Abstracts: S5

2.00pm 26 November 

Facilitator: Fiona Walter

Faraz Mughal

Background: Self-harm in young people is a major public health concern and is the strongest risk factor for suicide. Self-harm in young people presenting to general practice is rising, and general practice is where young people who self-harm attend for help most often. There is no published evidence on young people’s experiences and views of care received for self-harm in general practice. This study aimed to explore the experiences and perspectives of young people (aged 16-25) receiving care for self-harm in general practice, and barriers and facilitators to accessing general practice care.

Method: Semi-structured interviews with 13 young people from England were conducted between April-November 2019. Sampling was purposive to aim for maximum variation in age, gender, practice location, and socio-demographic status. Data are being analysed thematically using principles of constant comparison.

Results: Preliminary analysis has identified emerging themes. Young people report that stigma around self-harm behaviour hinders them from openly talking about self-harm with GPs, and that self-harm is overlooked by GPs. Young people describe how past experiences of GP care influence future help-seeking for self-harm. For young people who had positive experiences of GP care, continuity with the same GP was important. Full analysis will be presented.

Implications: This is the first study to relay young people’s experiences of care received for self-harm in general practice. These findings can improve care young people receive for self-harm. This study will inform the development of primary care self-harm models outlined in the NHS Long Term Plan and self-harm clinical guidelines.

Keywords: Self-harm, general practice, primary care, suicide prevention, young people

Laurie Davies

Introduction: Polypharmacy is common in older people with consequences that are not well understood. This is despite the very old (aged≥85) being the fastest growing subpopulation. I apply evidence synthesis and quantitative research methods to further our understanding of polypharmacy in later life.

Methods First, I summarise current evidence on the adverse outcomes of polypharmacy in older people through a systematic review of reviews. Building on my findings, including the lack of research in the very old and crude manner in which polypharmacy is often operationalised, I next examine polypharmacy in a more nuanced manner amongst the very old using data from the Newcastle 85+ Study. Finally, I examine the association between polypharmacy and all-cause mortality in the very old through Cox proportional hazards regression – operationalising polypharmacy at baseline, as a continuous and time-varying covariate.

Results Prescribing in the very old was relatively conservative, considering their complex medical conditions, but preventative medicines of unclear benefit were common. Each additionally prescribed medication increased the risk of mortality by a small amount, and as a time-varying covariate, a potential U-shaped pattern emerged with monotherapy (1 medicine) and hyperpolypharmacy (≥10 medicines) most associated with mortality.

Discussion More support to rationalise the prescription of preventative medicines in the very old might be helpful; the risk v benefit of each additionally prescribed medication should be carefully considered and monotherapy and hyperpolypharmacy might be able to serve as predictors of all-cause mortality at the population-level, potentially helping to facilitate a planned approach to palliative care.

Keywords: Polypharmacy, very old

Kieran Ayling

Background: Previous pandemics have resulted in high levels of psychological morbidity among frontline workers. Here I will discuss some of the early mental health impact of the COVID-19 pandemic on keyworkers in the UK, as assessed during the first six weeks of nationwide social distancing measures being introduced. Comparisons are made with non-keyworkers, and psychological factors that may be protective to keyworkers’ mental health are explored.

Methods: As part of a community cohort study instigated to examine the mental and physical health effects of the COVID-19 pandemic in the UK, keyworkers (n=1559) and non-keyworkers (n=1436) were recruited during April 2020. Participants completed an online survey measuring depression, anxiety, and stress levels and explanatory variables hypothesised to be related to these mental health outcomes.

Outcomes: Keyworkers and non-keyworkers reported significantly higher levels of depression, anxiety, and stress than pre-pandemic population norms. Compared to non-keyworkers, keyworkers were more likely to worry about COVID-19 and perceived they were at higher risk from COVID-19 but they reported significantly lower levels of stress. This was particularly evident for health and social care keyworkers. There were no significant differences between keyworkers and non-keyworkers for depression, anxiety, loneliness, or positive mood. Significant interactions were observed between keyworker status and gender. Specifically, female keyworkers reported lower levels of stress than female non-keyworkers whereas male keyworkers reported higher stress and anxiety levels than male non-keyworkers. Regression models among keyworkers showed younger keyworkers and those in a clinically increased risk group were more likely to report poorer mental health. Lower positive mood, greater loneliness and worrying more about COVID-19 were all associated with poorer mental health outcomes amongst keyworkers. Interpretation: The mental health impact of the COVID-19 pandemic on keyworkers in the UK has been substantial. Observed effects appear, however, to be broadly comparable to those seen in non-keyworkers. Worry about COVID-19 and perceived risk from COVID-19 in keyworkers are arguably understandable given potential increased exposure to the virus. Younger and clinically vulnerable keyworkers may benefit most from any interventions that seek to mitigate the negative mental health impacts of the pandemic. Addressing loneliness, worry about COVID-19, and increasing positive mood may be particularly beneficial.

Keywords: COVID-19, Keyworkers, Mental Health

Nicola Small

Establishing new Methods to utilise Patient reported feedback for Older people With multiple long-term conditions to increase EmpoweRment (EMPOWER) 

Little is known about how to empower older people with multiple long-term health conditions who have complex needs. Better use of patient reported outcome measures might enable measurement of feelings of empowerment to be expressed and measured by effective use of feedback data. Recent research indicates that feedback interventions that are evidence-based, person-centred and utilise digital methods have the potential to advance empowerment in practice, and my SPCR Launching fellowship aims to explore this area. I will pitch the first components to my study, EMPOWER, showcasing: (i) early results of a scoping review examining how feedback can be, or is used in primary care, with older people with multiple long-term conditions to share learning on the challenge of using feedback to drive change; (ii) virtual methods that I used to establish partnership working with members of the patient and public involvement and engagement group (PRIMER) at The Centre for Primary Care and Health Services Research at Manchester. Specially, how we co-created our aims for the review with two patient and public involvement contributors, and how we established our approach to patient and public involvement and engagement for the EMPOWER study with PRIMER members, to demonstrate how we formed a meaningful virtual partnership to establish a person-centred study. The next steps to the EMPOWER study will be unveiled, including the co-design of the ingredients of a new person-centred intervention, and a sub-study to EMPOWER revealed in a second pitch - please be sure to check the timetable to hear more!

Keywords: Empowering, person-centred, partnerships, evidence-based

Georgia Richards

Deaths from opioids have increased more than four-fold in England and Wales. In the US, 190 lives are lost every day due to opioid overdoses. Understanding how these deaths could be prevented may avert a US-style opioid crisis in the UK. Since 1984 in England and Wales, coroners have had a duty to report and communicate a death when the coroner believes that action should be taken to prevent future deaths. These reports, named Prevent Future Deaths (PFDs), became mandated and openly available on the Courts and Tribunals Judiciary website in 2013 (https://www.judiciary.uk/subject/prevention-of-future-deaths/). Under the new laws, individuals or organisations that receive PFDs are required to respond to the coroner within 56 days outlining actions taken or proposed. The aim of my research is to systematically analyse concerns raised by coroners’ in PFDs in which an opioid was implicated in a death, and the responses from individuals and organisations from such deaths. I have used an open and reproducible method called web scrapping to automatically collated all coroners’ PFD cases uploaded to the Judiciary website, and these methods were recently published in Nature (https://www.nature.com/articles/d41586-020-02558-0). Of the 3119 PFDs uploaded between 2013 and 2019, I have screened and categorised 1317 PFD reports of which 4.6% of deaths (n=142) involved an opioid. In this pitch I shall share preliminary findings of this research and dissemination methods I am employing to raise awareness of PFDs and prevent opioid deaths such as the creation of https://preventabledeathstracker.net/ and the launch of a new series titled Coroners’ Concerns to Prevent Harms in the BMJ Evidence Based Medicine journal (http://dx.doi.org/10.1136/bmjebm-2020-111567).

Keywords: Preventable, opioid, deaths