General Practitioner Appointments Research Articles

Importance of GP contact on readmission rate following psychiatric acute care: A Danish Nationwide study

Insufficient acute psychiatric care substantially impacts patient well-being and healthcare quality. Early readmissions after discharge from psychiatric care are common, and preventing these is important for the patients as well as appropriate resource allocation. The relationship between post-discharge general practitioner (GP) contact and readmission rates remains to be explored, as does the association between pre-hospital GP contact and post-discharge engagement. AimThis study examines post-discharge GP contact and its association with outpatient revisits and inpatient readmissions among unplanned psychiatric hospital contacts, including the impact of pre-visit GP contact on post-discharge care within 14 days. MethodsUtilizing data from the Danish healthcare system (2019–2023), unplanned psychiatric hospital contacts and subsequent 14-day GP encounters were analyzed. ResultsOf 298,085 unplanned psychiatric hospital contacts, 12.6% had a 14-day revisit as an outpatient and 13.6% had a 14-day readmission as an inpatient. During regular business hours, GP contact was associated with a decreased risk of unplanned outpatient revisits (HR 0.45, 95% CI 0.44–0.47) and inpatient readmissions (HR 0.43, 95% CI 0.41–0.44). Similarly, utilizing GP on-call services was linked to a reduced risk of unplanned revisits (HR 0.87, 95% CI 0.81–0.94) and readmissions (HR 0.81, 95% CI 0.76–0.87). Having a GP contact within two days before an unplanned psychiatric hospital contact increased the likelihood of having a GP contact within 14 days post-discharge. ConclusionPost-discharge GP encounters were associated with lower rates of 14-day outpatient revisits and inpatient readmissions following unplanned psychiatric hospital contacts. GP contact before psychiatric hospital contact enhances attendance at post-discharge appointments, suggesting a potential efficacy of promoting GP appointments for mental health care.

Association between emergency department attendances, sociodemographic factors and long-term health conditions in the population of Norfolk and Waveney, England: Cross sectional study.

Demand for urgent and emergency health care in England has grown over the last decade, for reasons that are not clear. Changes in population demographics may be a cause. This study investigated associations between individuals' characteristics (including socioeconomic deprivation and long term health conditions (LTC)) and the frequency of emergency department (ED) attendances, in the Norfolk and Waveney subregion of the East of England. The study population was people who were registered with 91 of 106 Norfolk and Waveney general practices during one year from 1 April 2022 to 31 March 2023. Linked primary and secondary care and geographical data included each individual's sociodemographic characteristics, and number of ED attendances during the same year and, for some individuals, LTCs and number of general practice (GP) appointments. Associations between these factors and ED attendances were estimated using Poisson regression models. 1,027,422 individuals were included of whom 57.4% had GP data on the presence or absence of LTC, and 43.1% had both LTC and general practitioner appointment data. In the total population ED attendances were more frequent in individuals aged under five years, (adjusted Incidence Rate Ratio (IRR) 1.25, 95% confidence interval 1.23 to 1.28) compared to 15-35 years); living in more socioeconomically deprived areas (IRR 0.61 (0.60 to 0.63)) for least deprived compared to most deprived,and living closer to the nearest ED. Among individuals with LTC data, each additional LTC was also associated with increased ED attendances (IRR 1.16 (1.15 to 1.16)). Among individuals with LTC and GP appointment data, each additional GP appointment was also associated with increased ED attendances (IRR 1.03 (1.026 to 1.027)). In the Norfolk and Waveney population, ED attendance rates were higher for young children and individuals living in more deprived areas and closer to EDs. In individuals with LTC and GP appointment data, both factors were also associated with higher ED attendance.

Association of antenatal or neonatal SARS-COV-2 exposure with developmental and respiratory outcomes, and healthcare usage in early childhood: a national prospective cohort study

Perinatal exposure to SARS-CoV-2 may affect neurodevelopment before 12 months of age, but longer-term outcomes remain unknown. We examined whether antenatal or neonatal SARS-CoV-2 exposure compared with non-exposure is associated with neurodevelopment, respiratory symptoms, and health care usage in early childhood. This prospective national population-based cohort study was conducted in England and Wales, United Kingdom. We enrolled term-born children (≥37 weeks' gestation) with and without antenatal or neonatal exposure to SARS-CoV-2 infection by approaching parents of eligible children who were cared for in 87 NHS hospitals. Potential participants were identified through the national active surveillance studies of pregnant women and newborn infants hospitalised with confirmed SARS-CoV-2 infection conducted through the UK Obstetric Surveillance System and the British Paediatric Surveillance Unit. We defined antenatal and neonatal SARS-CoV-2 exposure as infants born to mothers hospitalised with confirmed SARS-CoV-2 infection between 14+0 and 36+6 weeks gestation and infants admitted to hospital with confirmed SARS-CoV-2 infection within the first 28 days after birth. Children born preterm or with major congenital anomaly or who were not residing in the UK were excluded. We assessed children's development (Ages and Stages Questionnaire 3rd Edition (ASQ-3); Ages and Stages Questionnaire Social-Emotional 2nd Edition (ASQ:SE-2)), respiratory symptoms (Liverpool Respiratory Symptom Questionnaire (LRSQ)) and health care usage (parent-completed questionnaire) at 21-32 months of age. Primary outcome: total ASQ-3 score, converted to z-scores. Secondary outcomes: ASQ:SE-2 z-scores; risk of delay in ASQ-3 domains; total LRSQ scores, converted to z-scores. Analyses were adjusted for children's age, sex, maternal ethnicity, parental education, and index of multiple deprivation. Between October 20, 2021 and January 27, 2023, we approached 668 and 1877 families out of 712 and 1917 potentially eligible participants in the exposed and comparison cohort. Of the 125 and 306 participants who were enrolled to the exposed and comparison cohort 121 and 301 participants completed the questionnaires and 96 and 243 participants were included in the analysis. In the age adjusted analysis, the mean total ASQ-3 z-score was lower in the exposed than the comparison cohort (-0.3, 95% CI:-0.6 to-0.05), however, when adjusted for sex, parental education, ethnicity and IMD quintile, there was no significant difference (difference in mean z-score=-0.2 95% CI:-0.5 to 0.03). SARS-CoV-2 exposure was associated with increased risk of delayed personal-social skills (odds ratio=3.81; 95% CI: 1.07-13.66), higher ASQ:SE-2 total z-scores (difference in mean z-score=0.4; 95% CI: 0.2-0.6) and increased risk of delayed social-emotional development (OR=3.58, 95% CI: 1.30-9.83), after adjusting for sex, age at assessment, parental education, ethnicity and IMD quintile. The exposed cohort had a higher mean total LRSQ z-score than the comparison cohort (0.3 95% CI: 0-0.6) and higher inpatient (38% vs. 21%, p=0.0001), outpatient (38% vs. 30%, p=0.0090), and General Practitioner appointments (60% vs. 50%, p=0.021) than the comparison cohort, after adjusting for sex, age at assessment, parental education, ethnicity and IMD quintile. No differences in other secondary outcomes between the exposed and comparison cohorts were found. Although the exposed cohort did not differ from the comparison cohort on the primary outcome, total ASQ-3 score, the exposed cohort were at greater risk of delayed social-emotional development, had a greater prevalence of respiratory symptoms and increased health care usage relative to the comparison cohort. The study is limited by the smaller sample size due to the low response rate and lack of clinical developmental assessments. Given the association of poor social-emotional development with antenatal or neonatal SARS-CoV-2 exposure, developmental screening, and follow-up of children with confirmed antenatal or neonatal SARS-CoV-2 infection may be warranted to identify those in need of early intervention. Action Medical Research for Children.

Cancer in prison: barriers and enablers to diagnosis and treatment

Approximately 82,000 people are in prison annually in England and Wales. Limited research has investigated cancer in this population and none has explored experiences of imprisoned people with cancer. This study aimed to address this gap. We conducted 55 semi-structured, qualitative, audio-recorded interviews with: imprisoned people with cancer (n=24), custodial staff (n=6), prison healthcare staff (n=16) and oncology specialists (n=9). Data were collected 07/10/2019-20/03/2020. Patients were recruited by prison healthcare staff and interviews were conducted face-to-face. Professionals were recruited via professional networks and interviews were conducted face-to-face or via telephone. Transcribed interviews were analysed using reflexive thematic analysis. We also analysed relevant National Cancer Patient Experience Survey (NCPES) questions for those diagnosed in prison (n=78) and in the general population (n=390). Our findings highlight the complexities of cancer care for imprisoned people. We identified three core themes: control and choice, communication, and care and custody. Whilst people in prison follow a similar diagnostic pathway to those in the community, additional barriers to diagnosis exist including health literacy, the General Practitioner appointment booking system and communication between prison and oncology staff. Tensions between control and choice in prison impacted aspects of cancer care experience such as symptom management and accessing cancer information. NCPES results supported the qualitative findings and showed people in prison reported significantly poorer experiences than in the general population. Our findings demonstrate the complexity of cancer care in custodial settings, identifying barriers and enablers to equitable cancer care provision and offering insights on how to improve care for this population. National Institute for Health and Social Care Research Delivery Research Programme 16/52/53 and Strategic Priorities Fund 2019/20 Research England via University of Surrey.

Two-year follow-up of a clustered randomised controlled trial of a multicomponent general practice intervention for people at risk of poor health outcomes

BackgroundThis study was a two-year follow-up evaluation of health service use and the cost-effectiveness of a multicomponent general practice intervention targeted at people at high risk of poor health outcomes.MethodsA two-year follow-up study of a clustered randomised controlled trial was conducted in South Australia during 2018–19, recruiting 1044 patients from three cohorts: children; adults (aged 18–64 years with two or more chronic diseases); and older adults (aged ≥ 65 years). Intervention group practices (n = 10) provided a multicomponent general practice intervention for 12 months. The intervention comprised patient enrolment to a preferred general practitioner (GP), access to longer GP appointments and timely general practice follow-up after episodes of hospital care. Health service outcomes included hospital use, specialist services and pharmaceuticals. The economic evaluation was based on quality-adjusted life years (QALYs) calculated from EuroQoL 5 dimensions, 5 level utility scores and used an A$50,000 per QALY gained threshold for determining cost-effectiveness.ResultsOver the two years, there were no statistically significant intervention effects for health service use. In the total sample, the mean total cost per patient was greater for the intervention than control group, but the number of QALYs gained in the intervention group was higher. The estimated incremental cost-effectiveness ratio (ICER) was A$18,211 per QALY gained, which is lower than the A$50,000 per QALY gained threshold used in Australia. However, the intervention's cost-effectiveness was shown to differ by cohort. For the adult cohort, the intervention was associated with higher costs and lower QALYs gained (vs the total cohort) and was not cost-effective. For the older adults cohort, the intervention was associated with lower costs (A$540 per patient), due primarily to lower hospital costs, and was more effective than usual care.ConclusionsThe positive cost-effectiveness results from the 24-month follow-up warrant replication in a study appropriately powered for outcomes such as hospital use, with an intervention period of at least two years, and targeted to older people at high risk of poor health outcomes.

General practice staff and patient experiences of a multicomponent intervention for people at high risk of poor health outcomes: a qualitative study

BackgroundThis study reports the experiences of general practice staff and patients at high risk of poor health outcomes who took part in a clustered randomised controlled trial of a multicomponent general practice intervention. The intervention comprised patient enrolment to a preferred General Practitioner (GP) to promote continuity of care, access to longer GP appointments, and timely general practice follow-up after hospital care episodes. The aims of the study were to better understand participant’s (practice staff and patients) perspectives of the intervention, their views on whether the intervention had improved general practice services, reduced hospital admissions and finally whether they believed the intervention would be sustainable after the trial had completed.MethodsA qualitative study design with semi-structured interviews was employed. The practice staff sample was drawn from both the control and intervention groups. The patient sample was drawn from those who had expressed an interest in taking part in an interview during the trial and who had also experienced a recent hospital care episode.ResultsInterviews were conducted with 41 practice staff and 45 patients. Practice staff and patients expressed support for the value of appointments with a regular GP and having sufficient time in appointments for the provision of comprehensive care. There were mixed views with respect to the extent to which the intervention had improved services. The positive changes reported were related to services being provided in a more proactive, thorough, and systematic manner with a greater emphasis on team based care involving the Practice Nurse. Patients nominated after hours care and financial considerations as the key reasons for seeking hospital care. Practice staff noted that the intervention would be difficult to sustain financially in the absence of additional funding.ConclusionsThe multicomponent intervention was supported by practice staff and patients and some patients perceived that it had led to improvements in care.

Patients' experiences of primary healthcare and dermatology provision for alopecia.

Alopecia describes a group of dermatological conditions characterised by hair loss, which are either non-scarring or scarring in nature, and range from bald patches to complete body hair loss, to general thinning. In the UK, the General Practitioner (GP) is typically the first point of contact, and some patients are referred for specialist dermatology consultation. However, little is known about how individuals with alopecia in the UK experience the care provided by the National Health Service. We aimed to understand patients' perceptions of primary healthcare and dermatology provision. Further, we aimed to investigate how care provision and patients' overall patient journey might be improved in the UK, and how these lessons may apply internationally. An online mixed methods survey was distributed by Alopecia UK to UK-based individuals with alopecia. Open-ended text responses were analysed using qualitative content analysis. Quantitative data were analysed using descriptive analyses and dependent measures t-tests. A total of 291 participants completed the survey. They reported neutral-to-partial dissatisfaction with their GP appointments, with greater satisfaction in their most recent compared to their first appointment. Participants highlighted positive experiences with GPs and dermatologists as well as areas for improvement. Participants also expressed a desire for a greater degree of support and understanding about the psychological impact of alopecia. Results highlight the importance of being empathic and caring healthcare professionals for patients with alopecia, the need for training for GPs on alopecia, as well as a simplified and joined up pathway between primary and secondary healthcare.

How does the environment in and around the home affect social care and health outcomes for older people? A national longitudinal dynamic cohort study

BackgroundReducing the burden of falls and fall-related admissions to hospital and care homes is an important policy area because falls cause significant injury leading to a reduced quality of life. We investigated the effect of the environment around people's homes on the risk of falls for older people in Wales. MethodsIn this longitudinal cohort study, we created a dynamic national e-cohort of individuals aged 60 years or older living in Wales between Jan 1, 2010, and Dec 31, 2019. Using the Secure Anonymised Information Linkage Databank, we linked routinely collected, anonymised health-data on general practitioner (GP) appointments; hospital and emergency admissions; and longitudinal individual-level demographic data to metrics detailing the built environment and deprivation as determined by the Welsh Index of Multiple Deprivation. Using adjusted cox regression models, we assessed how the risk of a fall changed with sex, age, deprivation quintile, urban or rural classification, household occupancy, care status, frailty, dementia diagnosis, and built environment metrics. Built environments of urban and rural areas are very different, so we stratified our analysis by urbanicity to compare these associations in each setting. FindingsWe analysed 5 536 444 person-years of data from 931 830 individuals (sex: 51·5% female, 48·5% male; age: 69·2% aged 60–64 years, 12·3% aged 65–69 years, 13·3% aged 70–79 years, 4·4% aged 80–89 years, and 0·7% aged ≥90 years). 154 060 (16·5%) had a fall between joining the cohort and Dec 31, 2019. Men had a lower risk of falling than women (adjusted hazard ratio [aHR] 0·736 [0·729–0·742]), and the risk increased with age compared with individuals aged 60–64 years (1·395 [1·378–1·412] for 65–69 years, 1·892 [1·871–1·913] for 70–79 years, 2·668 [2·623–2·713] for 80–89 years, 3·196 [3·063–3·335] for ≥90 years) and with frailty compared with fit individuals (1·609 [1·593–1·624] for mild frailty, 2·263 [2·234–2·293] for moderate frailty, and 2·833 [2·770–2·897] for severe frailty). Those living in rural areas were less likely to fall than those in urban areas (0·711 [0·702–0·720]). All p values were less than 0·0001. InterpretationAlthough preliminary, these results corroborate current knowledge that as we age and become frailer, the risk of falling increases. The effect of urbanicity on risk of fall suggests that the built environment could be associated with fall risk. We only detected falls that caused emergency or hospital admission, leading to potential selection bias. Nevertheless, this research could help guide policy to reduce the incidence of injuries caused by falls in older people. FundingHealth and Care Research Wales

Opportunistic identification of atrial fibrillation during unscheduled contact with emergency ambulance services in England: a qualitative exploration

Abstract Background Atrial fibrillation (AF) is an important risk factor for stroke which commonly affects people attended by Emergency Medical Services (EMS). There may be an opportunity for. EMS clinicians to find new incidental cases of AF suitable for oral anticoagulation (OAC) amongst the population who do not require conveyance to hospital following urgent ambulance review. Purpose This study explored whether it was acceptable to propose a formal pathway for identification and subsequent referral of non-conveyed EMS patients with incidental AF to their general practitioner (GP) for consideration of OAC prescription. The perspectives of patients, paramedics, and field experts were included. Methods This qualitative study included four online focus groups involving 18 members of the public and one-to-one online interviews in England with 11 health care and service providers (6 paramedics, 5 field experts providing multiple expertise in cardiology, general practice, public health, academic research, healthcare policy, and primary care commissioning) between June and September 2022. A semi-structured topic guide was used, with purposive sampling to maximise the diversity of perspective and experience in all participant groups. Data were audio-recorded, transcribed anonymously and analysed thematically. Results All participant groups supported formalising the opportunistic detection of AF during EMS review, but each had concerns and caveats. Of paramount concern to all groups was that any change in practice must not create delays in the emergency response system since incidental AF is non-urgent and other community pathways are in place for detection and management. Public participants were also concerned about how the diagnosis would be communicated to the patient, and opinion was split between whether this should be ‘on the scene’ or in a subsequent GP appointment. Paramedics reported that they frequently identify incidental AF, but that there is variation in practice regarding whether (and how) this is communicated to the GP. There was a concern that the finding of AF was not easily visible within the existing EMS report and may be missed. Paramedics also focussed on safety-netting of patients not being conveyed to hospital and of a need for an ‘active’ reporting process to ensure that the finding of AF was acted upon. In general, field experts felt that a formal pathway would be useful but relatively low impact, and favoured a simple intervention that did not overly complicate existing AF pathways. Conclusions There is support amongst the public and professionals for the development of a formal pathway to ensure ongoing follow-up and care for people with AF incidentally detected in the community by EMS. This novel case finding opportunity has the potential to improve AF detection, oral anticoagulation rates, and reduce the risk of stroke.

Digital primary care visits designed for different patient segments in the pre-pandemic era: A scoping review

Digital healthcare services have been implemented increasingly during and after the COVID-19 pandemic. They have been expected to improve access, reduce inefficiencies, improve the quality of care, lower the cost of healthcare, and provide more personalised care. This study focuses on digital visits: digital health care services that replace a general practitioner (GP) appointment in primary care. The aim of this review is to assess the perspectives used in studying digital visits, and to describe the services studied in terms of modalities used and patient segments targeted. We aim to find how digital visits were studied prior to their becoming a necessity during the COVID-19 pandemic. This is a scoping review of English language papers published between 1.1.2010-31.5.2020. The papers were eligible for the review if they focused on a digital primary care visit which replaced a face-to-face appointment with a GP. In total, 36 papers were included. Ten of the studies described services tailored to the needs of a patient segment. The rest of the studies (26/36) did not differentiate between patient segments. The most often-used perspective was that of the clinician (16/36 studies). Fifteen studies were descriptive. The costs and outcomes were rarely utilised as a perspective: the costs were used in only one study and outcomes in six. Patient experience was the perspective chosen in 11 studies. Among all the interventions, the most common modality was by phone call (20), and the second most common was asynchronous messaging and video consultation (10 each). Prior to the COVID-19 pandemic, digital visits had mostly been developed for the entire population instead of a particular segment of patients. We argue that developing them to fit the needs of a patient segment would help make them more acceptable and suitable for patients. More studies from the patient perspective are needed to develop these services to better fit the needs of patients. The situation is likely to have changed during the pandemic, as a large number of studies has been published since May 2020.

Innovative primary care lead community palpitation management and investigation pathway

Abstract Funding Acknowledgements Type of funding sources: None. Background Palpitations are a common reason for General Practitioner (GP) appointment in primary care and a frequent reason for cardiology referral. In the region where this project was performed, this translated to approximately 24,000 primary care and out of hours consultations in 2021 alone. Purpose The purpose of this pilot was to evaluate a pathway for palpitations diagnosis and management in primary care. The proposed pathway was designed to avoid unnecessary referrals to secondary care, to shorten the waiting time to diagnosis for patients and to cut down visits to A&E and out of hours service in primary care. Method The pathway, which was piloted at a federation for 30,000 patients, was based on a community cardiology approach, where a GP with Special interest in cardiology could offer the service for the wider community. The pathway began with an initial clinical evaluation comprising medical history, physical examination, and a standard 12-lead ECG. After ruling out of any red flags and otherwise deemed appropriate to continue to be assessed with the proposed diagnostic method, the patients were provided with a handheld ECG device for intermittent 30 seconds ECG registration at home. During a four-week investigation period the patients would record their ECG when experiencing symptoms. The primary care team remotely monitored the traces which were received on a cloud-based system with AI capabilities, and if pathology was recorded, patient was contacted and informed of management plan. If after four weeks no pathology was found, patients received a discharge consultation for reassurance and final report was generated. Results During the 24-month pilot we screened the total of 191 patients. Out of the patients screened 24 (13%) were diagnosed with atrial fibrillation, 92 (48%) were diagnosed with benign ectopics as the cause of their palpitations. Two rare occurrences of a life threatening broad complex tachycardias were also detected, both of which ended up needing defib implantation. Table 1. further presents the results by diagnosis for rest of the patients. Conclusions The results from the pilot indicated a reduction in GP / out of hours consultations by 50% and over 90% reduction in referral to secondary care for Holter monitoring by implementing an easy-to-use handheld ECG as part of the community led palpitation pathway. The results further implied that a district-wide implementation could lead to at least 120 new AF diagnosis in our project district per year, having a knock-on benefit of stroke reduction and cost economic impact in the society by reducing anxiety, lost employment hours and increasing productivity. Another key outcome seen is the reassurance value of conducting symptomatic palpitation monitoring to reassure patients, majority of whom had either normal sinus rhythm or benign ventricular ectopics and had failed to be satisfied with conventional Holter monitoring in the past.

Effectiveness of a collaborative diabetes screening campaign between community pharmacies and general practitioners

AimTo evaluate the impact of a collaborative screening campaign on the prevalence of pre-diabetes and diabetes among the screened population. MethodsA Longitudinal, multicentre study was developed. The Finnish Diabetes Risk Score (FINDRISC) was applied to the eligible population in the participating community pharmacies. Individuals with a FINDRISC score ≥ 15, were eligible to measure their glycated haemoglobin (HbA1c) level at the community pharmacy. If HbA1c≥ 5.7%, participants were referred to a general practitioner (GP) appointment for potential diagnosis of Diabetes. ResultsOut of 909 screened subjects, 405 (44.6%) presented a FINDRISC score ≥ 15. Among the latter, 94 (23.4%) had HbA1c levels that made them eligible for GP referral, of which 35 (37.2%) completed the scheduled appointments. 24 participants were diagnosed with pre-diabetes, and 11 with diabetes. The prevalence was estimated at 2.5% (CI95% 1.6–3.8%) and 7.8% (CI95% 6.2–9.8%) for diabetes and pre-diabetes, respectively. ConclusionThis collaborative model has proved to be effective in the early detection of diabetes and pre-diabetes. Joint initiatives between health professionals can play a pivotal role in the prevention and diagnosis of diabetes, which may lead to a reduction on the burden to health system and society.

Exploring the views of low-acuity emergency department consulters on an educational intervention and general practitioner appointment service: a qualitative study in Berlin, Germany

ObjectivesLow-acuity patients presenting to emergency departments (EDs) frequently have unmet ambulatory care needs. This qualitative study explores the patients’ views of an intervention aimed at education about care options and...

Keeping an eye on cost: What can eye tracking tell us about attention to cost information in discrete choice experiments?

Concern has been expressed about including a cost attribute within discrete choice experiments (DCEs) when individuals do not have to pay at the point of consumption. We use eye tracking to investigate attention to cost when valuing publicly financed health care. One-hundred and four individuals completed a DCE concerned with preferences for UK general practitioner appointments: 51 responded to a DCE with cost included and 53 to the same DCE without cost. Eye-movements were tracked whilst respondents completed the DCE. We assessed if respondents pay attention to cost. We then compare fixation time (FT) on attributes, eye movement patterns and mental effort across the experimental groups. Results are encouraging for the inclusion of cost in DCEs valuing publicly provided healthcare. Most respondents gave visual attention to the cost attribute most of the time. Average FT on multi-attribute tasks increased by 44% in the cost DCE, with attention to non-monetary attributes increasing by 22%. Including cost led to more structured decision-making and did not increase mental effort. Acceptability of the cost attribute and difficulty of choice tasks were predictors of cost information processing, highlighting the importance of both motivating the cost attribute and considering difficulty of the tasks when developing DCEs.

Impact of a dietitian in general practice: paediatric food allergy.

Food allergy in infants and young children places a significant burden on primary care. This study evaluated a dietetic-led paediatric food allergy service, which attempts to provide more rapid access to the dietitian and reduce the need for general practitioner (GP) and secondary care appointments. Two community dietetic services for children referred with food allergy were compared. The first was dietetic-led care where dietitians train community children's nurses to recognise potential cases of food allergy, undertake basic diagnostic assessment and subsequently refer to the dietitian. The other was a more traditional dietetic community service where patients were referred predominantly by the GP or secondary care. In dietetic-led care 86 patients were seen, compared to 96 in dietetic community care. Dietetic-led care received fewer referrals from the GP, 36% versus 67% (p < 0.001); GP appointments for allergy-related conditions prior to dietetic referral were lower, 3 versus 6 visits (p = 0.001); and input from secondary care was also lower, 8 versus 25 patients (p = 0.002) compared with dietetic community care. Children referred to dietetic-led care were younger, 78% <6 months versus 40% (p < 0.001) in dietetic community care. Dietetic-led care describes a model that has the potential to reduce GP and secondary care appointments, identify patients more quickly and reduce the time to receive dietetic input, thereby resolving symptoms more quickly and reducing prescribed medications. This model demonstrates the importance of integrated care and multidisciplinary working, offering a solution to reducing GP workload while maintaining or improving patient care.

Healthcare consumption, readmission and death rates after heart failure hospitalization: Insights from reimbursement databases of the France Grand Est region

Heart failure (HF) in France is a major healthcare issue. Hospitalization for HF is a major severity marker and requires optimal subsequent management to prevent further hospitalizations. Our aim is to describe the outpatient healthcare utilization after an hospitalization for HF and to identify clinical profiles associated with low rates of healthcare utilization. Data were extracted from the National Health Insurance database. Patients of the France Grand Est region hospitalized for HF (as main or associated diagnosis) for the first time from 2016 to 2020 were included. Patients’ follow-up was 1 to 6 years, depending on the inclusion date. A total of 65 476 patients (mean age 80.3 ± 11.3 years, 53% women) were analyzed. The mean Charlson comorbidity index was 4.8 ± 2.9. 62 156 patients (92.2%) survived their hospital stay and were followed for 827 ± 609 days. During the study period, 34.8% of patients were re-hospitalized for HF, and the risk of death at two-year was 40.3%. The proportion of patients who had at least one appointment with a general practitioner (GP), geriatrician or internist was 71.2% at 1 month and 87.6% at 3 months; at least one appointment with a cardiologist (consult and/or echocardiography) was far lower: 20.8% at 1 month and 43.9% at 3 months. A minority of patients (19.5%) were followed according to the recommended initial clinical post-discharge follow-up of the French “Haute Autorité de Santé” guidelines (GP appointment within 15 days and cardiologist appointment within 2 months). These patients had a 38% lower risk of death compared to patients who did not undergo the recommended follow-up (Adjusted HR: 0.621, IC [0.669–0.713], P < 0.0001). Compared to younger subjects, patients > 85 years were less likely to see a GP and/or a cardiologist and to undergo blood tests (including BNP) evaluations (p.e. 59.4% of patients < 55 had a cardiology appointment within 3 months versus 31.8% of patients ≥ 85). Patient referral to health care professional remains low following HF hospitalization. There is an urgent for the implementation of HF management pathways to ensure adequate post-discharge follow-up.

How does community pharmacy reduce the GPS workload by helping patients living with diabetes?

Abstract Introduction Diabetes mellitus is a metabolic disorder that affects more than 220 million people worldwide.1 The prevalence of type 2 diabetes is on the rise, leading to higher levels of morbidity, workload, and cost for the National Health Service (NHS).2 In addition, the long-term complications of diabetes can also contribute to higher levels of morbidity and workload for General Practice. Community pharmacists have clinical knowledge which is being utilised to provide a range of services to patients living with long term conditions.3 These include the New Medicines Service (NMS) and the Community Pharmacist Consultation Service (CPCS) that can both support those living with diabetes by helping patients to understand their condition and use their medication correctly, reducing the need for a General Practitioner (GP) appointment. The role of the pharmacist in community pharmacy diabetes management currently has limited research. Aim The aim of the study was to explore the role of community pharmacy in helping diabetic patients and thereby decrease the workload of the GP. Methods This study targeted community pharmacies in Croydon (n=77) and Kingston Upon Thames (n=34) in greater London, aiming for one response per pharmacy. A survey consisting of 29 questions was crated with a mixture of tick box and free text questions. Community pharmacies were visited in both boroughs, and surveys were distributed and collected. After data collection, quantitative analysis was completed through SPSS and qualitative analysis was using thematic analysis. Ethical approval was granted by Kingston University. Results In total, 65 responses were received (59% response rate). Diabetes was found to be the long-term condition that had the greatest number of referrals to the GP (n=30/65; 46%). Referrals were mainly in response to recurrent infections and over the counter sales linked to eyes and feet. Community pharmacies provided an average of 3 advanced services, including NMS (n=63/65; 97%), CPCS (n=61/65; 94%), flu vaccinations (n=59/65; 91%) and hypertension screening (n=24/65; 37%). Some of the key themes when participants were asked about the most common issues identified in an NMS consultation with a diabetic patient, was adherence issues to their medication, lack of knowledge about diabetes and about lifestyle changes, leading to opportunities for community pharmacy-based interventions, and limiting a referral to a GP. Pharmacists felt confident in having intervention conversations and felt knowledgeable about diabetes. Discussion/Conclusion Community pharmacies are an essential part of a patient’s diabetic journey, supporting person centred care. This study outlines and establishes a clear role of how community pharmacies can carry out different services for diabetic patients, be able to identify any diabetic complications in the community setting. NMS and CPCS were found to be beneficial services for diabetic patients unlocking the full potential of a community pharmacist. Although a small study in a limited geography, this study highlights that community pharmacists support diabetic patients to manage their condition, thus reducing referrals to GPs and therefore the GP workload. Future studies can be carried out over a larger area to extrapolate findings.

Using virtual wards and long-term conditions management network to improve practice and performance

England has more than 15 million people and counting with long-term conditions who have the greatest healthcare needs of the population accounting for 50% of all General Practitioner (GP) appointments...

Use of a pharmacy-based GP video consultation service: a mixed methods study.

Little is known about private general practice appointment services offered via video. This study aimed to explore which patients are using a video pharmacy-based general practitioner (GP) appointment service, including patterns of use, reasons for using the service, and satisfaction with the service. Descriptive statistics and parametric and nonparametric tests were used to conduct a retrospective cross-sectional analysis of routinely collected data on consultations, and postconsultation questionnaires. Interviews were conducted with patients and GPs. A total of 7,928 consultations were included in the analysis. More than half of appointments were booked for the same day, with lunchtime appointments being popular. The most common health condition was respiratory conditions, and 9% of consultations were used by patients using the service more than once. At least one prescription was issued in over half of all consultations. Overall, satisfactions of consultations were high. The characteristics of those patients using the video consultation service match data on who uses online services in general practice. This study shows that some patients are willing to pay to use this private service because they feel it is more convenient, NHS services do not have capacity to see them at the time they need, or they do not have access to regular GP services.

1027 Urology Teaching - Improving Hesitancy by Live-Streaming!

The covid-19 pandemic and associated social distancing restrictions had a significant impact on medical education and clinical learning opportunities for not only medical students, but for all those involved in the healthcare system. Given that up to 15% of general practitioner appointments and more than 25% of acute surgical referrals are urology related, adequate teaching is pertinent to ensure medical staff have the confidence and competence to manage urological concerns in a clinical setting. This quality improvement project aimed to design and develop an international educational series of virtual teaching sessions by the collaboration of senior urological trainees from various trusts across the United Kingdom.We designed a once-weekly urology teaching series that targeted all healthcare workers (medical students, junior doctors, nurses, ANPs, PAs…etc). The series continued for 12 consecutive weeks, with each session discussing a different aspect of clinical urology and delivered by different senior urology trainees with varying experiences across the UK. Pre-session surveys and post-session feedback were collected to evaluate levels of confidence in said topics before and after session delivery.Session attendance averaged 250 individuals per session, of multiple healthcare backgrounds and from varying countries across the world (UK, Asia, Middle East, Australia, New Zealand…etc). Overall confidence improved on average from 2/5 to 4/5 across all 12 sessions. An average of 4.5/5 agreed that the content of the sessions was beneficial, and 4.5/5 would recommend future sessions to colleagues.Virtual learning can thus be a useful tool to aid in improving medical education, even on an international level.