Patient Leaflets Research Articles

Patient engagement with antibiotic messaging in secondary care: a qualitative feasibility study of the \u2018review and revise\u2019 experience

BackgroundWe aimed to investigate and optimise the acceptability and usefulness of a patient leaflet about antibiotic prescribing decisions made during hospitalisation, and to explore individual patient experiences and preferences regarding the process of antibiotic prescription ‘review and revise’ which is a key strategy to minimise antibiotic overuse in hospitals.MethodsIn this qualitative study, run within the feasibility study of a large, cluster-randomised stepped wedge trial of 36 hospital organisations, a series of semi-structured, think-aloud telephone interviews were conducted and data were analysed using thematic analysis. Fifteen adult patients who had experienced a recent acute medical hospital admission during which they had been prescribed antimicrobials and offered a patient leaflet about antibiotic prescribing were recruited to the study.ResultsParticipants reacted positively to the leaflet, reporting that it was both an accessible and important source of information which struck the appropriate balance between informing and reassuring. Participants all valued open communication with clinicians, and were keen to be involved in antibiotic prescribing decisions, with individuals reporting positive experiences regarding antibiotic prescription changes or stopping. Many participants had prior experience or knowledge of antibiotics and resistance, and generally welcomed efforts to reduce antibiotic usage. Overall, there was a feeling that healthcare professionals (HCPs) are trusted experts providing the most appropriate treatment for individual patient conditions.ConclusionsThis study offers novel insights into how patients within secondary care are likely to respond to messages advocating a reduction in the use of antibiotics through the ‘review and revise’ approach. Due to the level of trust that patients place in their care provider, encouraging HCPs within secondary care to engage patients with greater communication and information provision could provide great advantages in the drive to reduce antibiotic use. It may also be beneficial for HCPs to view patient experiences as cumulative events that have the potential to impact future behaviour around antibiotic use. Finally, pre-testing messages about antibiotic prescribing and resistance is vital to dispelling any misconceptions either around effectiveness of treatment for patients, or perceptions of how messages may be received.Trial registrationCurrent Controlled Trials ISRCTN12674243 (10 April 2017),

Survey of healthcare professionals' practices, expectations, and attitudes towards provision of patient information leaflets in Thailand.

Background Patient information leaflets are an important source of medicine information for patients. In Thailand, there is a lack of studies exploring activities of healthcare professionals and their attitudes towards provision of patient information leaflets. Objectives This study aimed to survey healthcare professionals' practices on provision of medicine information, expectations of, attitudes towards provision of patient information leaflets and factors influencing these. Setting Two university hospitals in Thailand. Methods A self-completion questionnaire was distributed to chiefs of departments for further distribution to staff. A stratified sample of physicians and nurses was invited, while all pharmacists were invited to ensure sufficient numbers for comparison. Main outcome measure Healthcare professionals' practices on provision of medicine information, expectations of, attitudes towards provision of patient information leaflets. Results Of the total 981 healthcare professionals invited, 493 responded (50.3% response rate). The number of respondents aware of patient information leaflets was 270 (57.6%). Of these, only 44.4% had ever given patient information leaflets to patients. Pharmacists provided patient information leaflets more frequently than other healthcare professionals. The expectation for patient information leaflets to be available was high; mean score 7.9 ± 2.31 of possible 10. Most respondents had positive attitudes towards providing patient information leaflets to patients (58.2%). Respondents who were aware of patient information leaflets availability were more likely to have a positive attitude (OR 0.543, p = 0.002). Level of education, time spent in direct care and being aware of patient information leaflets were factors associated with healthcare professionals' attitudes. Conclusion Limited number of healthcare professionals had provided patient information leaflets to patients but most had positive attitudes regarding the usefulness of patient information leaflets for patients. Increased availability and use of patient information leaflets should be promoted.

MDM and proportionate universalism applied to cervical cancer prevention

For over 30years, Médecins du Monde (MDM) has been working with people living in vulnerable conditions in order to promote and facilitate their access to fundamental human rights and healthcare. Women encountered within MDM programs have many risk factors for developing precancerous and cancerous lesions of the cervix. They may not seek or have little access to health services and preventive health measures.These findings prompted MDM to adopt a 'proportionate universalism' approach in order to improve access to prevention for people living in vulnerable conditions, by reaching out to the population and offering preventative health consultations. In order to address health inequalities, this approach combines health mediation, use of visuals (binder, patient leaflet), professional interpretation services, as well as preventative health consultations run by a team aware of counselling approaches and techniques. MDM diversifies screening options by inviting women to perform a self-collected vaginal swab for high risk HPV testing.This multi-level intervention aims to create favorable conditions for public participation and empowerment by promoting specifically tailored tools and a "proportionate universalism" approach.

Decentralising NCD management in rural southern Africa: evaluation of a pilot implementation study

BackgroundThe prevalence of non-communicable diseases, and associated morbidity and mortality, is increasing rapidly in low and middle-income countries where health systems often have limited access and lower quality of care. The intervention was to decentralise uncomplicated non-communicable disease (NCD) care from a hospital to nurse practitioners in health centres in a poor rural district in Eswatini, southern Africa. The objective of this study was to assess the feasibility and impact of decentralised care for NCDs within nurse-led clinics in order improve access and inform healthcare planning in Eswatini and similar settings.MethodsIn collaboration with the Eswatini Ministry of Health, we developed and implemented a package of interventions to support nurse-led delivery of care, including: clinical desk-guide for hypertension and diabetes, training modules, treatment cards and registries and patient leaflets. Ten community clinics in the Lubombo Region of Eswatini were randomly selected to be trained to deliver NCD care for a period of 18 months. Observational data on follow-up rates, blood pressure (BP), glucose etc. were recorded and evaluated. We compared blood pressure and blood glucose measurements between the first and fourth visits and fitted a linear mixed effects model.ResultsOne thousand one hundred twenty-five patients were recruited to the study. Of these patients, 573 attended for at least 4 appointments. There was a significant reduction in mean BP among hypertensive patients after four visits of 9.9 mmHg systolic and 4.7 mmHg diastolic (p = 0.01), and a non-significant reduction in fasting blood glucose among diabetic patients of 1.2 mmol/l (p = 0.2). Key components of NCD care were completed consistently by nurses throughout the intervention period, including a trend towards patients progressing from monotherapy to dual therapy in accordance with prescribing guidelines.ConclusionsThe findings suggest that management of diabetes and hypertension care in a rural district setting can be safely delivered by nurses in community clinics according to a shared care protocol. Improved access is likely to lead to improved patient compliance with treatment.

Developing a list of important drug- drug interactions in the clinical practice in the internal department – Kien An Hospital, Hai Phong City

This study was aimed to develop a list of important drug- drug interactions (DDIs) at the Internal department – Kien An Hospital. Subjects and methods: This study was 3 phases: (1) The construction of the initiative list was based on consenous of the documentations from the list of drugs in Kien An hospital: Micromedex 2.0, the patient leaflets and Drug Interaction Fact 2014. (2) The research group reviewed all the in-patient medical records in the General internal department and Cardiology department and sorted the high-frequency DDIs with prevalance higher than 1%. (3) After the DDIs of the first list and the second list were assessed by a group of doctors and pharmacists who the proposed a list of important DDIs at the internal deparment – Kien An Hospital. Results: From the documentations, the research group constructed 27 DDIs of the list. Conclusion: This DDIs list can be disseminated in clinical departments and integrated into the prescribing software of Kien An hospital.
 Keywords
 Kien An hospital, DDIs, Micromedex 2.0, high-frequency.
 References
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Effectiveness and cost-effectiveness of Improving clinicians\u2019 diagnostic and communication Skills on Antibiotic prescribing Appropriateness in patients with acute Cough in primary care in CATalonia (the ISAAC-CAT study): study protocol for a cluster randomised controlled trial

BackgroundDespite their marginal benefit, about 60% of acute lower respiratory tract infections (ALRTIs) are currently treated with antibiotics in Catalonia. This study aims to evaluate the effectiveness and efficiency of a continuous disease-focused intervention (C-reactive protein [CRP]) and an illness-focused intervention (enhancement of communication skills to optimise doctor-patient consultations) on antibiotic prescribing in patients with ALRTIs in Catalan primary care centres.Methods/designA cluster randomised, factorial, controlled trial aimed at including 20 primary care centres (N = 2940 patients) with patients older than 18 years of age presenting for a first consultation with an ALRTI will be included in the study. Primary care centres will be identified on the basis of socioeconomic data and antibiotic consumption. Centres will be randomly assigned according to hierarchical clustering to any of four trial arms: usual care, CRP testing, enhanced communication skills backed up with patient leaflets, or combined interventions. A cost-effectiveness and cost-utility analysis will be performed from the societal and national healthcare system perspectives, and the time horizon of the analysis will be 1 year. Two qualitative studies (pre- and post-clinical trial) aimed to identify the expectations and concerns of patients with ALRTIs and the barriers and facilitators of each intervention arm will be run. Family doctors and nurses assigned to the interventions will participate in a 2-h training workshop before the inception of the trial and will receive a monthly intervention-tailored training module during the year of the trial period. Primary outcomes will be antibiotic use within the first 6 weeks, duration of moderate to severe cough, and the quality-adjusted life-years. Secondary outcomes will be duration of illness and severity of cough measured using a symptom diary, healthcare re-consultations, hospital admissions, and complications. Healthcare costs will be considered and expressed in 2021 euros (year foreseen to finalise the study) of the current year of the analysis. Univariate and multivariate sensitivity analyses will be carried out.DiscussionThe ISAAC-CAT project will contribute to evaluate the effectiveness and efficiency of different strategies for more appropriate antibiotic prescribing that are currently out of the scope of the actual clinical guidelines.Trial registrationClinicalTrials.gov, NCT03931577.

Viewpoint: Why I prescribe podcasts to my patients.

During my revision for the Clinical Skills Assessment (CSA) part of the MRCGP examination, I finished many simulated consultations by referring paper leaflets for patients to collect at reception. Such leaflets corroborate information given within the consultation and provide supplementary information about a condition or medication in primary care. In my current practice, I print out leaflets on clinical conditions and on medications but wonder whether patients actually read them, how much they retain, and whether leaflets directly change health behaviour. A systematic review of literature reviews1 suggested that leaflets do improve patient knowledge and medication adherence. However, within many countries health literacy is often low, especially in low socioeconomic groups whose health needs may very well be …

Connecting patients, practitioners, and regulators in supporting positive experiences and processes of shared decision making: A progress report.

This paper describes a novel approach to explore how regulators, working with patients and practitioners, may contribute to supporting person‐centred care and processes of shared decision making in implementing professional standards and reducing harms. Osteopathic patients report high levels of patient care. However, areas of consultations less likely to be rated as high included “fully understanding your concerns,” “helping you to take control,” and “making a plan of action with you,” suggestive of a paternalistic approach to care and a barrier to the effective implementation of standards. This programme explored how to support patients and practitioners to make more explicit what is important to support consultations with better communication in accordance with standards. A series of workshops took place involving approximately 80 participants, which explored and identified practitioner and patient values; these were themed to develop a common framework and tested using case studies. Aspects of what enables or presents a barrier to a positive consultation were further explored with real patient narratives, and a range of resources were subsequently developed, which may support patients and practitioners to make explicit what is important to them in a consultation. A series of approaches and tools were then developed for piloting including patient curriculum vitae; patient goal planner; patient animation to support preparation for an appointment; infographic: a patient poster or leaflet; practitioner reflective tool; and an audio recording to increase awareness and understanding of values‐based practice. In conclusion, a range of approaches may help to support patients and practitioners to make explicit what is important to them in a consultation. The next phase of our programme will use a range of methods including cluster sampling, pre‐testing and post‐testing with the Consultation and Relational Empathy (CARE) measure tool, and interviews and focus groups with users and practitioners to demonstrate impact.

Adaptation and implementation of the ARK (Antibiotic Review Kit) intervention to safely and substantially reduce antibiotic use in hospitals: a feasibility study

Antimicrobial stewardship initiatives in secondary care depend on clinicians undertaking antibiotic prescription reviews but decisions to limit antibiotic treatment at review are complex. To assess the feasibility and acceptability of implementing ARK (Antibiotic Review Kit), a behaviour change intervention made up of four components (brief online tool, prescribing decision aid, regular data collection and feedback process, and patient leaflet) to support stopping antibiotic treatment when it is safe to do so among hospitalized patients; before definitive evaluation through a stepped-wedge cluster-randomized controlled trial. Acceptability of the different intervention elements was assessed for a period of 12 weeks by uptake of the online tool, adoption of the decision aid into prescribing practice, and rates of decisions to stop antibiotics at review (assessed through repeated point-prevalence surveys). Patient perceptions of the information leaflet were assessed through a brief questionnaire. All elements of the intervention were successfully introduced into practice. A total of 132 staff encompassing a broad range of prescribers and non-prescribers completed the online tool (19.4 per 100 acute beds), including 97% (32/33) of the pre-specified essential clinical staff. Among 588 prescription charts evaluated in seven point-prevalence surveys over the 12-week implementation period, 82% overall (76-90% at each survey) used the decision aid. The median antibiotic stop rate post implementation was 36% (range: 29-40% at each survey) compared with 9% pre implementation (P < 0.001). ARK provides a feasible and acceptable mechanism to support stopping antibiotics safely at post-prescription reviews in an acute hospital setting.

Fasting, feasting, feet: religious festivals and diabetes

Fasting, feasting, feet: religious festivals and diabetes

What do European women know about their female cancer risks and cancer screening? A cross-sectional online intervention survey in five European countries

ObjectivesInformed decisions about cancer screening require accurate knowledge regarding cancer risks and screening. This study investigates: (1) European women’s knowledge of their risk of developing breast, ovarian, cervical or endometrial...

Interventions to support shared decision making for hypertension: A systematic review of controlled studies.

BackgroundHypertension (high blood pressure) is a common long‐term health condition. Patient involvement in treating and monitoring hypertension is essential. Control of hypertension improves population cardiovascular outcomes. However, for an individual, potential benefits and harms of treatment are finely balanced. Shared decision making has the potential to align decisions with the preferences and values of patients.ObjectiveDetermine the effectiveness of interventions to support shared decision making in hypertension.Search strategySearches in MEDLINE, EMBASE, CINAHL, Web of Science and PsycINFO up to 30 September 2017.Eligibility criteriaControlled studies evaluating the effects of shared decision‐making interventions for adults with hypertension compared with any comparator in any setting and reporting any outcome measures.ResultsSix studies (five randomized controlled trials) in European primary care were included. Main intervention components were as follows: training for health‐care professionals, decision aids, patient coaching and a patient leaflet. Four studies, none at low risk of bias, reported a measure of shared decision making; the intervention increased shared decision making in one study. Four studies reported blood pressure between 6 months and 3 years after the intervention; there was no difference in blood pressure between intervention and control groups in any study. Lack of comparability between studies prevented meta‐analysis.ConclusionsDespite widespread calls for shared decision making to be embedded in health care, there is little evidence to inform shared decision making for hypertension, one of the most common conditions managed in primary care.

Potentially inappropriate prescribing of drugs in elderly patients on chronic hemodialysis treatment .

The aim of this study was to determine the prevalence of potentially inappropriate drug prescription (PIP) in older patients who were on chronic hemodialysis treatment and to explore the factors that lead to PIP. The study was performed at the Department of Nephrology, Clinical Center Niš, Serbia. It included patients who were 65 years old and older who suffered from the end-stage of kidney failure and were treated by hemodialysis. Univariate and subsequent multivariate logistic regression was used to analyze risk factors for PIP or omission (PPO) according to the STOPP and START criteria. The study included 83 patients. According to the START criteria, PPO was found in 18 (22%) patients, and 32 (39%) patients experienced PIPs according to the STOPP criteria. The following factors were associated with PIP according to the START criteria: a number of comorbidities, reading the patient leaflet, and having the habit of drinking coffee. According to the STOPP criteria, polypharmacy was associated with PIP (OR=1.287, p=0.021): each additional drug increased the risk of potentially inadequate medications (PIM) by 28.7%. Adequate consideration of potential risk factors, as well as the implementation of valid criteria for assessment of PIP, are just some of the measures that would contribute to solving complex therapeutic problems and designing strategies for rational prescribing according to the individual characteristics of patients. .

Urinary tract infections (UTIs); a leaflet for older adults, and carers: the development of a UTI leaflet for older adults and their carers

BackgroundEscherichia coli bacteraemia rates are rising with highest rates in older adults. Mandatory surveillance identifies previous Urinary Tract Infections (UTI) and catheterisation as risk factors.AimTo help control bacteraemias in older frail patients by developing a patient leaflet around the prevention and self-care of UTIs informed by the Theoretical Domains Framework.MethodFocus groups or interviews were held with care home staff, residents and relatives, GP staff and an out of hours service, public panels and stakeholders. Questions explored diagnosis, management, prevention of UTIs and antibiotic use in older adults. The leaflet was modified iteratively. Discussions were transcribed and analysed using Nvivo.ResultsCarers of older adults reported their important role in identifying when older adults might have a UTI, as they usually flag symptoms to nurses or primary care providers. Information on UTIs needs to be presented so residents can follow; larger text and coloured sections were suggested. Carers were optimistic that the leaflet could impact on the way UTIs are managed. Older adults and relatives liked that it provided new information to them. Staff welcomed that diagnostic guidance for UTIs was being developed in parallel; promoting consistent messages. Participants welcomed and helped to word sections on describing asymptomatic bacteriuria simply, preventing UTIs, causes of confusion and when to contact a doctor or nurseConclusionA final UTI leaflet for older adults has been developed informed by the TDF. See the TARGET website www.RCGP.org.uk/targetantibiotics/

Local implementation of AMS initiatives: a mixed-methods study

BackgroundThe NHS English Quality Premium recommends that inappropriate antibiotic prescribing is reduced; there are a range of national antimicrobial stewardship (AMS) initiatives to support this.AimThe aim of this study is to assess AMS activities in primary care across England. The findings will be used to inform how the RCGP, PHE and NHS can help optimise stewardship activities.MethodQualitative interviews: with AMS leads within Clinical Commissioning Groups’ (CCGs) and Commissioning Support Units’ (CSUs) medicines management teams. Questionnaire: informed by the qualitative data, sent to all 209 CCGs in England in 2017.ResultsIn total, 89% (187/209) of CCGs returned a questionnaire; 82% of AMS leads reported spending only 0.1 whole-time equivalent on AMS activities, as it was only one role within a wider remit, so dedicating time is challenging. 99% (167/169) of CCGs had delivered AMS education in the last 2 years: 140 face-to-face; 121 via e-learning. 99% (184/186) actively promoted the TARGET Antibiotics Toolkit; 94% (175/187) actively promoted TARGET patient leaflets: 92% The Treating Your Infection (TYI) leaflet. 90% (166/185) used the PHE managing common infections guidance: 81% (149/185) modify or localise; 41/185 (22%) signpost directly to it. Eighty-six CCGs reported using CCG audit tools and 82 CCGs reported using TARGET’s audit tools. 85% (142/168) fed back antimicrobial prescribing data to the CCG/CSU board; 100% (169/169) to general practices and 33% (56/169) to out-of-hours providers.ConclusionAlthough CCGs reported promoting these AMS activities, there was little evaluation of uptake by primary care practitioners. Future work should focus on measuring AMS uptake; having staff dedicated solely to AMS could facilitate this.

Doctors and pharmacists provision and opinions of medicines information leaflets in New Zealand

Background Providing verbal medicines information to patients may be insufficient. Providing medicine information leaflets could support verbal information, however New Zealand health professionals' opinions or use of leaflets is unknown. Objective To examine self-reported provision and health professionals' views about medicine information leaflets and to determine their support for tailoring patient leaflets. Setting A cross sectional survey of general practitioners (GPs) and community pharmacists in New Zealand primary care. Method GPs and pharmacists completed validated questionnaires. Data was collected using SurveyMonkey® and where applicable, Chi squared analysis was carried out. Main outcome measures Frequency of leaflet provision, how leaflets are used in practice and why, likes and dislikes of available leaflets, and opinions on providing tailored information. Results 143 GPs and 126 pharmacists responded. For new medicines, significantly more pharmacists than GPs reported providing leaflets all or most of the time. For repeat medicines, leaflets were more likely to be given only on request. Leaflets were given to ensure patients are well-informed. Most GPs and pharmacists report discussing sections of leaflets with patients. The likes and dislikes of leaflets were mostly about design and content. Both professions support tailoring leaflets to meet individual's requirements. Conclusions Provision of medicines information needs to be re-evaluated. Relying on verbal communication is inadequate and leaflet provision appears to be suboptimal. Making leaflets more patient-centred and accessible could improve health professionals' perceptions and use of them. Automated creation and provision of tailored summary leaflets would be beneficial. Further advantage could be gained by digital patient access.

Assessment of information resources for people with hypodontia

Aim:To assess the adequacy of patient information to support understanding and decision-making for people affected by hypodontia.Methods:1) Questionnaire to understand the provision of patient information by dentists; 2) Systematic search to identify online open-access patient information; 3) Quality assessment of written patient information.Results:Questionnaire response rate was 49% (319/649); 91% examined and/or treated people with hypodontia. Most general dentists referred patients to specialist services without providing written hypodontia information. The majority of dental specialists provide patient leaflets but less than a third used web-resources. Only 19% of respondents felt current resources were fit-for-purpose. Thirty-one patient resources (18 leaflets and 13 online) were assessed against quality criteria. The aim of the resource was seldom explicit, the content was often incomplete and variation in readability scores indicated high levels of literacy were required.Discussion:Access to, and quality of, patient information for hypodontia is inadequate. Current resources are not sufficiently comprehensive to prepare young patients to engage in shared dental care decisions with their parents and/or dental professionals.Conclusion:There is a need for improved access to, and provision of, information about hypodontia if dental professionals want to meet best practice guidance and involve patients in shared decision-making.

Human factors study of ZENEO® (needle-free autoinjector) and comparison of different user instruction formats.

ZENEO® (Crossject, Dijon France) is a novel prefilled, disposable needle-free auto-injector (AI) device under development for drug deliverer in a variety of routine-use or emergency situations. At present, reported user experience and patient preferences are limited. To determine what impact different forms of user instructions may have on successful use of the ZENEO® device. We conducted a human factors study on 134 healthy volunteers. On enrolment, subjects were provided with different instructive training material; a device quick guide plus either use of a dummy training device, an illustrated leaflet, or a demonstration video. After 6 weeks, subjects returned and performed an unaided simulated injection, and compliance with specific steps necessary for successful use, and avoidance of actions that interfere with appropriate use was recorded by an investigator. Most subjects (93.3%) successfully performed a simulated injection without major errors (regardless of type of educational instructions), and the great majority (97.5%) reported no difficulty in a range of objective measures of important necessary steps. Compliance with necessary steps and avoidance of detrimental actions was greater in those subjects with prior access to a demonstration video or provided with an illustrated patient leaflet. Prior experience with a dummy training device provided little if any benefit. User satisfaction with the device was high. The results show that the ZENEO® device can be effectively used with a conventional suite of printed user instructions. Use of a demonstration video provides additional value, whereas use of a dummy training device had limited value.

Community pharmacists' attitudes towards patient leaflets: Exploring perceptions underlying an electronic local production of tailored written information.

IntroductionLow health literacy in Portugal, revealed by limited patients' knowledge of their medication, may be improved by written information that is individually tailored for each patient. Tailored content can be produced through computer software and delivered by community pharmacies to patients.ObjectiveTo assess community pharmacists' real-life management, usage and perceived utility of software developed to produce individually tailored patient leaflets at community pharmacies.MethodsThe software contained five different pharmacist-selected clinical information fields which allows for the adjustment of information to each patient's information needs. Using an exploratory study design, community pharmacists' perceptions were purposively selected and qualitatively assessed. Interviews were recorded, transcribed verbatim and iteratively coded using a thematic approach outlined by attitudinal theory.ResultsEight participants took part in the study. Emerging codes led to the construction of two main themes: Current PLs usage in Portuguese community pharmacy; and Tailored PLs usage in Portuguese community pharmacy. Pharmacists exhibited a generally positive attitude concerning the relevance and use of patient leaflets to address individual patient's information needs, including an improvement in health literacy. The model was considered effective, functional, satisfying and user-friendly.ConclusionAlthough additional studies are needed, the introduction of a leaflet-tailoring software in Portuguese community pharmacies seems to be feasible as an additional resource to improve the quality of patient information and counselling. The next research steps should address the impact on patients' medicines-related information, including the level to which patients are able to correctly interpret the information and to adjust accordingly their health behaviours.Practice implicationsThe software fits present community pharmacy practice and routines, bringing advantages to pharmacists' willingness to deliver meaningful written information to patients, thus contributing to improved patient health literacy.

Is an opportunistic primary care-based intervention for non-responders to bowel screening feasible and acceptable? A mixed-methods feasibility study in Scotland

ObjectivesWe aimed to test whether a brief, opportunistic intervention in general practice was a feasible and acceptable way to engage with bowel screening non-responders.DesignThis was a feasibility study testing an...