BJGP Interviews

In this episode we talk to Dr Tom Margham who is a GP and Clinical Director at EQUIP (Enabling Quality Improvement in Practice) at Tower Hamlets Clinical Commissioning Group.

The title paper is: Reducing missed appointments in general practice: evaluation of a quality improvement programme in east London.

Read the paper: https://doi.org/10.3399/bjgp20X713909

Missed appointments (DNAs) in general practice reduce clinical capacity and waste money. Most research on reducing DNAs focus on changing patient behaviour to optimise the existing appointment system.

This study shows the impact of quality improvement coaching, including sharing appointment system data, among practices in one CCG. A case study illustrates how structural change to the appointment system can produce sustained reductions in DNA rates.

In this episode we talk to Dr Sarah Bailey who is a senior research fellow with the DISCO Cancer Diagnostics Group at the University of Exeter in the UK.

The title of the paper is: Association of non-malignant diseases with thrombocytosis: a prospective cohort study in general practice

Read the paper: https://doi.org/10.3399/bjgp20X713501

Thrombocytosis has recently emerged as a risk marker of undiagnosed cancer in patients in primary care. However, 89% of patients with thrombocytosis do not have undiagnosed cancer. This study estimates the link between thrombocytosis and non-malignant diseases. Primary care clinicians can use the results of this study as a clinical aid to look for and to diagnose associated diseases other than cancer in patients with thrombocytosis.

In this episode we talk to Dr Professor Alastair Hay from the Centre for Academic Primary Care, NIHR School for Primary Care Research, Bristol Medical School at the University of Bristol in the UK.

Editorial: Point-of-care testing for respiratory infections during and after COVID-19 by Hannah V Thornton, Tanzeela Khalid and Alastair D Hay

Read the editorial: https://doi.org/10.3399/bjgp20X713561

Alastair is an academic GP with a long interest in management of acute infections and the use of antibiotics in primary care and he leads a research group down in Bristol.

He talks about attitudes and understanding of COVID testing; point-of-care testing; recent research on multiviral testing; and the use of CRP and how it fits into clinical care. He also tells us the research he would like to do in the future to help move this area of clinical practice forward.

In this episode I am talking to Dr Emma Sowden about heart failure with preserved ejection fraction. Emma is a research associate at the NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, University of Manchester.

The title of the paper is: Understanding the management of heart failure with preserved ejection fraction: a qualitative multiperspective study

Read the paper: https://doi.org/10.3399/bjgp20X713477

The type of heart failure called heart failure with preserved ejection fraction (HFpEF) is more common in older people with multiple long-term conditions. Although it is increasing in prevalence, it lacks evidence-based treatments. Research is needed to understand how to improve the management of patients with the condition. This study aimed to develop a detailed understanding of the perspectives of patients (including some relatives/carers), as well as primary and secondary care clinicians to inform the development of an improved model of care. The study found there were difficulties surrounding the timely identification of HFpEF and a widespread lack of understanding and awareness of the condition, which had the potential to influence approaches to management.

There is a need to raise public and clinical awareness of HFpEF and develop a clear set of accepted practices concerning its management.

In this episode I am talking to Dr Bethany Bareham who is a research associate at the Population Health Sciences Institute at Newcastle University and she is funded by the School of Primary Care Research postdoctoral launching fellowship.

The title of her paper is: Managing older people’s perceptions of alcohol-related risk: a qualitative exploration in Northern English primary care

Read the paper: https://doi.org/10.3399/bjgp20X713405

Different types of information and experiences affect older people’s perceptions of alcohol's effects and their decisions for alcohol use. This study suggests that older people may struggle to recognise risks associated with drinking, unless ill health or screening results indicate that they may be experiencing alcohol-related harm. Older people's perceptions that their drinking is ‘sensible’, or where their health has become difficult for them to manage, are challenges to be navigated in supporting healthier decisions. Primary care practitioners can help older people to recognise individual risks and the potential benefits of making healthier drinking decisions to maintain their quality of life.

We talk to Dr Daniel Stow about research into end-of-life recognition in older people. Daniel is a Research Associate at the Population and Health Sciences Institute, Newcastle University. He is funded by the School of Primary Care Research postdoctoral launching fellowship.

Research title: Timing of GP end-of-life recognition in people aged ≥75 years: retrospective cohort study using data from primary healthcare records in England

Read the paper: https://doi.org/10.3399/bjgp20X713417

Identification of end of life can be challenging for clinicians, particularly in older people living with frailty. In this study, fewer than half of people aged ≥75 years who died had a code in their electronic health record (EHR) to suggest that their death was anticipated by their GP. End-of-life codes in EHRs were entered near to death (median 4 months prior). In the minority of older decedents (aged ≥75 years) for whom end of life was recognised, only a small proportion were on the palliative care register or had their preferences for place of care or death recorded.

Dr Sian Russell talks about research into the use of NEWS in care homes. Sian Russell is a postdoctoral research associate at the Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne.

Research title: Implementation of the National Early Warning Score in UK care homes: a qualitative evaluation

Read the paper: https://doi.org/10.3399/bjgp20X713069

Despite limited evidence for its feasibility and practicality, the National Early Warning Score (NEWS) is being implemented in community settings, such as care homes, and primary care. This evaluation of an implementation of NEWS in care homes in northern England adds to the growing debate on the use of NEWS in non-acute settings. Findings indicate that the implementation of NEWS in complex community settings, such as care homes, requires diligent and thoughtful planning. Communication with care home staff and health professionals, such as community nurses and GPs, should be ongoing during intervention development and implementation.

In this episode we talk to Professor Simon de Lusignan. He is Professor of Primary Care and Clinical Informatics at the Nuffield Department of Primary Health Care Sciences at the University of Oxford. Simon is Director of the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC). This is one of Europe's oldest sentinel systems. RCGP RSC has produced a weekly report of influenza, respiratory and other infections in primary care for over 50 years. RCGP RSC works closely with Public Health England (PHE) to report vaccine effectiveness.

Title: Excess mortality in the first COVID pandemic peak: cross-sectional analyses of the impact of age, sex, ethnicity, household size, and long-term conditions in people of known SARS-Cov-2 status in England

Read the paper: https://doi.org/10.3399/bjgp20X713393

The UK had one of the highest SARS-CoV-2 associated mortality rates, with >42,000 deaths during the first wave of infection. Concerns about excess mortality still exist in care homes and widening social inequality has been suggested as a possible associated factor. Published reports showing disparities in SARS- CoV-2 infection and its impact on ethnic and socioeconomic variables have not included data on household size or clinical risks. Results from this observational cohort study showed living in households of ≥9 occupants was associated with a fivefold increase in relative mortality in the general population. Among people with known SARS-CoV-2 status (clinical or virological diagnosis), male sex, population density, black ethnicity (compared to white), and people with long-term conditions or learning disabilities had a higher odds of mortality. These findings reinforce the importance of the need for risk reduction strategies to reduce ethnic disparities, the impact of large household size, and increased risk associated with long-term conditions and learning disability.

In this episode Dr Elizabeth Lovegrove talks about research into ACE inhibitors and ARBs and the risk they pose in pregnancy.

Pregnancy protection and pregnancies in women prescribed ACE inhibitors or ARBs: a cross-sectional study in primary care

Read the paper: https://doi.org/10.3399/bjgp20X712997

Exposure to angiotensin-converting enzyme inhibitors or angiotensin receptor blockers during pregnancy is associated with teratogenic risk to the fetus. This study shows that the recording of pre-pregnancy advice and contraception in women of childbearing age, who are prescribed such medicines, is suboptimal and a number of pregnancies occur in this population. As this may place women and their babies at risk of exposure to teratogens, there is a need for significant improvements in the care of these patients.

In this episode Dr Carol Sinnott talks about research into operational failures in primary care. She is a GP and a senior clinical research associate at the THIS Institute, University of Cambridge.

Operational failures and how they influence the work of GPs: A qualitative study in primary care

Read the paper: https://doi.org/10.3399/bjgp20X713009

Operational failures, defined as inadequacies or errors in the information, supplies, or equipment needed for patient care, are known to be highly consequential in hospital environments. This qualitative study shows that operational failures are also common and burdensome in UK primary care. Examples included problems in the supply of information to GPs from external healthcare providers, technology problems, and missing or broken equipment. These problems required what was termed ‘compensatory labour’ to address them. Although GPs’ compensatory labour usually resolved the problem more quickly in the short term than did redirecting failures to their source, it may in fact be counterproductive in the longer term by rendering invisible at system level the operational failures themselves and the possible improvement opportunities associated with them.