Secondary Care Services Research Articles

Examining the Relationship Between Trauma, Post-Traumatic Stress Disorder and Psychosis in Patients in a UK Secondary Care Service.

Traumatic experiences and post-traumatic stress disorder (PTSD) are common in schizophrenia. However, few studies screening for PTSD have established the temporality of PTSD-related traumatic events to psychosis onset. Furthermore, it is unclear how many patients attribute a trauma-based contribution to their psychosis or would find trauma-focused therapy acceptable. We examine the prevalence and timing of trauma in psychosis, as well as patient views on the relationship between their trauma experiences and mental health difficulties, and on receiving trauma-focused therapy. Sixty-eight patients with an at-risk mental state (ARMS) or psychotic disorder in a UK secondary-care setting completed self-report measures of trauma and PTSD, and undertook research interviews. Proportions and odds ratios were derived with 95% confidence intervals. We recruited 68 participants (estimated response rate 62%; psychotic disorder n=61, ARMS n=7). Sixty three (95%) reported traumatic events and 32 (47%) reported childhood abuse. Twenty-six individuals (38%) met criteria for PTSD, though for >95% this was not recorded in their notes, and 25 (37%) had sub-threshold PTSD. For 69% of participants, their worst trauma occurred before the onset of their psychosis symptoms. Most (65%) believed their psychosis symptoms were related to past traumas and 82% of these were interested in receiving trauma-focused therapy. PTSD is common in and often pre-dates onset of psychosis. Most patients believe their symptoms and traumas are related and would be interested in trauma-focused therapy if available. Studies evaluating the effectiveness of trauma-focused therapies for those with or at high-risk of psychosis are required.

Relationships Between Work Stress and Job Satisfaction Among Nurses

The aim of this research – to analyze the stress experienced by nurses at work and their job satisfaction.
 The broad professional competencies of nurses, constantly changing and unpredictable situations, and increasing work demands often cause stress for nurses [2]. Based on the analyzed literature of foreign authors, it can be stated that the stress of nurses in the work environment is widespread, and the high level of stress is determined by workload, responsibility, conflictual relationships and excessive authority [3-4]. Research evidence has shown that working in a supportive environment is necessary to increase nurses' job satisfaction [1]. Therefore, it can be assumed that one of the factors determining job satisfaction is the stress experienced in the working environment.
 The study was conducted in 2022. from May to September, it was attended by 382 nurses working in health care institutions providing secondary and tertiary health care services. A quantitative research method was chosen. The questionnaire is based on standardized scales. The approval of the Ethics Commission of the Department of Nursing, Faculty of Health Sciences, Klaipėda University (No. 46Sv-S0-07) was obtained for conducting the study.
 Conclusions. The level of subjectively perceived stress of nurses was found to be higher than average. Nurses under the age of 50, with a university education and working for less than 10 years felt statistically significantly more stressed. Stress at work is caused by patient death and dying, heavy workload and problems with patients and their families. More than two thirds of nurses are moderately satisfied with their work. Job satisfaction was provided by the nature of work, management and relations with colleagues. The least satisfied were the salary, the possibility of recognition, the privileges granted and the work organization.

Agreement and consistency in the triaging of musculoskeletal primary care referrals by vetting clinicians using a knowledge-based triage tool.

Primary care referrals received by secondary care services are vetted or triaged to pathways best suited for patients' needs. If knowledge-based triaging is used by vetting clinicians, accuracy is required to avoid incorrect decisions being made. With limited evidence to support best practice, we aimed to evaluate consistency across vetting clinicians' decisions and their agreement with a criterion decision. Twenty-nine trained vetting clinicians (18 female) representative of pay grades independently triaged five musculoskeletal physiotherapy referral cases into one of 10 decisions using an internally developed triage tool. Agreement across clinicians' decisions between and within cases was assessed using Fleiss's kappa overall and within pay grade. Proportions of triage decisions consistent with criterion decisions were assessed using Cochran's Q test. Clinician agreement was fair for all cases (κ = 0.385) irrespective of pay grade but varied within clinical cases (κ = -0.014-0.786). Proportions of correct triage decisions were significantly different across cases [Q(4) = 33.80, P < 0.001] ranging from 17% to 83%. Agreement and consistency in decisions were variable using the tool. Ensuring referrer information is accurate is vital, as is developing, automating and auditing standards for certain referrals with clear pathways. But we argue that variable vetting outcomes might represent healthy pathway abundance and should not simply be automated in response to perceived inefficiencies.

La Medicina Traslazionale: un ponte tra laboratorio e letto del paziente?

Translational Medicine: a bridge between bench and patient bedside? Translational medicine (TM) can be defined as the interdisciplinary application of biomedical research for the improvement of health of patients and society. The focus of TM has so far been largely on the bench-to-bedside rather than bedside-community transition of research. Several “Valleys of Death” in this process have been described, identifying transitional failures that may halt or impede the pathway, which would otherwise lead to the development of medicines, technologies, and/or evidence-based practice guidelines. In order to help bridge these gaps, increasing patient-orientated research at each stage could improve the success of projects and increase societal impact. Increasing the accessibility and involvement of patients in TM outside of traditional research centers, such as universities and teaching hospitals, is one crucial pre-requisite. For example, where clinical research units with active links to local universities have been set-up, research participation can be increased. Such non-traditional research centers (NRTCs) might include primary or secondary care services, or even social care institutions. TM professionals (TMPs) from multi-disciplinary backgrounds, with work experience in university or research centers and with experience of TM, could play a vital role in this organizational change. TMPs in NTRCs are well placed to collaborate with local universities, larger research centers and commercial research and development organizations. Exchanging information could benefit all shareholders involved. TMPs can also stimulate the education and innovative thinking that is required for TM to achieve its full societal impact. We discuss the scope of a potential role for TMPs in NTRCs, as well as the possible barriers and difficulties they might face, along with measures that could widen the accessibility of TM outside of the traditional setting.

The feasibility and effectiveness of telecare consultations in nurse-led post-acute stroke clinics: A study protocol.

Globally, nurse-led post-acute stroke clinics have been developed to provide secondary care services to stroke survivors. Although synthesized evidence supports the idea that the secondary prevention services delivered by nurses in these clinics can improve the functional ability of stroke survivors and reduce their readmission rates, long travel and waiting times, high costs, and the pandemic have limited the utilization of such clinics. Telecare consultations are a new modality for expanding public access to healthcare services, although how it can be applied in nurse-led clinics has not been reported. The aim of this study is to determine the feasibility and effects of telecare consultations in nurse-led post-acute stroke clinics. The study adopts a quasi-experimental design. The participants will receive three secondary stroke care consultations in 3 months provided via telecare by experienced advanced practice nurses. The outcome measures include feasibility (reasons for refusing to participate and for dropping-out, the attitudes and satisfaction of both the advanced practice nurses and their patients towards the programme), and preliminary effectiveness (degree of disability after stroke, activities of daily living, instrumental activities of daily living, health-related quality of life, depression) outcomes. Data will be collected at pre-(T1) and post-(T2) intervention. The findings of this study may help facilitate the implementation of telecare consultations in a nurse-led post-acute stroke clinic, which may benefit the stroke survivors who are having mobility restrictions from accessing customary healthcare services and may protect them from being exposed to the infectious risk.

Protein Convertase Subtilisin/Kexin Type 9 Monoclonal Antibodies (PCSK9mab) in Clinical Practice at Secondary Care - Real World Multicentre Experience.

Background and Aims Protein convertase subtilisin/Kexin type 9 monoclonal antibodies (PCSK9mab) are a novel addition to the therapeutic options for managing hyperlipidemia. Various guidelines have advocated the addition of these agents if the target low-density lipoprotein-cholesterol ( LDL-C) is not achieved by maximum lipid-lowering therapy. They have shown a robust and consistent reduction in LDL-C in clinical trials. However, the translation of these results in a real-world setting is limited and confined mainly to tertiary lipid centers. This service evaluation aimed to assess their efficacy in a real-world outpatient setting of secondary care centers. Methods Data was collected retrospectively from four hospitals in the North-West of England. Patients were required to attend a lipid clinic for follow-up investigations to continue with the prescription of PCSK9mab. Results A total of 175 patients were identified. Efficacy outcomes were measured in 169 patients. 6 discontinued the agent within 3 months of initiation and were excluded from the efficacy outcomes. 19.5% (n=33) had confirmed familial hypercholesterolemia. 61% (n=103) of the patients were intolerant to statins. 53.2% (n=90) of the patients have been prescribed Alirocumab. Mean LDL-C reduction was 50.6% at 6-month which was sustained at 48.9% at 12 months. There was no difference in % reduction of LDL-C between Alirocumab and Evolocumab. LDL-C reduction was more significant in patients who were on concomitant statins. 9.1% of patients experienced side effects, and 5.1% discontinued the PCSK9mab during treatment. Conclusion The efficacy of lipid reduction and the side effect profile of PCSK9mab from these secondary care services are similar to randomized clinical trials and real-world observational studies from tertiary lipid centers.

Health related quality of life, service utilization and costs for patients with Huntington’s disease in Norway

BackgroundHuntington’s disease (HD) is a progressive genetic neurodegenerative disease accompanied by mental and neurocognitive disabilities, which requires long-term and comprehensive treatment and care. Information on the health and economic burden of HD is scarce, but essential for conducting health economic analyses, in light of the prospect of new therapies for HD. In this study, we aim to identify values for Health-Related Quality of Life (HRQoL), describe service utilization and costs, and their associations with clinical and socio-demographic variables across all phases of HD.MethodsA cross-sectional study including 86 patients across all phases of HD. Values of HRQoL were calculated based on EQ-5D-3L index scores. Additionally, health care and societal costs were estimated based on service utilization collected using the Client Service Receipt Inventory (CSRI) and data from the patients’ interviews. Total societal costs included costs of primary and secondary health care services, informal care and productivity loss of the patients. Multiple regression analyses were used to investigate associations between socio-demographic and clinical variables on HRQoL and costs.ResultsHRQoL values declined, while total costs increased across disease severity. Total six-month healthcare costs and total societal costs were € 18,538 and € 66,789 respectively. Healthcare and societal costs doubled from early to middle phase, and tripled from middle to advanced disease phase. Main six-month cost components for the three disease phases were informal care costs (€ 30,605) accounting for approximately half the total societal costs, and costs due to production loss (€ 18,907) being slightly higher than the total healthcare costs. Disease severity and gender were found to have the strongest effect on both values of HRQoL and costs.ConclusionsReported values of HRQoL and costs including costs for production loss may be used in modelling the cost-effectiveness of treatment for HD. Our results highlight the crucial role the informal caregivers play in the care provided to HD patients in all disease phases. Future research should focus on the estimation of productivity loss among informal caregivers.

Prevalence of and factors associated with multimorbidity among 18 101 adults in the South East Asia Community Observatory Health and Demographic Surveillance System in Malaysia: a population-based, cross-sectional study of the MUTUAL consortium

ObjectivesTo assess the prevalence and factors associated with multimorbidity in a community-dwelling general adult population on a large Health and Demographic Surveillance System (HDSS) scale.DesignPopulation-based cross-sectional study.SettingSouth East Asia Community...

Beliefs and Sociodemographic and Occupational Factors Associated with Vaccine Hesitancy among Health Workers.

Introduction: Vaccine hesitancy has been implicated in the low-vaccination coverage in several countries. Knowledge about vaccine hesitancy predictors in health workers is essential because they play a central role in communication about the importance and safety of vaccines. This study aimed to assess beliefs and sociodemographic and occupational factors associated with vaccine hesitancy in health workers. Methods: This was a cross-sectional study among 453 health workers in primary and medium complexity services in a municipality in the state of Bahia, Brazil. The variable vaccine hesitancy was operationalized based on the answers related to incomplete vaccination against hepatitis B, measles, mumps and rubella, and diphtheria and tetanus. Associations between variables were expressed as prevalence ratios (PR) and their respective 95% confidence intervals (CI). Results: Endemic disease combat agents, administrative service workers, and support staff had the highest levels of vaccine hesitancy. Among the analyzed variables, the following were associated with vaccine hesitancy: working in secondary health care services (PR: 1.21; CI: 1.07-1.36), working as an endemic disease combat agent (PR = 1.42; 95% CI: 1.165-1.75), not sharing information about vaccines on social media (PR = 1.16; 95% CI: 1.05-1.28), distrusting information about vaccinations (PR: 0.86; CI: 0.75-0.99), and not feeling safe receiving new vaccines (PR = 1.16; 95% CI: 1.06-1.28). Conclusions: Strategies to enhance confidence in vaccination among health workers should consider differences in occupations and their working settings. Improving vaccination-related content in training and continuing education activities and facilitating access to onsite vaccinations at the workplace are crucial elements to reduce vaccine hesitancy among health workers.

Occupational health patients' parallel use of primary- and secondary-care services and linkage to work disability: A follow-up study in Finland.

This study aimed to investigate occupational health (OH) primary-care patients' use of other health-care services and whether parallel use affects their likelihood to have sickness absences (SA) or disability pensions (DP). Primary-care services in Finland are provided through three parallel health-care sectors, all available to the working population: public, private and OH sectors. Patients may also be referred to secondary care. This follow-up study combines real-world medical record data containing SA data from a nationwide OH provider with health-care attendance data from public and private primary-care sectors and public secondary care, sociodemographic data and DP decisions. Patients between 18 and 68 years of age who used OH primary care at least once during the study years 2014-2016 were included. The total study population comprised 59,650 patients. Odds ratios were used to analyse association between parallel service use and SA or DP. Females and patients with a lower educational level were more likely to use services in other health-care sectors in addition to OH than others. Those patients who used any other health-care sector in addition to OH primary care had an increased likelihood of having long SA or receiving DP. OH primary-care patients using the services of several health-care sectors in parallel have an increased likelihood of receiving disability benefits - either SA or DP. There is need for care coordination to ensure adequate measures for work-ability support.

Recovering from COVID-19: lessons learnt from an intensive secondary care follow-up service

In response to the first COVID-19 surge in 2020, secondary care outpatient services were rapidly reconfigured to provide specialist review for disease sequelae. At our institution, comprising hospitals across three sites in London, we initially implemented a COVID-19 follow-up pathway that was in line with expert opinion at the time but more intensive than initial clinical guidelines suggested. We retrospectively evaluated the resource requirements for this service, which supported 526 patients from April 2020 to October 2020. At the 6-week review, 193/403 (47.9%) patients reported persistent breathlessness, 46/336 (13.7%) desaturated on exercise testing, 167/403 (41.4%) were discharged from COVID-19-related secondary care services and 190/403 (47.1%) needed 12-week follow-up. At the 12-week review, 113/309 (36.6%) patients reported persistent breathlessness, 30/266 (11.3%) desaturated on exercise testing and 150/309 (48.5%) were discharged from COVID-19-related secondary care services. Referrals were generated to multiple medical specialties, particularly respiratory subspecialties. Our analysis allowed us to justify rationalising and streamlining provisions for subsequent COVID-19 waves while reassured that opportunities for early intervention were not being missed.

Classification of private hospitals in Northern Senatorial District of Taraba State, Nigeria

The study determined the spatial distribution and classification of private hospitals in the Northern Senatorial District of Taraba, Nigeria. A survey research design was adopted for the study. Interview, ground truth observation and handheld GPS device were the tools employed in data collection. Data analysis involved the descriptive statistics and geospatial mapping of the study area. The result shows that there are 40 private hospitals across the northern senatorial districts of Taraba state. These are distributed as follows; Karim-Lamido has seven (7), Ardo-Kola has three (3), Lau has three (3), Yorro has three (3), Zing has one (1), and Jalingo has twenty-three (23). The result shows that the nearest neighbour ratio is 0.816940 (observed mean distance divided by the expected mean distance), with a critical value of &lt;-2.58 and a test of significance of P-value of 0.0071445. The result shows that the spatial pattern of distribution of private hospitals in the northern Taraba senatorial district is random, and there is less than 1% likelihood that this random pattern could be the result of random chance. The random pattern shows that the hospitals are not evenly distributed over space. This implies that the private hospitals in the northern senatorial district of Taraba State are randomly distributed. The result shows that there are 94 medical doctors and 176 nurses representing 27.9% and 52.2%, respectively, showing an average ratio of one doctor to two nurses per hospital (1:2). The result revealed that two (2) private hospitals are single-specialty tertiary care hospitals; Nobis Eye Clinic offering ophthalmological care services while Balsam Clinic offers osteology services. Three (3) general secondary care services (Jaji Memorial Hospital, UMCN Hospital &amp; Catholic Hospital), while the remaining thirty-five offer primary care/nursing homes. The result also shows that there are three (3) specialty hospitals in the study area; this includes osteology (Balsam Clinic), ophthalmology (Nobis Eye Clinic) and a dental hospital (Family Dental Hospital). All these are located in Jalingo, the state capital. The others offer services in the category of general hospitals, though only a few (3) have the bed capacity to be classified as a general hospital. The study recommended that the distribution of private hospitals should be planned in such a way that they can reach more patients in terms of spatial coverage. It is further recommended that private hospitals should upgrade their facilities and bed capacity and employ more nurses and pharmacists to cater for the vast number of patients in the study area.

Mainstreaming adult ADHD into primary care in the UK: guidance, practice, and best practice recommendations

BackgroundADHD in adults is a common and debilitating neurodevelopmental mental health condition. Yet, diagnosis, clinical management and monitoring are frequently constrained by scarce resources, low capacity in specialist services and limited awareness or training in both primary and secondary care. As a result, many people with ADHD experience serious barriers in accessing the care they need.MethodsProfessionals across primary, secondary, and tertiary care met to discuss adult ADHD clinical care in the United Kingdom. Discussions identified constraints in service provision, and service delivery models with potential to improve healthcare access and delivery. The group aimed to provide a roadmap for improving access to ADHD treatment, identifying avenues for improving provision under current constraints, and innovating provision in the longer-term. National Institute for Health and Care Excellence (NICE) guidelines were used as a benchmark in discussions.ResultsThe group identified three interrelated constraints. First, inconsistent interpretation of what constitutes a ‘specialist’ in the context of delivering ADHD care. Second, restriction of service delivery to limited capacity secondary or tertiary care services. Third, financial limitations or conflicts which reduce capacity and render transfer of care between healthcare sectors difficult. The group recommended the development of ADHD specialism within primary care, along with the transfer of routine and straightforward treatment monitoring to primary care services. Longer term, ADHD care pathways should be brought into line with those for other common mental health disorders, including treatment initiation by appropriately qualified clinicians in primary care, and referral to secondary mental health or tertiary services for more complex cases. Long-term plans in the NHS for more joined up and flexible provision, using a primary care network approach, could invest in developing shared ADHD specialist resources.ConclusionsThe relegation of adult ADHD diagnosis, treatment and monitoring to specialist tertiary and secondary services is at odds with its high prevalence and chronic course. To enable the cost-effective and at-scale access to ADHD treatment that is needed, general adult mental health and primary care must be empowered to play a key role in the delivery of quality services for adults with ADHD.

Measuring Efficiency Performance in Primary Public Health Clinics, Sarawak, Malaysia

The health care system in Malaysia has undergone various reforms in order to improve its performance. In Malaysia, secondary and tertiary care services are provided by hospitals, while primary care services are supplied by health clinics. Health clinics are constrained with limited resources in providing health services to the public. The optimum utilization of resources in health clinics is thus critical and warrants empirical investigation. Using data envelopment analysis (DEA) by employing three inputs and three outputs of 32 decision-making units (DMUs), this study aims to measure the technical efficiency and scale efficiency of health clinics in Samarahan District, Sarawak. Data was drawn from 16 public health clinics in the district over 2 years from 2015 to 2016. Our results show that only 34.37% of health clinics are operating at the efficient scale of production within the most productive scale size (MPSS), while the remaining 65.63% of health clinics either experience increasing returns to scale (37.50%) or diminishing returns to scale (28.13%). 68.75% of health clinics are technically efficient while only 31.25% are technically inefficient. The article advances several public policy recommendations for improving the performance of the health clinics.

미등록 이주아동의 기본권 보장에 관한 연구

About 20,000 undocumented immigrant children live in Korea, but the fundamental rights for their lives are not guaranteed. In particular, they are suffering from problems such as birth registration, the infringement of the right to health and education. With regard to the birth registration of undocumented immigrant children, european countries stipulate that the birth of all children in that country can be registered regardless of their parents’ status and automatically issue birth certificates without further action. Since the universal birth registration system and issuance of related documents are the basic premise for respecting children's dignity as human beings, Korea also needs to introduce such procedures as soon as possible. Regarding the right to health of undocumented immigrant children, providing daily medical services other than emergency medical services is considered a social security area, but children's health is the most significant element for life maintenance and whole-person development, so medical access should be guaranteed regardless of the legality of residence status. We need to guarantee minimum medical access of undocumented children to maintain their health through providing emergency medical services, primary and secondary medical care services to the same extent as Korean children, or providing cost support. And in respect of guaranteeing undocumented immigrant children's right to education, we should strive to ensure that undocumented immigrant children receive education without discrimination in accordance with international society’s good practice of explicitly stipulating all children's right to education including undocumented immigrant children.

Impact of integrating out-of-hours services into Emergency Medical Services Copenhagen: a descriptive study of transformational years

BackgroundMany emergency medical services and out-of-hours systems are facing an increasing demand for primary, ambulance, and secondary care services caused by population aging and a higher prevalence of long-term and complex conditions. In order to ensure safety and efficiency for future demands, many systems are changing their dispersed healthcare services towards a more integrated care system. Therefore, an evaluation of the production and performance over time of such a unified system is desirable.MethodsThis retrospective quantitative study was performed with dispatch and financial accounting data of Copenhagen Emergency Medical Services for the period 2010–2019. Copenhagen Emergency Medical Services operates both an emergency number and a medical helpline for out-of-hours services. The number of calls to the emergency number, the centralized out-of-hours medical helpline, the number of dispatches, and the annual expenditure of the system are described for both the periods before and after the major reforms. Production of the emergency number and the centralized medical helpline were analyzed separately.ResultsThe average number of dispatches increased from 328 per 10,000 inhabitants in 2010 to 361 per 10,000 inhabitants in 2019. The newly initiated medical helpline received 533 calls per 10,000 inhabitants in its first year and 5 years later 548 calls per 10,000 inhabitants. A cost increase of 10% was observed in the first year after the reforms, but it decreased again to 8% in the following year.ConclusionsThere is a population demand for a centralized telephone access point for (semi-)emergency medical services. A more integrated EMS system is promising for a sustainable healthcare provision for a growing population with complex healthcare demands and multi-morbidities.

Primary and Secondary Care Related Quality Indicators for Dementia Care Among Australian Aged Care Users: National Trends, Risk Factors, and Variation.

Studies related to clinical quality indicators (CQIs) in dementia have focused on hospitalizations, medication management, and safety. Less attention has been paid to indicators related to primary and secondary care. To evaluate the incidence of primary and secondary care CQIs for Australians with dementia using government-subsidized aged care. The examined CQIs were: comprehensive medication reviews, 75+ health assessments, comprehensive geriatric assessments, chronic disease management plans, general practitioner (GP) mental health treatment plans, and psychiatrist attendances. Retrospective cohort study (2011-2016) of 255,458 individuals. National trend analyses estimated incidence rates and 95% confidence intervals (CI) using Poisson or negative binomial regression. Associations were assessed using backward stepwise multivariate Poisson or negative binomial regression model, as appropriate. Funnel plots examined geographic and permanent residential aged care (PRAC) facility variation. CQI incidence increased in all CQIs but medication reviews. For the overall cohort, 75+ health assessments increased from 1.07/1000 person-days to 1.16/1000 person-days (adjusted incidence rate ratio (aIRR) = 1.03, 95% CI 1.02-1.03).Comprehensive geriatric assessments increased from 0.24 to 0.37/1000 person-days (aIRR = 1.12, 95% CI 1.10-1.14). GP mental health treatment plans increased from 0.04 to 0.07/1000 person-days (aIRR = 1.13, 95% CI 1.12-1.15). Psychiatric attendances increased from 0.09 to 0.11/1000 person-days (aIRR = 1.05, 95% CI 1.03-1.07). Being female, older, having fewer comorbidities, and living outside a major city were associated with lower likelihood of using the services. Large geographical and PRAC facility variation was observed (0-92%). Better use of primary and secondary care services to address needs of individuals with dementia is urgently needed.

UK healthcare services for people with fibromyalgia: results from two web-based national surveys (the PACFiND study)

BackgroundThe UK’s “Getting It Right First Time” programme recommends that management of people with fibromyalgia should centre on primary care. However, it remains unclear as to how best to organise health systems to deliver services to optimise patient outcomes.AimTo profile UK healthcare services for people with fibromyalgia: provision of National Health Services (NHS) and use of non-NHS services by people with fibromyalgia.MethodsTwo online open surveys (A and B) incorporating questions about diagnosis, treatment and management of fibromyalgia and gaps in healthcare services were conducted between 11th September 2019 and 3rd February 2020. These were targeted to NHS healthcare professionals consulting with people with fibromyalgia (Survey A) and people ≥16 years diagnosed with fibromyalgia using non-NHS services to manage their condition (Survey B). Descriptive statistics were used to report quantitative data. Thematic analysis was undertaken for qualitative data.ResultsSurvey A received 1701 responses from NHS healthcare professionals across the UK. Survey B received 549 responses from people with fibromyalgia. The results show that NHS services for people with fibromyalgia are highly disparate, with few professionals reporting care pathways in their localities. Diagnosing fibromyalgia is variable among NHS healthcare professionals and education and pharmacotherapy are mainstays of NHS treatment and management. The greatest perceived unmet need in healthcare for people with fibromyalgia is a lack of available services. From the pooled qualitative data, three themes were developed: ‘a troublesome label’, ‘a heavy burden’ and ‘a low priority’. Through the concept of candidacy, these themes provide insight into limited access to healthcare for people with fibromyalgia in the UK.ConclusionThis study highlights problems across the NHS in service provision and access for people with fibromyalgia, including several issues less commonly discussed; potential bias towards people with self-diagnosed fibromyalgia, challenges facing general practitioners seeking involvement of secondary care services for people with fibromyalgia, and a lack of mental health and multidisciplinary holistic services to support those affected. The need for new models of primary and community care that offer timely diagnosis, interventions to support self-management with access to specialist services if needed, is paramount.

Inpatient palliative care use by patients with sickle cell disease: a retrospective cross-sectional study

ObjectiveSickle cell disease (SCD) is a highly morbid condition notable for recurrent hospitalisations due to vaso-occlusive crises and complications of end organ damage. Little is known about the use of...

Did the March 2020 lockdown cause an increase in patients presenting to the emergency department with odontogenic pain and infection? A single centre, retrospective analysis

On the 25 March 2020 the Chief Dental Officer (CDO) published guidance to restrict the provision of routine dental care in England due to the rapid spread of the severe acute respiratory syndrome Coronavirus 2 (COVID-19). We analysed the impact of the pandemic on the number of patients presenting with odontogenic pain and infection to the emergency department (ED) of an urban-based teaching hospital, the Bristol Royal Infirmary (BRI). Furthermore, we investigated the severity of infection at first presentation to the ED. The study period encompassed three phases that represented the stages of pandemic restrictions: phase 1 prior to lockdown measures, with no restrictions to dental practice; phase 2 during the government lockdown, with the severest restrictions on dental practices; and phase 3 following the ease of lockdown measures, with return to limited dental services. Data were collected retrospectively from electronic patient records (EPR) regarding adult patients presenting to the ED with dental pain. The rate of presentations (per week) was calculated for each timepoint and compared. A severity score was assigned to each patient using a grading system based on signs of clinical infection and treatment modality. Patients' presentations were analysed at each phase of the pandemic. There was a 42.8% increase in attendance with oral facial pain and infection to ED from phases 1 to 3. The COVID-19 pandemic resulted in restrictions to routine primary dental care services, which were deemed necessary to reduce the spread of the virus. However, this increased demand on secondary care services, as patients increasingly struggled to access primary dental care to manage dental pain.