Pub Date : 2024-09-04DOI: 10.1101/2024.08.29.24312797
Arsenio Páez, David Nunan, Peter McCulloch, David Beard
Background The focus of clinical trials is typically interventions’ efficacy, or whether they attain their desired outcomes. Comparatively less attention is focused on understanding how or why interventions succeed, or fail to attain, those outcomes. This may be particularly important in trials of complex interventions such as surgery or physiotherapy, which are multifaceted and often tailored to individual participants, providers, or settings, increasing the potential for variations in intervention delivery and effects. The correspondence between the intervention that was planned and what was actually delivered in a trial is the intervention’s fidelity. Several benefits for high levels of intervention fidelity have been proposed. However, a lack of a uniform definition for fidelity and its key components may hinder intervention delivery in clinical trials and the translation of evidence-based interventions to clinical practice.
{"title":"The CONSIDER Intervention Fidelity Framework for Complex Interventions in Healthcare: A “Best-Fit” Framework Synthesis","authors":"Arsenio Páez, David Nunan, Peter McCulloch, David Beard","doi":"10.1101/2024.08.29.24312797","DOIUrl":"https://doi.org/10.1101/2024.08.29.24312797","url":null,"abstract":"<strong>Background</strong> The focus of clinical trials is typically interventions’ efficacy, or whether they attain their desired outcomes. Comparatively less attention is focused on understanding how or why interventions succeed, or fail to attain, those outcomes. This may be particularly important in trials of complex interventions such as surgery or physiotherapy, which are multifaceted and often tailored to individual participants, providers, or settings, increasing the potential for variations in intervention delivery and effects. The correspondence between the intervention that was planned and what was actually delivered in a trial is the intervention’s fidelity. Several benefits for high levels of intervention fidelity have been proposed. However, a lack of a uniform definition for fidelity and its key components may hinder intervention delivery in clinical trials and the translation of evidence-based interventions to clinical practice.","PeriodicalId":501023,"journal":{"name":"medRxiv - Primary Care Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142197524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-30DOI: 10.1101/2024.08.30.24312843
Abdul-Basit Abdul-Samed, Yasmin Jahan, Veronika Reichenberger, Ellen Barnie Peprah, Mary Pomaa Agyekum, Henry Lawson, Dina Balabanova, Tolib Mirzoev, Irene Agyepong
Background The prevalence of diabetes is rising rapidly across West Africa, posing a significant public health challenge. Effective diabetes management through accessible and quality primary healthcare is crucial, yet multiple barriers persist. This review aimed to synthesise the available evidence on factors influencing access, utilisation, and quality of diabetes primary care in West Africa.
{"title":"Improving Type II Diabetes Care in West Africa: A Scoping Review of Barriers, Facilitators and the Way Forward","authors":"Abdul-Basit Abdul-Samed, Yasmin Jahan, Veronika Reichenberger, Ellen Barnie Peprah, Mary Pomaa Agyekum, Henry Lawson, Dina Balabanova, Tolib Mirzoev, Irene Agyepong","doi":"10.1101/2024.08.30.24312843","DOIUrl":"https://doi.org/10.1101/2024.08.30.24312843","url":null,"abstract":"<strong>Background</strong> The prevalence of diabetes is rising rapidly across West Africa, posing a significant public health challenge. Effective diabetes management through accessible and quality primary healthcare is crucial, yet multiple barriers persist. This review aimed to synthesise the available evidence on factors influencing access, utilisation, and quality of diabetes primary care in West Africa.","PeriodicalId":501023,"journal":{"name":"medRxiv - Primary Care Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142197525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-26DOI: 10.1101/2024.08.26.24312573
Danielle Schoenaker, Elizabeth Lovegrove, Miriam Santer, Karen Matvienko-Sikar, Helen Carr, Nisreen A Alwan, Laura Kubelabo, Nathan Davies, Keith M Godfrey
Background: Preconception medical, behavioural and socioeconomic risk factors are common among people of reproductive age and can impact pregnancy and offspring outcomes. In line with clinical guidance, primary care practitioners are encouraged to support patients to manage and optimise their health prior to pregnancy. Due to barriers, including lack of time and resources, this support is not currently part of routine practice. Aim: As a first step towards the co-development of practical and realistic best practice guidance, this study aims to achieve consensus on a list of priority risk factors that can be used in general practice to guide opportunistic preconception care for patients of reproductive age. Methods: This study protocol was developed with a Public Advisory Group of people of reproductive age, researchers and primary care practitioners. The consensus study will consist of three steps: 1) identifying an initial long-list of candidate risk factors and defining principles for scoring the importance of each risk factor, through a literature review, workshops with people of reproductive age, and interviews with primary care practitioners; 2) stakeholder participant prioritisation of each candidate risk factor for its importance for preconception care through a three-round eDelphi survey; and 3) agreeing on the final priority list through consensus meetings with a selected group of stakeholders. Participants living in the UK will be recruited across two stakeholder groups: people of reproductive age (through the Public Advisory Group and charities) and primary care professionals (through professional organisations). Ethical approval: This study has been approved by the University of Southampton Faculty of Medicine Ethics Committee (ERGO 83699 and 92950). Dissemination: All study findings will be shared through stakeholder participants, peer-reviewed publication, lay summary, meetings and conference presentations, and relevant professional and community organisations. Ongoing research will inform implementation of the priority list in clinical practice.
{"title":"Developing consensus on priorities for preconception care in the general practice setting in the UK: study protocol","authors":"Danielle Schoenaker, Elizabeth Lovegrove, Miriam Santer, Karen Matvienko-Sikar, Helen Carr, Nisreen A Alwan, Laura Kubelabo, Nathan Davies, Keith M Godfrey","doi":"10.1101/2024.08.26.24312573","DOIUrl":"https://doi.org/10.1101/2024.08.26.24312573","url":null,"abstract":"Background: Preconception medical, behavioural and socioeconomic risk factors are common among people of reproductive age and can impact pregnancy and offspring outcomes. In line with clinical guidance, primary care practitioners are encouraged to support patients to manage and optimise their health prior to pregnancy. Due to barriers, including lack of time and resources, this support is not currently part of routine practice. Aim: As a first step towards the co-development of practical and realistic best practice guidance, this study aims to achieve consensus on a list of priority risk factors that can be used in general practice to guide opportunistic preconception care for patients of reproductive age.\u0000Methods: This study protocol was developed with a Public Advisory Group of people of reproductive age, researchers and primary care practitioners. The consensus study will consist of three steps: 1) identifying an initial long-list of candidate risk factors and defining principles for scoring the importance of each risk factor, through a literature review, workshops with people of reproductive age, and interviews with primary care practitioners; 2) stakeholder participant prioritisation of each candidate risk factor for its importance for preconception care through a three-round eDelphi survey; and 3) agreeing on the final priority list through consensus meetings with a selected group of stakeholders. Participants living in the UK will be recruited across two stakeholder groups: people of reproductive age (through the Public Advisory Group and charities) and primary care professionals (through professional organisations).\u0000Ethical approval: This study has been approved by the University of Southampton Faculty of Medicine Ethics Committee (ERGO 83699 and 92950).\u0000Dissemination: All study findings will be shared through stakeholder participants, peer-reviewed publication, lay summary, meetings and conference presentations, and relevant professional and community organisations. Ongoing research will inform implementation of the priority list in clinical practice.","PeriodicalId":501023,"journal":{"name":"medRxiv - Primary Care Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142197526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-22DOI: 10.1101/2024.08.22.24312420
Caroline McCarthy, Patrick Moynagh, Aine Mannion, Ashley Wei, Barbara Clyne, Frank Moriarty
Background Rising levels of both high-risk and low-value prescribing have the potential for adverse effects on patients, healthcare systems and society. It is thus necessary to develop effective and cost-effective interventions to support safe, effective and cost-effective prescribing. Advancements in technology, including machine learning coupled with the vast amounts of routine prescribing data available in primary care have supported the development of novel approaches to provide prescribers with ongoing and comparative prescribing data feedback. This systematic review aimed to explore the characteristics of interactive dashboard interventions in primary care that provide visual and longitudinal feedback on prescription data and to explore the effect of these interventions on prescribing-related outcome measures. Methods and Findings This systematic review was registered prospectively and reported in line with PRISMA guidelines. Multiple databases and grey literature were searched in November 2023 to identify interventional studies, including quasi-experimental designs that explored the effect of interactive dashboards on prescribing-related outcomes in primary care. Identified records were assessed for inclusion and data extraction and risk of bias assessment were completed by two independent researchers. Interventions characteristics and effects were described narratively. A meta‐analysis using a random‐effects model was performed where at least two studies were comparable in terms of participants, study design and outcomes. Twelve studies, reported across eleven different papers were included, eight randomised controlled trials, one controlled before and after study and three interrupted time series analyses. Nine papers were assessed to be of low risk of bias. Six studies reported a significant effect on prescribing-related outcomes, with an effect seen more often for studies focusing on potentially inappropriate or high-risk prescribing (four out of six studies). Two of the six studies that focused on antibiotic prescribing demonstrated a significant effect. A meta-analysis of three RCTs involving 406 general practices and 337,963 patients demonstrated the overall odds of having at least one potentially inappropriate prescription was 0.87 (95% CI 0.81 to 0.93 I2 =0.0%) in the intervention compared to control group. Conclusion Interactive dashboards have the potential to support safe and effective prescribing in primary care. To support their implementation, it is essential to establish the necessary data infrastructure within primary cares systems. This encompasses electronic health records (EHR) systems, data integration tools, analytics platforms, and compliance with data privacy regulations, all working together to facilitate the efficient use of data for improving prescribing and ultimately patient care.
{"title":"Effectiveness of interactive dashboards to optimise prescribing in primary care: A systematic review","authors":"Caroline McCarthy, Patrick Moynagh, Aine Mannion, Ashley Wei, Barbara Clyne, Frank Moriarty","doi":"10.1101/2024.08.22.24312420","DOIUrl":"https://doi.org/10.1101/2024.08.22.24312420","url":null,"abstract":"Background Rising levels of both high-risk and low-value prescribing have the potential for adverse effects on patients, healthcare systems and society. It is thus necessary to develop effective and cost-effective interventions to support safe, effective and cost-effective prescribing. Advancements in technology, including machine learning coupled with the vast amounts of routine prescribing data available in primary care have supported the development of novel approaches to provide prescribers with ongoing and comparative prescribing data feedback. This systematic review aimed to explore the characteristics of interactive dashboard interventions in primary care that provide visual and longitudinal feedback on prescription data and to explore the effect of these interventions on prescribing-related outcome measures. Methods and Findings\u0000This systematic review was registered prospectively and reported in line with PRISMA guidelines. Multiple databases and grey literature were searched in November 2023 to identify interventional studies, including quasi-experimental designs that explored the effect of interactive dashboards on prescribing-related outcomes in primary care. Identified records were assessed for inclusion and data extraction and risk of bias assessment were completed by two independent researchers. Interventions characteristics and effects were described narratively. A meta‐analysis using a random‐effects model was performed where at least two studies were comparable in terms of participants, study design and outcomes. Twelve studies, reported across eleven different papers were included, eight randomised controlled trials, one controlled before and after study and three interrupted time series analyses. Nine papers were assessed to be of low risk of bias. Six studies reported a significant effect on prescribing-related outcomes, with an effect seen more often for studies focusing on potentially inappropriate or high-risk prescribing (four out of six studies). Two of the six studies that focused on antibiotic prescribing demonstrated a significant effect. A meta-analysis of three RCTs involving 406 general practices and 337,963 patients demonstrated the overall odds of having at least one potentially inappropriate prescription was 0.87 (95% CI 0.81 to 0.93 I2 =0.0%) in the intervention compared to control group.\u0000Conclusion\u0000Interactive dashboards have the potential to support safe and effective prescribing in primary care. To support their implementation, it is essential to establish the necessary data infrastructure within primary cares systems. This encompasses electronic health records (EHR) systems, data integration tools, analytics platforms, and compliance with data privacy regulations, all working together to facilitate the efficient use of data for improving prescribing and ultimately patient care.","PeriodicalId":501023,"journal":{"name":"medRxiv - Primary Care Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142197528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-22DOI: 10.1101/2024.08.21.24312365
Lisa Bailey-Davis, Carolyn F McCabe, Chengpeng Zeng, Karissa L Peyer, Samuel S. Gidding, Adam Cook, G. Craig Wood, Jennifer Franceschelli-Hosterman, Shuping Ge, Gregory J Welk
Objectives and Background: This study explores the potential moderating influence of Family Nutrition and Physical Activity (FNPA) behavior scores on reducing hypertension incidence associated with overweight changes during childhood. Methods: A longitudinal design was used to explore associations between childrens FNPA scores and overweight status change (when ages 3-9 years) on hypertension during latter childhood and adolescence (ages 9-18 years). Data were obtained from well-child visits. Participants were classified into 3 by 3 subgroups by FNPA score (low, moderate, high) and overweight status (loss, stable, gain). Cox proportional hazards models were used to estimate hazard ratios of hypertension development with the moderate FNPA score X overweight stable reference group. Results: Among 3808 participants, 58% were publicly insured. Among participants who gained overweight during childhood, 41.7% developed hypertension compared to 29.9% who were overweight stable and 27.3% who lost overweight (P <0.001). After accounting for confounders, participants who gained vs. maintained overweight had 2.01 (95% CI 1.65-2.44) times higher hypertension risk. Although FNPA scores were not associated with hypertension incidence, the interaction term between a high FNPA and overweight gain was significant (P = 0.01). Among children who gained, hazard ratios for hypertension among low, moderate, and high FNPA groups were estimated at 1.99 (95% CI 0.98-4.05), 2.01 (95% CI 1.64-2.44), 1.54 (95% CI 0.71-3.34), respectively. Conclusions: FNPA screening can inform preventive counseling about healthy home environments. Behaviors associated with high FNPA scores potentially reduce hypertension risk among children who experience overweight gain by approximately 25%.
目的和背景：本研究探讨了家庭营养和体育活动（FNPA）行为评分对降低与儿童期超重变化相关的高血压发病率的潜在调节作用。研究方法采用纵向设计，探讨儿童 FNPA 分数和超重状况变化（3-9 岁时）对儿童后期和青春期（9-18 岁）高血压的影响。数据来自儿童健康检查。根据 FNPA 分数（低、中、高）和超重状况（减轻、稳定、加重）将参与者分为 3 个亚组。采用 Cox 比例危险模型估算 FNPA 中度分值 X 超重稳定参照组患高血压的危险比。结果显示在 3808 名参与者中，有 58% 参加了公共保险。在儿童期体重增加的参与者中，41.7%的人患上了高血压，相比之下，29.9%的人体重稳定，27.3%的人体重减轻（P <0.001）。在考虑了混杂因素后，体重增加与保持超重的参与者患高血压的风险相差2.01倍（95% CI 1.65-2.44）。虽然 FNPA 分数与高血压发病率无关，但高 FNPA 与超重增加之间的交互项具有显著性（P = 0.01）。在体重增加的儿童中，低、中、高 FNPA 组的高血压危险比估计分别为 1.99（95% CI 0.98-4.05）、2.01（95% CI 1.64-2.44）、1.54（95% CI 0.71-3.34）。结论FNPA 筛查可为有关健康家庭环境的预防咨询提供依据。与 FNPA 高分相关的行为可将超重儿童患高血压的风险降低约 25%。
{"title":"Weight-Related Hypertension in Youth: Evaluation of Family Nutrition and Physical Activity Tool","authors":"Lisa Bailey-Davis, Carolyn F McCabe, Chengpeng Zeng, Karissa L Peyer, Samuel S. Gidding, Adam Cook, G. Craig Wood, Jennifer Franceschelli-Hosterman, Shuping Ge, Gregory J Welk","doi":"10.1101/2024.08.21.24312365","DOIUrl":"https://doi.org/10.1101/2024.08.21.24312365","url":null,"abstract":"Objectives and Background: This study explores the potential moderating influence of Family Nutrition and Physical Activity (FNPA) behavior scores on reducing hypertension incidence associated with overweight changes during childhood. Methods: A longitudinal design was used to explore associations between childrens FNPA scores and overweight status change (when ages 3-9 years) on hypertension during latter childhood and adolescence (ages 9-18 years). Data were obtained from well-child visits. Participants were classified into 3 by 3 subgroups by FNPA score (low, moderate, high) and overweight status (loss, stable, gain). Cox proportional hazards models were used to estimate hazard ratios of hypertension development with the moderate FNPA score X overweight stable reference group. Results: Among 3808 participants, 58% were publicly insured. Among participants who gained overweight during childhood, 41.7% developed hypertension compared to 29.9% who were overweight stable and 27.3% who lost overweight (P <0.001). After accounting for confounders, participants who gained vs. maintained overweight had 2.01 (95% CI 1.65-2.44) times higher hypertension risk. Although FNPA scores were not associated with hypertension incidence, the interaction term between a high FNPA and overweight gain was significant (P = 0.01). Among children who gained, hazard ratios for hypertension among low, moderate, and high FNPA groups were estimated at 1.99 (95% CI 0.98-4.05), 2.01 (95% CI 1.64-2.44), 1.54 (95% CI 0.71-3.34), respectively. Conclusions: FNPA screening can inform preventive counseling about healthy home environments. Behaviors associated with high FNPA scores potentially reduce hypertension risk among children who experience overweight gain by approximately 25%.","PeriodicalId":501023,"journal":{"name":"medRxiv - Primary Care Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142197527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-21DOI: 10.1101/2024.08.21.24312333
Gayasha Batheegama Gamarachchige, Elizabeth Ford, Jo Armes, Sotiris Moschoyiannis, Michelle Collins, Patrick Francsics, Agnieszka Lemanska
Background: Primary care data in the UK are widely used for cancer research, but the reliability of recording key events such as diagnoses remains uncertain. Data linkage can mitigate these uncertainties; however, researchers may avoid linkage due to high costs, tight timelines, and sample size limitations. Hence, this study aimed to assess the quality of prostate cancer (PCa) diagnoses in primary care. We utilised Clinical Practice Research Datalink (CPRD) primary care data linked to National Cancer Registration and Analysis Service (NCRAS) and Hospital Episode Statistics (HES) in England. We compared accuracy, completeness, and timing of diagnosis recording between sources to facilitate decision-making regarding data source selection for future research. Methods: Incident PCa diagnoses (2000-2016) for males aged ≥46 years recorded in at least one study data source were examined. The accuracy of a data source was estimated by the proportion of diagnoses recorded in the specific source that was also confirmed by any linked source. Completeness was estimated by identifying the proportion of all diagnoses in linked sources with a matching diagnosis in the specific source. Results: The study included 51,487 PCa patients from either source. CPRD demonstrated 86.9% accuracy and 68.2% completeness against NCRAS and 75.1% accuracy and 61.1% completeness against HES. Overall, CPRD showed the highest accuracy (93%) but the lowest completeness (60.7%). Diagnosis dates in CPRD were more concordant with NCRAS (90.6% within 6 months) than with HES (61.2%). Over time, accuracy and completeness improved, especially after 2004. Discrepancies in diagnosis dates revealed a median delay of 2 weeks in CPRD than NCRAS and 1 week than HES. CPRD Aurum exhibited better quality compared to GOLD. Conclusions: While the accuracy of PCa diagnoses in CPRD compared to linked sources was high, completeness was low. Therefore, linking to HES or NCRAS should be considered for improved case capture, acknowledging their inherent limitations.
{"title":"Evaluating the quality of prostate cancer diagnosis recording in routinely collected primary care data for observational research: A study using multiple linked English electronic health records databases","authors":"Gayasha Batheegama Gamarachchige, Elizabeth Ford, Jo Armes, Sotiris Moschoyiannis, Michelle Collins, Patrick Francsics, Agnieszka Lemanska","doi":"10.1101/2024.08.21.24312333","DOIUrl":"https://doi.org/10.1101/2024.08.21.24312333","url":null,"abstract":"Background: Primary care data in the UK are widely used for cancer research, but the reliability of recording key events such as diagnoses remains uncertain. Data linkage can mitigate these uncertainties; however, researchers may avoid linkage due to high costs, tight timelines, and sample size limitations. Hence, this study aimed to assess the quality of prostate cancer (PCa) diagnoses in primary care. We utilised Clinical Practice Research Datalink (CPRD) primary care data linked to National Cancer Registration and Analysis Service (NCRAS) and Hospital Episode Statistics (HES) in England. We compared accuracy, completeness, and timing of diagnosis recording between sources to facilitate decision-making regarding data source selection for future research. Methods: Incident PCa diagnoses (2000-2016) for males aged ≥46 years recorded in at least one study data source were examined. The accuracy of a data source was estimated by the proportion of diagnoses recorded in the specific source that was also confirmed by any linked source. Completeness was estimated by identifying the proportion of all diagnoses in linked sources with a matching diagnosis in the specific source. Results: The study included 51,487 PCa patients from either source. CPRD demonstrated 86.9% accuracy and 68.2% completeness against NCRAS and 75.1% accuracy and 61.1% completeness against HES. Overall, CPRD showed the highest accuracy (93%) but the lowest completeness (60.7%). Diagnosis dates in CPRD were more concordant with NCRAS (90.6% within 6 months) than with HES (61.2%). Over time, accuracy and completeness improved, especially after 2004. Discrepancies in diagnosis dates revealed a median delay of 2 weeks in CPRD than NCRAS and 1 week than HES. CPRD Aurum exhibited better quality compared to GOLD. Conclusions: While the accuracy of PCa diagnoses in CPRD compared to linked sources was high, completeness was low. Therefore, linking to HES or NCRAS should be considered for improved case capture, acknowledging their inherent limitations.","PeriodicalId":501023,"journal":{"name":"medRxiv - Primary Care Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142197529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-20DOI: 10.1101/2024.08.14.24311940
Eddie Donaghy, Kieran D Sweeney, Lauren Ng, Hollie Haines, Alexandra Thompson, David Henderson, Harry H.X. Wang, Andrew Thompson, Bruce Guthrie, Stewart W Mercer
Objectives The new general practitioner (GP) contract for Scotland, introduced in 2018, established GP Clusters and expanded multidisciplinary team (MDT) working. This paper compares the views of GPs in Scotland regarding the new contract, their working lives, and career intentions in 2018 and 2023. Methods Cross-sectional postal survey of all qualified GPs in Scotland in late 2023 exploring views on Cluster working, MDT-expansion, their working lives, and career intentions, compared with a similar survey from 2018. Results Job pressure was significantly higher in 2023 than 2018, but overall job satisfaction and negative job attributes were unchanged, while positive job attributes improved. More GPs were planning to reduce their hours and leave direct patient care in 2023 than 2018. Quality leads views on Cluster working were unchanged, with 70-80% reporting insufficient support in both surveys. Cluster knowledge and engagement was unchanged but all GPs showed small but significant increases in understanding of quality improvement. Most felt MDT expansion was insufficient to reduce workload and fewer GPs reported giving longer consultations for complex patients in 2023 than 2018. Significantly more practices were trying to recruit GPs in 2023, and GPs reported worsening NHS services, higher workload, and lower practice sustainability. Only 1 in 20 GPs in the 2023 survey thought that the new contract had improved the care of patients with multimorbidity. Conclusions GPs report few improvements in working life five years after the new contract was introduced, and are responding by planning to reduce their hours or leave direct patient care.
{"title":"Primary care transformation in Scotland: a comparison two cross-sectional national surveys of general practitioners views in 2018 and 2023","authors":"Eddie Donaghy, Kieran D Sweeney, Lauren Ng, Hollie Haines, Alexandra Thompson, David Henderson, Harry H.X. Wang, Andrew Thompson, Bruce Guthrie, Stewart W Mercer","doi":"10.1101/2024.08.14.24311940","DOIUrl":"https://doi.org/10.1101/2024.08.14.24311940","url":null,"abstract":"Objectives\u0000The new general practitioner (GP) contract for Scotland, introduced in 2018, established GP Clusters and expanded multidisciplinary team (MDT) working. This paper compares the views of GPs in Scotland regarding the new contract, their working lives, and career intentions in 2018 and 2023.\u0000Methods\u0000Cross-sectional postal survey of all qualified GPs in Scotland in late 2023 exploring views on Cluster working, MDT-expansion, their working lives, and career intentions, compared with a similar survey from 2018.\u0000Results\u0000Job pressure was significantly higher in 2023 than 2018, but overall job satisfaction and negative job attributes were unchanged, while positive job attributes improved. More GPs were planning to reduce their hours and leave direct patient care in 2023 than 2018. Quality leads views on Cluster working were unchanged, with 70-80% reporting insufficient support in both surveys. Cluster knowledge and engagement was unchanged but all GPs showed small but significant increases in understanding of quality improvement. Most felt MDT expansion was insufficient to reduce workload and fewer GPs reported giving longer consultations for complex patients in 2023 than 2018. Significantly more practices were trying to recruit GPs in 2023, and GPs reported worsening NHS services, higher workload, and lower practice sustainability. Only 1 in 20 GPs in the 2023 survey thought that the new contract had improved the care of patients with multimorbidity.\u0000Conclusions\u0000GPs report few improvements in working life five years after the new contract was introduced, and are responding by planning to reduce their hours or leave direct patient care.","PeriodicalId":501023,"journal":{"name":"medRxiv - Primary Care Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142197530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background The value of pharmaceutical services for Chinese patients with cardiovascular chronic conditions was not recognized. Aim To investigate the comprehensive value of pharmaceutical services in China and find factors influencing patient benefits. Design and setting This was a systematic review with multilevel meta-analysis of 183 randomized control trials focusing on the benefits of pharmaceutical services for patients with cardiovascular chronic conditions in China. Methods English databases (PubMed, EMBASE, the Cochrane Library) and Chinese databases (China National Knowledge Infrastructure, WanFang database) were searched from database inception to March 27, 2023 for studies focusing on the comparation of benefits between pharmaceutical services and usual care. Results Our analysis of 187 studies involving 23,895 patients demonstrated significant benefits of pharmaceutical services, particularly in reducing readmission (OR: 0.32; 95%CI: 0.2 to 0.52; I2=50.12%), mitigating ADR (OR: 0.28; 95%CI: 0.24 to 0.33; I2=18.07%), and improving patient adherence. However, no benefit was observed in terms of mortality rate and the cost of hospitalization and medication and the risk of bias was generally existed among the included studies. Conclusions This study highlights the significant benefits of pharmaceutical services for clinical outcomes and adherence among Chinese patients with cardiovascular chronic conditions. However, the benefits in terms of economic outcomes remain unclear. The influence of population-specific factors, such as disease and age, underscores the need for context-specific and disease-tailored studies to provide precise evidence regarding the advantages of pharmaceutical services. And our findings provide some new ideas for the subsequent research and design, standard formulation and policy implementation.
{"title":"Could Chinese cardiovascular chronic conditions patients gain benefits from pharmaceutical services? A multilevel meta-analysis","authors":"Zhijie Deng, Fanglu Chen, Shunshun Peng, Yangjin Huang, Jing Chen, Yufeng Ding, Anhua Wei","doi":"10.1101/2024.07.25.24310734","DOIUrl":"https://doi.org/10.1101/2024.07.25.24310734","url":null,"abstract":"Background\u0000The value of pharmaceutical services for Chinese patients with cardiovascular chronic conditions was not recognized.\u0000Aim\u0000To investigate the comprehensive value of pharmaceutical services in China and find factors influencing patient benefits.\u0000Design and setting\u0000This was a systematic review with multilevel meta-analysis of 183 randomized control trials focusing on the benefits of pharmaceutical services for patients with cardiovascular chronic conditions in China.\u0000Methods\u0000English databases (PubMed, EMBASE, the Cochrane Library) and Chinese databases (China National Knowledge Infrastructure, WanFang database) were searched from database inception to March 27, 2023 for studies focusing on the comparation of benefits between pharmaceutical services and usual care.\u0000Results\u0000Our analysis of 187 studies involving 23,895 patients demonstrated significant benefits of pharmaceutical services, particularly in reducing readmission (OR: 0.32; 95%CI: 0.2 to 0.52; I2=50.12%), mitigating ADR (OR: 0.28; 95%CI: 0.24 to 0.33; I2=18.07%), and improving patient adherence. However, no benefit was observed in terms of mortality rate and the cost of hospitalization and medication and the risk of bias was generally existed among the included studies.\u0000Conclusions\u0000This study highlights the significant benefits of pharmaceutical services for clinical outcomes and adherence among Chinese patients with cardiovascular chronic conditions. However, the benefits in terms of economic outcomes remain unclear. The influence of population-specific factors, such as disease and age, underscores the need for context-specific and disease-tailored studies to provide precise evidence regarding the advantages of pharmaceutical services. And our findings provide some new ideas for the subsequent research and design, standard formulation and policy implementation.","PeriodicalId":501023,"journal":{"name":"medRxiv - Primary Care Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141770657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-19DOI: 10.1101/2024.07.19.24310681
Fiona FJ Ng, Rashmi Verma, Levana Sani, Astrid Irwanto, Michael Lee, Angeline Wee, Shih Kiat Chng, Melvyn Wong, Alexandre Chan
Background: In view of the limited data related to preemptive pharmacogenomics (PGx) testing in the primary care setting, we designed a study to assess the feasibility of implementing preemptive PGx services at outpatient clinics, with the aim to assess the practicality and challenges of implementing preemptive PGx testing within primary care, and its impact on clinical workflows and patient care. Methods: This prospective study was conducted between October 2022 and August 2023 at five outpatient clinics located in Singapore. Patients aged 21 to 65 with a reported history or risk of developing any of the target chronic conditions or any patients receiving one of the 29 PGx-associated medications were recruited. Patients' buccal samples were processed using the Nala RxReady, a multi-gene qPCR-based panel of 21 allele variants of five pharmacogenes. Surveys were administered to study participants and clinicians to assess their perceptions and outcomes related to PGx testing. Results: Among the 222 patients, 95% had at least one clinically actionable variant. Of these patients, 113 reported taking at least one of the 29 studied drugs, with 21.2% of them receiving at least one clinically actionable recommendation based on their PGx results. A total of 150 patients (67.6%) participated in the post-test follow-up survey. Among them, 70% expressed feeling relieved and happy upon receiving their test reports and reported increased confidence in taking their prescribed medication. Furthermore, clinicians identified the necessity for clearer legal regulations regarding PGx testing and insurance coverage to enhance future adoption of PGx testing. Conclusions: Given a high prevalence of clinically actionable variants in almost all tested patients, this study underscores the feasibility and clinical benefits of preemptive PGx testing in primary care clinics.
{"title":"Implementation of Pre-emptive Pharmacogenomics Testing in Outpatient Clinics in Asia (IMPT study)","authors":"Fiona FJ Ng, Rashmi Verma, Levana Sani, Astrid Irwanto, Michael Lee, Angeline Wee, Shih Kiat Chng, Melvyn Wong, Alexandre Chan","doi":"10.1101/2024.07.19.24310681","DOIUrl":"https://doi.org/10.1101/2024.07.19.24310681","url":null,"abstract":"Background: In view of the limited data related to preemptive pharmacogenomics (PGx) testing in the primary care setting, we designed a study to assess the feasibility of implementing preemptive PGx services at outpatient clinics, with the aim to assess the practicality and challenges of implementing preemptive PGx testing within primary care, and its impact on clinical workflows and patient care.\u0000Methods: This prospective study was conducted between October 2022 and August 2023 at five outpatient clinics located in Singapore. Patients aged 21 to 65 with a reported history or risk of developing any of the target chronic conditions or any patients receiving one of the 29 PGx-associated medications were recruited. Patients' buccal samples were processed using the Nala RxReady, a multi-gene qPCR-based panel of 21 allele variants of five pharmacogenes. Surveys were administered to study participants and clinicians to assess their perceptions and outcomes related to PGx testing. Results: Among the 222 patients, 95% had at least one clinically actionable variant. Of these patients, 113 reported taking at least one of the 29 studied drugs, with 21.2% of them receiving at least one clinically actionable recommendation based on their PGx results. A total of 150 patients (67.6%) participated in the post-test follow-up survey. Among them, 70% expressed feeling relieved and happy upon receiving their test reports and reported increased confidence in taking their prescribed medication. Furthermore, clinicians identified the necessity for clearer legal regulations regarding PGx testing and insurance coverage to enhance future adoption of PGx testing.\u0000Conclusions: Given a high prevalence of clinically actionable variants in almost all tested patients, this study underscores the feasibility and clinical benefits of preemptive PGx testing in primary care clinics.","PeriodicalId":501023,"journal":{"name":"medRxiv - Primary Care Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141739375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-10DOI: 10.1101/2024.07.10.24310207
Roel van Straalen, Michiel de Boer, Francine Vos, Paul Werker, Dieuwke Broekstra
Background The focus of research and management of Dupuytrens disease (DD) is shifting from relieving symptoms in the later stages of disease towards the prevention of contractures. Treatment services might likewise shift towards primary care. Studying characteristics of DD patients who seek medical care for the first time, may identify a symptomatic target group for early DD treatments. We present the first study that estimates the incidence and prevalence of DD in primary care by applying a text-mining algorithm to registration data. Methods This is a population-based cohort study using electronic health records from Dutch general practices involved in a regional research network. Descriptive statistics were used to describe sex, age, comorbidities and lifestyle factors, the latter two were identified via International Classification of Primary Care (ICPC) codes. Incidence rate was calculated as number of patients with a first contact for DD/1000 person years for the years 2017 to 2021, point prevalence as the percentage of patients with a contact for DD in 2021. DD contacts were identified using a text-mining algorithm. Results The incidence ranged between 1.41 to 1.72/1000 person years and the overall prevalence was 1.99%. Incidence and prevalence are higher among males and increase with age, peaking between 61 to 80 years. Conclusions Our results of prevalence and incidence of DD in primary care give an insight into the relevant population of patients with symptomatic DD that might be the future target group for potential disease controlling treatments.
{"title":"The incidence and prevalence of Dupuytren disease in primary care: Results from a text-mining approach on registration data.","authors":"Roel van Straalen, Michiel de Boer, Francine Vos, Paul Werker, Dieuwke Broekstra","doi":"10.1101/2024.07.10.24310207","DOIUrl":"https://doi.org/10.1101/2024.07.10.24310207","url":null,"abstract":"Background\u0000The focus of research and management of Dupuytrens disease (DD) is shifting from relieving symptoms in the later stages of disease towards the prevention of contractures. Treatment services might likewise shift towards primary care. Studying characteristics of DD patients who seek medical care for the first time, may identify a symptomatic target group for early DD treatments. We present the first study that estimates the incidence and prevalence of DD in primary care by applying a text-mining algorithm to registration data. Methods\u0000This is a population-based cohort study using electronic health records from Dutch general practices involved in a regional research network. Descriptive statistics were used to describe sex, age, comorbidities and lifestyle factors, the latter two were identified via International Classification of Primary Care (ICPC) codes. Incidence rate was calculated as number of patients with a first contact for DD/1000 person years for the years 2017 to 2021, point prevalence as the percentage of patients with a contact for DD in 2021. DD contacts were identified using a text-mining algorithm. Results\u0000The incidence ranged between 1.41 to 1.72/1000 person years and the overall prevalence was 1.99%. Incidence and prevalence are higher among males and increase with age, peaking between 61 to 80 years. Conclusions\u0000Our results of prevalence and incidence of DD in primary care give an insight into the relevant population of patients with symptomatic DD that might be the future target group for potential disease controlling treatments.","PeriodicalId":501023,"journal":{"name":"medRxiv - Primary Care Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141587640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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