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2.00pm, 7 December 

Facilitator: Elizabeth Murray

Laura Swaithes

Background: Musculoskeletal disorders are one of the most common causes of pain and disability. We know from research evidence what ‘best care’ for musculoskeletal disorders looks like. However best care rarely happens in practice. This means there is a gap between research evidence and real practice. Researchers and clinicians try to bridge this gap to improve quality care. Yet, we don’t know how to best support clinicians (e.g. physiotherapists) and funders of care (e.g. commissioners) to give best care. We also don’t know what role patients play in bridging this gap. A national NIHR report (Moving Forward themed review) provides an overview of recommended research for physiotherapy in treating musculoskeletal disorders. Keele University have established a Community of Practice to ensure that the recommendations from this national report are taken up across Staffordshire. This project is nested within this larger program of work and aims to a) investigate how research evidence, from a national report, for musculoskeletal disorders is used within a single physiotherapy setting, b) investigate the role that patients and the public play, and, c) inform the development of ‘lessons learnt’

Methods:
1. Interviews with stakeholders (patients, physiotherapists, commissioners, managers, researchers)
2. Observations of Community of Practice and planning meetings

Outputs:
1.Evidence of the factors that help or hinder the uptake of evidence
2.Understanding the role that patients and the public play in applying evidence into physiotherapy practice
3. Development of ‘lessons learnt’ to support other areas to apply the evidence from the national report

Keywords: musculoskeletal; implementation; qualitative

Ben Bowers

Community end-of-life injectable anticipatory medication prescribing practice: a retrospective mixed methods observational study. Standardised anticipatory medication prescribing patterns and the variability in the timing of prescriptions highlight the challenges in diagnosing dying, and the risks involved in prescribing far in advance of possible need.

Keywords: End-of-life Care, Prescribing, Decision Making, General Practice, Community Nursing

Johanne Dow

Abstract to follow

Keywords: Dementia, primary care, chronic disease management

Alexandra Jager

The 2012 Health and Social Care Act and subsequent governmental health policies have mandated of the use of research and evidence in commissioning and stated that service commissioners should be able to access and utilise data for commissioning planning and research. Despite the availability of an unprecedented amount of data, there is limited understanding about how this is used to inform commissioning decisions. Integrating more evidence into commissioning is a complex process and previous interventions suggest it is unlikely to be achieved solely through dissemination of evidence amongst commissioners or closer relationships between commissioners and researchers. Adjacent literature on bridging the “gap” between evidence and policy has identified numerous barriers e.g. a lack of skills amongst policy makers, but the process of the use of evidence by policy remains understudied.

The aim of this research is to explore the contexts that influence the usage of data within NHS primary care commissioning by asking:
• What are the underlying mechanisms to using data in primary care commissioning, in what contexts do they occur and how do they vary?
• Which contexts relate to which outcomes, and which contexts are more likely to result in data being used in commissioning decisions?

In this DPhil, data is defined as quantitative, statistical evidence.

This DPhil project began with a systematic review to collect and analyse secondary data and synthesise findings qualitatively using a realist approach. The second, ongoing part of the research consists of primary data collection utilising a multi-method approach consisting of interviews, analysis of meeting minutes and document analysis.

Keywords: Commissioning, realist review, data, evidence

Anna Stevenson

GENERALISM Systematic Mixed-Studies Review

Authors: Anna Stevenson, Sarah Cheung, Martina Kelly, Surinder Singh, Agalya Ramanathan, Julia Hamer-Hunt (PPI representative) and Sophie Park.

Background: Educating clinicians to support development of a generalist skill base is a well-recognised need. However, recruitment of graduates into generalist disciplines is internationally less than anticipated to meet societal needs. Potential factors for this deficit include the lack of a clear definition of ‘generalism’, professional stigma about medical generalism, and a lack of explicit attention to the topic of generalism within undergraduate training.

Aim: This systematic review aimed to examine published, international empirical literature about physician clinical practice to: describe how Generalism and 'being a generalist' are characterised; recommend how review findings can inform healthcare professions’ training and curricula to meet future system needs for generalism and generalists; and examine how patients are described and positioned within this literature.

 Methods/Design: Seven databases (Medline, Psycinfo, Socioindex, EMBASE, OVID Healthstar, Scopus, Web of Science) were searched and refined to 265 eligible papers including quantitative, qualitative, mixed-methods study designs and systematic reviews. Data was extracted and analyzed using convergent synthesis design, facilitated by template analysis. This presentation focuses on findings relevant to patient characteristics, experience and pathways described within the data.

Discussion/ Conclusions: We focus discussion on implications of key review findings for patient access, use and interface with generalist healthcare. We share PPI discussion of the review, and propose recommendations for future ways to support patient use and engagement with generalist services, alongside ideas for shifting public and societal attitudinal norms about the strengths and limitations of generalism.

Keywords: Generalism, patient characteristics, systematic mixed study review, patient engagement

AARON POPPLETON

Over 2 million Central and Eastern Europe (CEE) nationals live within the UK. They are at increased risk of poor mental health, with high rates of stress, homlessness, alcohol overuse, and suicide. Barriers to engagement, community dissatisfaction and mental health stigma have led to primary care underutilisation, with resultant unmet health needs, late presentations and poorer outcomes. My PhD aims to build the evidence and intervention base for primary care to effectively meet the mental health needs of the UK CEE community. This will be realised through: 1) Developing a health beliefs and utilisation framework of UK CEE primary care mental health engagement; 2) Coproducing primary care resources and recommendations; and 3) Output dissemination and implementation in practice. The research will comprise four work packages (WP1-4). WP1. Representative in-depth qualitative community member interviews, employing co-produced culturally adapted semi-structured questions. WP2. Primary care clinician and non-clinician staff focus groups exploring perceptions of UK-CEE patients’ healthcare usage and mental health beliefs. Analyses of WP1/2 will employ a constructivist approach, with outcome mapping to a ‘behavioural model of health services’ informed multidimensional thematic framework. WP3. Development of a theory informed co-designed ‘multi-level mental health resource’ package incorporating psychological behaviour change and normalisation process theories. Components will be community member and clinician defined, likely including structural guidance, educational and self-care resources. WP4. In-practice field testing will occur concurrently with iterative focus group directed refinement. Tailored output dissemination to stakeholders, academics, clinicians, and policymakers will inform resource implementation within a postdoctoral feasibility trial.

Keywords: Ethnic minority, Mental health, Primary Care