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10.00 am 23 November 

Facilitator: Alyson Huntley

Jamie Ross

Supporting self-management by patients with long term conditions is an important and accepted part of addressing disease burden and managing health service use. For diabetes, self-management education (DSME) offers strategies to offset the challenges providers face in delivering chronic disease management, while also improving health outcomes for patients. Globally however, there are serious problems with participation in DSME. In the UK only 10.4% of patients diagnosed with type 2 diabetes attended DSME in 2016. The role of health care professionals (HCPs) is pivotal in patient decisions to attend DSME. Lack of enthusiasm, inadequate information provision and poor promotion of available programmes by HCPs have all been cited as affecting patients’ decisions to attend. Despite HCPs playing a key role in integrating DSME into routine care delivery and promoting self-management, there is little research into how this is actually done. This study investigates the ways in which issues of diabetes self-care, including DSME are raised and discussed in consultations between GPs and patients. Video recorded GP consultations from the One in a Million study (Bristol University) and the HaRi study (UCL) are analysed using a conversation analysis of relevant interactions between GPs and patients with type 2 diabetes or those at risk of developing diabetes. We explore whether/ how issues of self-care and DSME are raised as topics by GPs and how they are received and responded to by patients to identify strategies for GP consultations around DSME that will improve patient uptake.

Keywords: Diabetes, self-management, qualitative, healthcare interactions

Daniel Stow

Background: Tracking COVID-19 infections in the care home population has been challenging, because of the limited availability of testing and varied disease presentation. We consider whether National Early Warning Scores (NEWS/NEWS2) could contribute to COVID-19 surveillance in care homes.

Methods: We analysed NEWS measurements from care homes in England (December 2019 to May 2020). We estimated pre-COVID (baseline) levels for NEWS and NEWS components using 80th and 20th centile scores for measurements before March 2020. We used time-series to compare the proportion of weekly above-baseline NEWS to area-matched reports of registered deaths in care home residents from the Office for National Statistics Results: 29,656 anonymised NEWS were available from 6,464 people in 480 care home units across 46 local authority areas. From March 23rd to May 20th, there were 5,753 deaths (1,532 involving COVID-19, 4,221 other causes) in corresponding geographical areas. We observed a rise in the proportion of above-baseline NEWS beginning March 16th 2020. The proportion of above-baseline oxygen saturation, respiratory rate and temperature measurements also increased approximately two weeks before peaks in deaths.

Conclusions: NEWS could contribute to disease surveillance in care homes during the COVID-19 pandemic. Oxygen saturation, respiratory rate and temperature could be prioritised as they appear to signal rise in mortality almost as well as NEWS. This study reinforces the need to collate data from care homes, to monitor and protect residents’ health. Further work using individual level outcome data is needed to evaluate the role of NEWS in the early detection of resident illness.

Keywords: Covid, care homes, disease surveillance, public health

Ralph Kwame Akyea

Background: Cardiovascular disease (CVD) remains the leading cause of mortality globally. However, with improvement in patient management, there is a large proportion of people (1 in 17 of the global population) living with this long-term condition. The prognosis of patients diagnosed with CVD is sub-optimal, mainly due to the risk of recurrent adverse coronary events being greatest during the first year but persisting over one’s lifetime. To make a meaningful difference to the health and wellbeing of these individuals with established CVD, secondary prevention aimed at preventing a recurrence is a major priority.

Aim: To assess the prognostic performance of prognostic prediction models for severe cardiovascular disease (CVD) in adults with an established diagnosis of CVD.

Methods: Four (4) databases were searched from inception to March 2019: Ovid MEDLINE (R), EMBASE, PsycINFO and web of Science, for articles published in peer-reviewed journals, using search terms that cover expressions for cardiovascular disease, risk scores, and predictive performance assessment. Full-text screening for inclusion, quality assessment, and data extraction were done independently by 2 reviewers.

Results: The initial electronic search generated 4,178 records, including 1,615 citations from OVID Medline, 1,217 citations from OVID EMBASE, 75 citations from OVID PsycINFO and 1,271 citations from Web of Science. After removal of duplicates (n=1,499), the titles and abstracts of 2,679 citations have been screened. 105 eligible articles have been included in the review.

Implications: The findings of this review will contribute to the existing literature by identifying the current and most effective risk prediction models used to stratify CVD severity. The review will also provide an evidence base for the development of a risk stratification model in primary care.

Keywords: Cardiovascular disease, secondary prevention, prediction

Katie Saunders

My launching fellowship this year has three parts, first a research prioritisation exercise for LGBT health to inform a future fellowship application, second an opportunity to try to publish some prior work - mostly looking at multimorbidity and LGBT health, and finally a small amount of clinical time to explore whether I want to try to return to practice.

Keywords: LGBT health, multimorbidity, primary care, research prioritisation

Emma Clare Kilgour

Education using in-situ simulation is well established in Emergency Medicine (EM) and focusses on the management of emergency presentations in secondary care. Many GP trainees hold posts in EM and may struggle to grasp the relevance of such simulation programmes to their future career. This project aims to deliver bespoke teaching that bridges the gap between EM topics and the learning needs of GP trainees, by developing an in-situ simulation workshop orientated towards emergency presentations in primary care. It aims to demonstrate the relevance of the skills that trainees develop during a rotation in EM and expand on these skills in a primary care context. A pilot workshop was run at a local practice. Trainees participated in ‘anaphylaxis’ and ‘cardiac arrest’ simulations, followed by a debrief reflecting on participants’ reactions and understanding in order to meet intended learning outcomes. Pre- and post-workshop questionnaires were completed. Participants enjoyed the workshop, and felt it was applicable to their work environment and improved their confidence in dealing with emergency presentations in a primary care context. They felt the debrief provoked in depth discussion and helped them to reflect on how to improve their performance in future. As the pilot workshop was received so favourably, we aimed to address the participants’ and our own reflections, and then repeat the workshop with the next group of GP trainees rotating through EM. We aimed to evaluate this workshop using semi-structured interviews and subsequent thematic analysis. However, the current Covid-19 pandemic has introduced challenges related to the delivery of face to face education. Plans are underway to adapt the project to comply with current government guidelines.

Keywords: Primary Care, In-Situ, Simulation

Samantha Hornsey

Exploring Online Forums to Understand Parents’ and Families’ Views about Resources and Sources of Support for the Management of Children’s Chronic Insomnia in the Community and Primary Care.

Background: Behavioural insomnia, a form of chronic insomnia, is one of the most common sleep problems in children. Behavioural interventions are effective, however, there is limited research into how chronic insomnia is managed in primary care. Qualitative research of parents suggested that the internet is accessed for advice about sleep. Other research suggested parents use online forums for questions about their children. No published research to date has explored what parents discuss in online forums about the management of childhood chronic insomnia in primary care.

This study explores (1) what parents/carers of children express in online forums about their concerns/expectations about children’s sleep problems, (2) what online, community and primary care resources they are aware of to manage these problems, and (3) their perceptions of how sleep problems are addressed in primary care.

Methods: A qualitative study exploring parents discussions about their children’s sleep problems, in two public online forums. Scoping searches determined which forums and the various searches within them. 100 search results (first threads) were viewed on each forum and eligible threads are being analysed in NVivo (based on inductive thematic analysis).

Findings: Data collection is complete. Approximately 326 pages of data (from a total of 98 threads) are being analysed from the two forums. Findings will be discussed within the elevator pitch.

Discussion: Parent/carer views about available support within primary care and the community will be highlighted. This will highlight any areas for improvement and help inform future research such as the development of support tools.

Keywords: chronic Insomnia, child, primary care, management