London journal of primary care最新文献

{"title":"How could the quality and outcomes framework (QOF) do more to tackle health inequalities?","authors":"Tim Thorne","doi":"10.1080/17571472.2016.1215370","DOIUrl":"10.1080/17571472.2016.1215370","url":null,"abstract":"<p><p>This paper outlines how the quality and outcomes framework (QOF) has done little to close the health inequality gap, and proposes possible ways in which future iterations of QOF could do more to address this crucial public health problem.</p>","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"8 5","pages":"80-84"},"PeriodicalIF":0.0,"publicationDate":"2016-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5330348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34776161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the potential impact of health promotion videos as a low cost intervention to reduce health inequalities: a pilot before and after study on Bangladeshis in inner-city London.","authors":"Suleman Latif,&nbsp;Imad Ahmed,&nbsp;Mohammed Shafiul Amin,&nbsp;Ismail Syed,&nbsp;Na'eem Ahmed","doi":"10.1080/17571472.2016.1208382","DOIUrl":"https://doi.org/10.1080/17571472.2016.1208382","url":null,"abstract":"<p><strong>Background: </strong>Coronary artery disease is the single most common cause of death in the UK. For those born in Bangladesh but dying in England and Wales, coronary artery disease causes 25% of all deaths. Cost-effective solutions are required to address this burden. Several studies have demonstrated the effectiveness of educational video intervention in informing patients in various settings.</p><p><strong>Setting: </strong>A Bangladeshi women's group in South London.</p><p><strong>Questions: </strong>The effectiveness of a health educational video in influencing the knowledge and attitudes towards a preventable illness amongst Bangladeshis in London? The scope of videos for health promotion?</p><p><strong>Methods: </strong>An educational video on the signs, symptoms and prevention of coronary artery disease was played to a Bangladeshi women's group in South London in the Bengali language. Participants (<i>n</i> = 18, mean age = 53.7) completed a fifteen-question survey to assess their baseline knowledge prior to viewing (pre-test). The group then viewed the video and repeated the initial questionnaire, with additional questions to solicit their attitudes and perceptions (post-test).</p><p><strong>Results: </strong>The intervention significantly improved the basic knowledge of coronary artery disease. There was a statistically significant improvement in the number of correct responses amongst participants with <i>p</i> = 0.0002 (mean change 2.28, 95% CI 1.29-3.27) and in the number of unsure responses <i>p</i> = 0.0042 (mean change 1.83, 95% CI 0.01-3.01). Upon viewing the video, all participants agreed that they wanted to implement the advice from the video into their current lifestyles.</p><p><strong>Conclusion/discussion: </strong>The educational video significantly improved the knowledge and attitudes pertaining to coronary artery disease amongst British-Bangladeshi individuals in the UK community setting. This project illustrated how commissioners may effectively utilise third-sector organisations through partnerships to implement innovative methods of health screening and promotion. Videos are a novel approach of providing culturally sensitive health education to ethnic minority groups, through screening in clinics and in local media.</p>","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"8 4","pages":"66-71"},"PeriodicalIF":0.0,"publicationDate":"2016-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2016.1208382","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34776158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are medical educators in general practice untapped potential to increase training capacity in sexual and reproductive healthcare? Results of a survey in London, UK.","authors":"Richard Ma,&nbsp;Radhika Shah","doi":"10.1080/17571472.2016.1209875","DOIUrl":"https://doi.org/10.1080/17571472.2016.1209875","url":null,"abstract":"<p><strong>Background: </strong>Long waiting times for training in sexual and reproductive healthcare (SRH) including long acting reversible contraception (LARC) might lead to attrition from training programmes, leading to reduced capacity for sexual health services, and reduced access to such contraception for women.</p><p><strong>Setting: </strong>General practice in London, UK.</p><p><strong>Question: </strong>Can medical educators in general practice be used as untapped potential to train other health care professionals in sexual and reproductive healthcare?</p><p><strong>Method: </strong>We conducted an online survey to find out the qualifications, skills and willingness of established educators in primary care in London to train other clinicians in sexual and reproductive healthcare, including LARC.</p><p><strong>Results: </strong>We received 124 responses from medical educators (10.1% response rate from general practitioner (GP) trainers and 59.0% of clinical supervisors for Foundation Year doctors). 86 (69.9%) had diploma of the Faculty of Sexual and Reproductive Healthcare (DFSRH) qualification and further 18 (14.6%) were interested in obtaining this qualification. Eleven respondents were trained to fit intrauterine contraception only, three for contraceptive implants only and 37 were trained to fit both. 50 (40.3%) of 124 respondents were willing get involved in DFSRH training; 74% of these were willing to teach on any component of DFSRH including LARC.</p><p><strong>Discussion: </strong>There is a shortage of training places and long waiting list for clinicians who wish to train in SRH. This survey suggests there is a pool of GP educators with skills and experience in SRH and are willing to train others. This can potentially increase the training capacity and improve overall access to good contraception and LARC for women.</p>","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"8 5","pages":"85-90"},"PeriodicalIF":0.0,"publicationDate":"2016-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2016.1209875","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34776162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Guy's and St Thomas's NHS Foundation Trust @home service: an overview of a new service.","authors":"Geraldine A Lee,&nbsp;Karen Titchener","doi":"10.1080/17571472.2016.1211592","DOIUrl":"https://doi.org/10.1080/17571472.2016.1211592","url":null,"abstract":"<p><p>Hospital in the home is a relatively new concept within the UK healthcare system. The Guy's and St Thomas's NHS Foundation Trust (GSTT) @home service 'Bringing hospital care to your home' was commissioned by Lambeth and Southwark CCG in 2014 to provide acute care in the patients' place of residence by facilitating rapid discharge from hospital. The service is designed for 260-280 referrals each month from local hospitals, London Ambulance Service, GPs, district nurses and palliative care services. The GSTT@home provides intensive care for a short episode through multidisciplinary team work with the aim of returning the patient to their prior health status following an acute episode of ill health. The main criteria for referrals are adults, living within Lambeth or Southwark with an acute onset of illness often with acute exacerbations of chronic conditions. Care is delivered using 25 clinical pathways using integrated care teams, including those for respiratory disease, heart failure and palliative care services. Recently, the service extended to include overnight palliative care. As care shifts from hospital to the community, it is envisaged that these types of programmes will become an essential component of care provision. This paper describes the service and presents initial service evaluation data.</p>","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"9 2","pages":"18-22"},"PeriodicalIF":0.0,"publicationDate":"2016-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2016.1211592","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34867276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of a patient at high risk of type 2 diabetes.","authors":"Lara Howells,&nbsp;Ailsa J McKay,&nbsp;Sufyan Hussain,&nbsp;Azeem Majeed","doi":"10.1080/17571472.2016.1203509","DOIUrl":"https://doi.org/10.1080/17571472.2016.1203509","url":null,"abstract":"<p><p>Rates of type 2 diabetes mellitus have risen rapidly over the past three to four decades. This article describes a typical patient presenting with intermediate hyperglycaemia in primary care. We suggest the appropriate action to reduce the risk of diabetes developing. Population-level preventive interventions, and adequate recognition and early management of those at risk of developing diabetes, could mitigate the impact of this evolving health epidemic.</p>","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"8 5","pages":"76-79"},"PeriodicalIF":0.0,"publicationDate":"2016-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2016.1203509","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34776160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sonia delaunay: a life in the <i>avant</i>-<i>garde</i>.","authors":"Francesco Carelli","doi":"10.1080/17571472.2016.1204009","DOIUrl":"https://doi.org/10.1080/17571472.2016.1204009","url":null,"abstract":"Sonia Delaunay (1885–1979) was a key figure in the Parisian avant-garde, whose vivid and colourful work spanned painting, fashion and design. In 2015, Tate Modern in London presented the first UK retrospective to assess the breadth of her vibrant artistic career, from her early figurative painting in the 1900s to the energetic abstract work of the 1960s. The exhibition offered a radical reassessment of Delaunay’s importance as an artist, showcasing her originality and creativity across the twentieth century. Born in Odessa and trained in Germany, Sonia Delaunay came to Paris in 1906 to join the emerging avant-garde. She met and married the artist Robert Delaunay, with whom she developed ‘Simultaneism’ – a style of abstract compositions with dynamic contrasting colours and shapes. Many iconic examples of these works were brought together at Tate Modern, including Bal Bullier [1913] and Electric Prisms [1914]. Her work expressed the energy of modern urban life, celebrating, for example, the birth of electric street lighting and the excitement of contemporary ballets and ballrooms. The exhibition showed how the artist dedicated her life to experimenting with colour and abstraction, bringing her ideas off the canvas and into the world through tapestry, textiles, mosaic and fashion. Delaunay premiered her first ‘simultaneous dress’ of bright patchwork colours in 1913 and even opened a boutique in Madrid in 1918! Her Atelier Simultané in Paris went on to produce radical and progressive designs for scarves, umbrellas, hats, shoes and swimming costumes throughout the 1920s and 1930s. Clients included the Hollywood star Gloria Swanson and the architect Erno Goldfinger, as well as department stores like Metz & Co and Liberty. The exhibition revealed how Delaunay’s designs presented her as a progressive woman synonymous with Modernity: embroidering poetry onto fabric, turning her apartment into a three-dimensional collage, and creating daring costumes for Diaghilev’s Ballets Russes. The diverse inspirations behind Delaunay’s work were also explored, from the highly personal approach to colour which harked back to her childhood in Russia, to the impact of her years in Spain and Portugal where she painted The Orange Seller [1915] and Flamenco Singers [1915–16]. The show also revealed the inspiration provided by modern technology throughout Delaunay’s career, from the Trans-Siberian Railway to the airplane, and from the Eiffel Tower to the electric light bulb. It also included her vast seven-metre murals Motor, Dashboard and Propeller, created for the 1937 International Exposition in Paris and never before shown in the UK. Following her husband’s death in 1941, Sonia Delaunay’s work took on a more formal freedom, including rhythmic compositions in angular forms and harlequin colours, which in turn inspired geometric tapestries, carpets and mosaics. Delaunay continued to experiment with abstraction in the post-war era, just as she had done since its birth in th","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"8 4","pages":"72-74"},"PeriodicalIF":0.0,"publicationDate":"2016-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2016.1204009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34776159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health is wisely sharing vulnerability.","authors":"Paul Thomas","doi":"10.1080/17571472.2016.1193590","DOIUrl":"https://doi.org/10.1080/17571472.2016.1193590","url":null,"abstract":"Papers in this (8.3) Issue of LJPC continue the theme of improving mental health – this time helping clinicians to be mentally healthy. How can we expect GPs and other primary care practitioners to remain open and empathetic, when so many things threaten our inner balance? How can I expect myself to do this? The papers are challenging at a very human level. They invite each of us to become more skilled at coming out of our shells and wisely exposing things we prefer to keep hidden – our vulnerabilities. This is not so easy because the fear of being injured when I expose a vulnerability is a real fear. There are plenty of people who are ready to pounce on exposed weakness. And then I have to handle my own self-doubt – anxiety that I might expose the cobwebs in the murkier parts of my mind; or that I might expose to myself that I am not my own person, but trapped in a story forced on me by others; or inhabiting a story that I have wilfully adopted without taking responsibility for my actions. It was Karl Weick who described leadership as ‘the legitimisation of doubt’.[1] It is not knowing everything that marks out a great leader, but knowing when to admit that you don’t know what to do, and then work through this uncertainty to a better place. Often, sharing uncertainty with others helps people to find good collaborative ways forward; and along the way develop trusted relationships that bind them together as a community of friends and followers who will protect each other against those who want to seize the opportunity of someone’s vulnerability to cause them harm. Showing vulnerability may at times be valuable, but it does need to be done wisely – in an invited and reciprocal way that harmonises with what others are doing. Making yourself vulnerable can be counter-productive – it makes you open to attack, and simply ‘bleeding all over the place’ is indulgent and portrays you as a victim. One thing is clear – you can’t understand vulnerability by imagining that people are simple machines. A broken heart cannot be fixed in the way a broken car tyre can be. Changing from being someone who hides their vulnerability to one who values it and uses it wisely is an internal transformation that is inevitably painful – too difficult for many to contemplate. This kind of transformation develops a new sense of who you are – someone who harmonises more than controls. The idea that harmonising is more important than control for good mental health has been explored in LJPC before. In LJPC 8.2 Hallam presented evidence that music helps people to reach out to others, and in doing this improve their mental health.[2] Her previous research revealed the beneficial effects of music on the child’s growing brain.[3] Her LJPC paper presented new evidence that music helps people over the age of 50 to improve their mental health, including:","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"8 3","pages":"33-34"},"PeriodicalIF":0.0,"publicationDate":"2016-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2016.1193590","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34776150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A collaborative approach to improving patient access in general practice: impact of three different pilot schemes in 12 general practices in Greenwich.","authors":"Melanie Lawless,&nbsp;Ellen Wright,&nbsp;Jackie Davidson","doi":"10.1080/17571472.2016.1173946","DOIUrl":"https://doi.org/10.1080/17571472.2016.1173946","url":null,"abstract":"<p><strong>Background: </strong>With rising patient demand and expectations, many practices are struggling to respond to the demand for appointments.</p><p><strong>Objective: </strong>To investigate different approaches to improving access to general practice and assess the impact on (i) patient experience, (ii) practice staff experience and (iii) activity in A&E and walk-in centres.</p><p><strong>Method: </strong>Greenwich CCG piloted three approaches in 12 volunteer practices. The schemes were:(1) Systematic GP telephone triage of all appointment requests.(2) Analysis and comparison of practice data including demand and capacity to identify opportunities for improvement.(3) Online consultations. Qualitative and quantitative evaluation was undertaken.</p><p><strong>Results: </strong>Overall results were inconclusive and no one pilot scheme was overwhelmingly successful in improving patient experience of access or reducing practice workload. Scheme 1 telephone triage: In some cases, overall demand on clinician time through the day reduced as face-to-face consultations were replaced with shorter telephone consultations. However, in other practices, total consulting time went up when telephone consultations took longer than the suggested average 5 min. Scheme 2 practice analysis and benchmarking: The pilot practices implemented no significant changes. Scheme 3 online consultations: Take up was low, with users as a percentage of total list size dropping significantly to even lower levels in the second half of the pilot - from 3.13% in the first three months to 1.20% in the second three months.</p><p><strong>Conclusion: </strong>As the pilots did not improve the overall patient experience of access or practice workload, the pilot schemes were not rolled out by the CCG. From the CCG's point of view, it was valuable to test out the effect of a scheme before committing further resources.</p>","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"8 4","pages":"56-65"},"PeriodicalIF":0.0,"publicationDate":"2016-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2016.1173946","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34776157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What do patients really know? An evaluation of patients' physical activity guideline knowledge within general practice.","authors":"S Morton,&nbsp;D Thompson,&nbsp;P Wheeler,&nbsp;G Easton,&nbsp;A Majeed","doi":"10.1080/17571472.2016.1173939","DOIUrl":"https://doi.org/10.1080/17571472.2016.1173939","url":null,"abstract":"<p><strong>Background: </strong>Physical inactivity is well recognised as one of the leading causes of preventable death. However, little is known about the general public's knowledge surrounding national physical activity guidelines, particularly within general practice (GP).</p><p><strong>Setting: </strong>Two GPs (York and Maidenhead, UK).</p><p><strong>Question: </strong>Are GP patients aware of the national physical guidelines? Also, are health care professionals routinely raising the issue of physical inactivity and would patients welcome support from health care professionals regarding inactivity?</p><p><strong>Methodology: </strong>A questionnaire was distributed in two GPs over a one-week period to evaluate patients knowledge of the national physical activity guidelines.</p><p><strong>Results: </strong>Ninety-four participants completed the questionnaire over one week (60 female; 34 male), with an average age of 54.2 (standard deviation: 19.9 years). 14% (95% Confidence Interval (CI): 8-22%) of the total participants correctly knew the recommended national guidelines for physical activity. 52% (95% CI: 42-63%) recalled being asked by a health care professional about their activity levels. 46% (95% CI: 35-56%) would welcome support from a health care professional around improving their activity levels.</p><p><strong>Discussion/conclusion: </strong>Only 14% of responders correctly knew the current national minimum activity guidelines. Encouragingly 46% of participants in our study were interested in physical activity advice from a health care professional. Health care professionals need to be aware that many patients do not know the current physical activity guidelines and recognise that primary care may be an underutilised opportunity to educate and promote physical activity.</p>","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"8 4","pages":"48-55"},"PeriodicalIF":0.0,"publicationDate":"2016-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2016.1173939","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34776156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding Health Systems: from Sierra Leone to WONCA.","authors":"Luke Kane","doi":"10.1080/17571472.2016.1173428","DOIUrl":"https://doi.org/10.1080/17571472.2016.1173428","url":null,"abstract":"© 2016 The author(s). Published by informa uK Limited, trading as Taylor & francis Group. This is an open access article distributed under the terms of the Creative Commons attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. CONTACT Luke Kane Lukejpkane@gmail.com Why this matters to me As a GP trainee, I am trying to understand and learn about the health systems in which I am building my career. Constant change and political turbulence can make understanding the NHS a challenge but I feel it is important to persevere and work to gain a good conceptual framework of the health system in which you function. Whilst working in an Ebola treatment centre in Sierra Leone, an unexpected aspect of my role was helping to develop the process of how cases of possible Ebola virus infection were identified, isolated and treated. This was a crash course in understanding how a health system functions. Attending the WONCA Europe Conference in 2015 enabled me to further my understanding about how health systems work and gave context to how such systems change when new pressures are put upon them, for example, the primary care health system in Turkey dealing with Syrian refugees. This matters to me, and should matter to all of us, because GPs are well placed to contribute both clinically and by developing and strengthening health systems in times of crisis.","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"8 3","pages":"35-36"},"PeriodicalIF":0.0,"publicationDate":"2016-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2016.1173428","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34776151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}