise mental illness or psychological distress. The idea that the common mental disorders of depression and anxiety are an inescapable part of being human has been replaced by a belief that these disabling extremes of sadness and worry are treatable conditions.
Changes in the treatment of depression have been part of wider cultural changes. There is an increased openness about sadness and distress, and a widespread belief, beginning with Freud, that at the very least ‘neurotic misery can be transformed into ordinary unhappiness’. The invention of psychotherapy has spawned numerous schools and sub-disciplines, but all hold to the common belief that with help, … Read more
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?
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
However, before I even knew what that term meant, I was several other things: a writer, a performer, a poet. I am drawn to words, and to the stories that they form. This is why I am passionate about qualitative research. I also love performance, and believe it is a fantastic mechanism for powerfully communicating important messages about humanity.
On my arrival at the University of Bristol, I was therefore thrilled to learn that the project I would be working on with Principal Investigator Ruth Riley included a collaboration with a performance artist, who would be communicating our findings about GPs’ mental health to an audience. This performance was to happen as part of the Elizabeth Blackwell Institute’s (EBI) Feel It Festival. … Read more