Search results

Drivers of primary care appointment volumes before and after the COVID-19 pandemic: a longitudinal study

Quality of life and physical activity in type 1 diabetes

Introduction T1 Diabetes (T1D) is one of the most common chronic diseases in children and young people [1] with almost 34 000 aged 18 years or less living with T1D [2]. Physical activity is promoted as one of a number of management tools for people living with diabetes, being associated with significant health benefits including improved glycaemic control. The benefits of physical activity on quality of life in children with T1D is unclear with confounding effects of disease duration and co-morbidities in studies. Aim To determine the effect of physical activity interventions on quality of life of children with type 1 diabetes. Methods A systematic review was conducted and reported in line with PRISMA 2009 guidance. The CINAHL, Embase, International Pharmaceutical Abstracts, Medline, PubMed and PsychINFO databases were searched for the period January 1994 to March 2025. Papers were included in the present review if they included a study intervention in children under 19 years of age that was more than a single exercise session and had a control group (with or without T1D) as a comparator group. The primary outcome measure was Quality of Life (QoL) indicators. Results We assessed 3020 records, of which three randomised controlled trials (RCT) published between 2007 and 2020 met study inclusion criteria. There was significant heterogeneity in study design, methods and reporting. Benefits of physical activity were not consistently seen across studies. Conclusion There remains limited data on QoL outcomes or even a standardisation for measuring QoL in this cohort as seen by the various validated tools used across studies. There continues to be a need for further work to understand the additional framework (psychological underpinning) to cause longer term impactful changes on both physical and psychological health in children with T1D.

Understanding Measurement of Postural Hypotension (UMPH): a nationwide survey of general practice in England

Background Postural hypotension (PH) is associated with excess mortality, falls and cognitive decline. PH is poorly recorded in routine general practice (practice) records. Few practice studies have explored measurement and diagnosis of PH. Aim To understand how PH is measured, diagnosed and managed in practice. Design and setting Online survey of practice staff in England. Method Clinical Research Networks distributed the survey to practices, seeking individual responses from any clinical staff involved in routine blood pressure (BP) measurement. Responses were analysed according to role and demographic data using descriptive statistics. Multivariable modelling of undertaking postural BP measurements was performed. Results 703 responses were received from 243 practices (mean practice-level response rate 17%). Half (362; 51%) of respondents were doctors, 196 (28%) practice nurses and 77 (11%) healthcare assistants (HCAs). Eight percent did not routinely check for PH, usually citing time constraints. For the remaining 92%, postural symptoms were the predominant reason for checking (97% respondents); only 24% cited any other guideline indication for PH testing. 77% used sit-to-stand BP measurements; only 25% measured standing BP for more than one minute. On regression modelling, other professionals tested less for PH than doctors (Odds ratios: nurses 0.323 (95% confidence interval 0.117 to 0.894), HCAs 0.102 (0.032 to 0.325), pharmacists 0.986 (0.024 to 0.412)). Conclusion Awareness of reasons, besides symptoms, and adherence to guidelines for PH testing, are low. Time is the key barrier to improved testing for PH. Clarity on pragmatic methods of measuring PH in practice would also facilitate measurement uptake.

Long acting injectable buprenorphine: Perspectives from service-users, staff and stakeholders

Abstract Introduction Long-acting injectable buprenorphine (LAIB) is a relatively novel pharmacological treatment for people with opioid dependence. Despite growing qualitative evidence, there is limited research on practitioner insights, and effectiveness of LAIB in a community setting. Methods Thirteen service-users (11 currently prescribed LAIB), 6 practitioners, and 4 stakeholders (public health workers) took part in semi-structured interviews (n = 23) to glean their perspectives on LAIB. They were recruited through a community drug treatment service in the NW of England. The interview schedule was informed by previous literature and co-produced with a peer worker with lived experience of drug recovery treatment. Transcripts were analysed thematically by the research team. Results Four major themes were identified from the interviews: A change of focus; challenges; wrap-around support; and target groups. Discussion Our findings support existing evidence around the individual benefits to service-users such as changes to lifestyle and reduction of stigma, as well as challenges such as the need for wrap-around support and accessible information. We found that commissioning considerations such as geographical inequalities and the need for multi-service collaboration are important in this setting. Conclusions LAIB treatment works well for many people in a community context that offers significant wrap-around support to service-users. The novelty of this research lies in bringing together the views of practitioners and stakeholders as well as treatment/service beneficiaries in evaluating the introduction of LAIB in a community service.

Predicting intentions towards long-term antidepressant use in the management of people with depression in primary care: A longitudinal survey study

Background Over the last two decades, antidepressant prescribing in the UK has increased considerably, due to an increased number of people staying on antidepressants for longer. Even when treatment is no longer clinically indicated, qualitative research suggests many people continue due to a fear of depressive relapse or antidepressant withdrawal symptoms. The quantitative effects of peoples’ beliefs and attitudes towards long-term antidepressant use remain relatively unexplored. Objectives To determine the extent to which beliefs and attitudes towards antidepressant treatment are associated with intentions to stop or continue long-term use; and whether intentions translate into actual discontinuation. Methods A questionnaire survey formed the main component of an embedded mixed-methods study. Twenty general practices posted questionnaires to adults aged over 18 receiving continuous antidepressant prescriptions for over two years. Outcomes and explanatory variables were determined using an extended model of the Theory of Planned Behaviour, conducting exploratory descriptive and regression analyses. The primary outcome was participants’ intentions to discontinue antidepressants. The secondary outcome of behaviour change was determined by any change in antidepressant dosage at six months. Results 277 people were surveyed from 20 practices, with 10 years median antidepressant duration. Mean questionnaire scores for intention and subjective norms towards starting to come off antidepressants were low, and 85% of participants declared that continuing their antidepressant was necessary. Prescribing outcomes retrieved from 175 participants’ medical records six months after they completed the survey found 86% had not changed their antidepressant, 9% reduced the dose, only 1% discontinued their antidepressant, and 4% increased the dose. All Theory of Planned Behaviour constructs and concerns were associated with intentions, with more favourable attitudes towards stopping and subjective norms having the strongest associations towards intentions to discontinue antidepressant use. Conclusion Given few intentions to stop taking antidepressants, patients should be made more aware of the importance of ongoing antidepressant monitoring and review from their primary care practitioners. This would promote discussion to support an attitudinal change and initiation of antidepressant tapering where appropriate.

Adapting the Germ Defence Web-Based Intervention to Improve Infection Prevention and Control in Care Homes: Interview Study Among Care Home Staff

Background: Infection prevention and control (IPC) is vital in care homes as it can reduce morbidity and mortality by 30%. Ensuring good IPC practice is a perennial challenge in the varied and complex context of care homes. Behavior change interventions delivered via digital technology may be effective in improving IPC among care home staff. Objective: This study aimed to evaluate how an evidence-based, digital behavior change intervention called Germ Defence can be rapidly adapted to meet the needs of care homes. Methods: This study applied the person-based approach, which emphasizes iterative approaches to optimizing interventions via individual user feedback. Phase 1 involved initial edits to the website by the research team to create Germ Defence for Care Homes (GDCH) version 1. Phase 2 consisted of stakeholder consultation on GDCH version 1 followed by edits to create GDCH version 2. The formal research (phases 3 and 4) involved individual think-aloud interviews with 21 staff members from management, care, and ancillary positions in 4 care homes providing real-time feedback as they worked through GDCH. Edits were made to create GDCH version 3 between phases 3 and 4. During the development of GDCH versions 2 and 3, it became clear that the intervention would need more fundamental changes beyond the pragmatic, incremental changes that would be possible within the scope of this study. Analysis was completed via a rapid, qualitative descriptive approach to develop a high-level summary of key findings from the interview data. Results: There were mixed results about the attractiveness of GDCH and its suitability to the care home context. Participants felt that the images needed to be aligned much more closely with the meaning of adjacent text. Many participants felt that they would not have time to read a text-based website, and some suggested that more engaging content, including audio and video, may be preferable. Most participants felt that the overall concept of Germ Defence was clearly relevant to their context. Some felt that it might be a useful introduction for new staff members or a refresher for current staff, but others felt that it did not add anything to their existing IPC training. There were mixed opinions about the level of detail provided in the information offered by the site. While the goal-setting behavior change mechanism may have potential, the findings suggested that it may be unsuitable for care homes and more work is needed to refine it. Conclusions: Much more work needs to be done to make Germ Defence more engaging, accessible, and relevant to the care home workforce. Our study highlights the challenges of rapidly adapting an existing intervention to a new context. Future research in this area will require a pragmatic methodological approach with a focus on implementation.

Cardiovascular disease burden and risk factor management in cancer survivors: insights into a multiethnic, socioeconomically deprived urban population

Background Cardiovascular disease (CVD) burden and risk factor management among cancer survivors, especially in socioeconomically deprived, multiethnic populations, remain understudied. This study examines CVD burden and risk factor control in survivors of 20 cancer types within a diverse urban population. Methods This matched cohort study used electronic health records from 127 urban primary care practices. Cancer survivors were matched to non-cancer comparators at a 1:4 ratio. Cancer and CVD diagnoses were defined using standard clinical code sets. Sociodemographic variables, lifestyle behaviours, blood pressure, cholesterol levels and statin prescriptions were analysed. Multivariable regression evaluated associations between cancer history, CVD prevalence and risk factor control. Results The cohort included 18 839 cancer survivors (43% men, average age 64±15 years), with high ethnic diversity (48% White, 24% Black, 22% Asian) and high deprivation levels. Cancer survivors had elevated odds of all CVDs considered, independent of shared risk factors. Heart failure was more common in haematological (OR 2.12; 95% CI 1.44 to 3.09) and breast cancer survivors (OR 1.38; 95% CI 1.16 to 1.64). Patients with bladder (OR 1.50; 95% CI 1.20 to 1.87) and lung cancer (OR 1.44; 95% CI 1.09 to 1.87) had higher odds of ischaemic heart disease. Venous thromboembolism risk was highest in ovarian cancer (OR 5.72; 95% CI 3.54 to 9.32). Blood pressure control was slightly better in cancer survivors (OR 0.92; 95% CI 0.87 to 0.97), yet one in three patients did not meet guideline-directed targets. Statin use and cholesterol management were similar between survivors and controls, but disparities were observed within certain ethnic groups. Conclusion Cancer survivors have an elevated risk of CVD, with variations by cancer type and ethnicity. Despite comparable or slightly better control of major risk factors, a significant proportion of cancer survivors do not achieve guideline-recommended targets, highlighting the need for optimised management strategies, particularly in high-risk subgroups.

Interventions that prevent or reduce perinatal loneliness and its proximal determinants: a restricted scoping review

Background The World Health Organisation’s Commission on Social Connection (2024–2026) highlights the importance of addressing loneliness because of its negative impact on health and well-being. The perinatal period carries an increased risk of loneliness for mothers and fathers which is elevated by intersectional inequalities, such as having a low income, being LGBTQ+, or being from a minoritised community. Perinatal loneliness is associated with perinatal mental illness, which can have lasting negative impacts on parents and their children. The aim of this review was to synthesise studies exploring interventions for perinatal loneliness. Methods We conducted a restricted scoping review following the Joanna Briggs Institute Methodology to develop a categorisation of interventions and intervention-mechanisms to reduce perinatal loneliness. We included studies that described and/or evaluated interventions in published studies that intentionally or unintentionally reduced loneliness, or its proximate determinants, such as social connectedness and social support. We searched eight electronic databases for peer-reviewed academic papers published in any country describing or evaluating these interventions between 2013–2023. Results Fifty papers were included in the review, from which the following categorisation of interventions was developed: 1) synthetic social support, 2) shared-identity social support groups, 3) parent and baby groups, 4) creative health approaches (arts, nature or exercise based), 5) holistic, place-based and multidisciplinary support that worked with parents to overcome a range of barriers to connection, and 6) awareness campaigns. Five mechanisms were identified within included papers: 1) opportunities for social connection to similar others, 2) positive relationships with a professional or volunteer, 3) normalisation and acceptance of difficulties, 4) meaningful activities and 5) support to overcome barriers (including cultural and financial) to connection. Few studies collected comprehensive demographic data, few considered fathers, and none were LGBTQ+ specific. Conclusions The review identified and synthesised approaches that might address perinatal loneliness and its proximate determinants. Further research is needed to scope the grey literature, review papers in the global south, appraise intervention effectiveness, and co-produce interventions, including for fathers, LGBTQ+ parents, and cultural and religious minorities.

A Co-produced International Qualitative Systematic Review on Lived Experiences of Trauma During Homelessness in Adulthood and Impacts on Mental Health

Abstract Trauma can be both a cause and a consequence of homelessness and has lasting impacts on mental health and wellbeing. Often research focusses on trauma and adversity in childhood leading to homelessness, but understanding traumatic experiences during adulthood homelessness can be just as important for informing intervention development and policies to mitigate and eradicate homelessness. Working with people with lived experience of homelessness, this review aimed to synthesis the qualitative evidence exploring the impact of trauma during homelessness on mental health (including substance use) from the perspective of adults (18 years of age and older) experiencing homelessness. Alongside gray literature, ASSIA, CINAHL, Cochrane, EMBASE, MEDLINE, Proquest theses and dissertations, PsychInfo, Scopus and Web of Science were searched from inception until February 2024. No language, date, or geographical limits were applied. A ‘best-fit’ framework synthesis of 26 papers, covering the experience of over 900 people, identified three overarching themes linked with the SAMHSA three E’s of trauma: 1) making sense of homelessness as a trauma, 2) dealing with the impacts of trauma and 3) responses to repeated exposure to trauma. Trauma rarely takes place in isolation and often prior experiences shape how people experiencing homelessness make sense and cope with trauma. Policy and prevention should prioritise early intervention to reduce the mental health burden of trauma and homelessness. Additionally, creating support that empowers and builds resilience will encourage more positive management strategies.

The Management of Chronic Insomnia in Young Children: A Survey of UK General Practice

ABSTRACT Objectives Chronic insomnia (CI), the most common sleep disorder in young children, is associated with negative outcomes for the child and family. This study explores the beliefs, current practice, and understanding of UK primary health care professionals (PCPs) regarding CI in children under 5 years. Method An online survey of UK PCPs (e.g. general practitioners (GPs), practice nurses) recruited through Clinical Research Networks. The survey consisted of Likert-style and closed- questions regarding beliefs, current practice, and training/knowledge. Data were analyzed descriptively. Results Two hundred and ninety-five PCPs took part (mostly GPs, n = 244). Respondents believe that CI has a large impact on children and family. 80% agreed that CI should be managed in health care and 66.3% in primary care. However, consultations with families regarding CI were reported as infrequent. 91.6% agreed that CI should be managed with behavioral approaches, and more than  85% of respondents recommend positive bedtime routines. Respondents had varied confidence and knowledge about management. They had received little to no professional education about CI. Conclusions PCPs recognize the importance of CI and understand some principles of management, though they lack training and confidence. Improved training and awareness of evidence-based resources for support would improve management in primary care.

Technostress, technosuffering, and relational strain: a multi-method qualitative study of how remote and digital work affects staff in UK general practice.

Abstract Background The introduction of remote and digital forms of working in UK general practice has driven the development of new routines and working styles. Aim To explore and theorise how new forms of work have affected general practice staff. Design and setting Multi-sited, qualitative case study in UK general practice. Method Using longitudinal ethnography by researchers in residence, we followed 12 practices for 28 months (September 2021 to December 2023). This core dataset was supplemented by workshops and stakeholder interviews. Data analysis applied theories from the sociology of work, organisation studies, and internet studies. Results Staff made significant efforts to adapt to and embed digital services into their work. When technologies work well they can offer improved convenience, efficiency, more comprehensive patient care, and workplace fulfilment for staff. However, for many clinical and administrative staff, compromises and frictions embedded in digitalised workplace routines and processes could also lead to job dissatisfaction, worsened wellbeing, and misalignments with professional values and identities. We found that this workplace suffering caused relational strain between team members and had an impact on team cohesiveness and coordination. Conclusion The digitalisation of working routines in UK general practice poses a unique challenge to the workforce, risking technostress, workplace suffering, and increased relational strain within and between teams. To embed the benefits of digitalisation, we must first improve practice teams’ readiness for change, which includes strengthening practices’ relational structures that provide support during periods of adaptation. Practices must be empowered to determine a locally appropriate configuration of digital tools and given the resources and time to adapt working routines.

Mortality in adolescents after therapeutic intervention for self-harm: A systematic review and meta-analysis

Background Self-harm in adolescents is an international concern. Evidence highlights that therapeutic intervention (TI), such as cognitive behaviour therapy informed treatments, after self-harm leads to reduced self-harm repetition. However, there is no prior literature about the effects of TI on future mortality in adolescents. We examined the effect of TI on mortality rates in adolescents across RCTs. Methods This review was reported in accordance with PRISMA guidance. MEDLINE, EMBASE, PsycINFO, and Cochrane Library were searched to 19 June 2024. Two authors independently screened titles, abstracts, and full texts against pre-defined criteria. RCTs were included if they compared a TI versus a comparator in adolescents up to 18 years with at least one prior self-harm episode. There was no lower age limit. For the pooled effect size of mortality, the DerSimonian-Laird method was used, and a random effects model for self-harm and suicide attempts. The primary outcome was intra or post-trial mortality in adolescent post TI, and the effect of TIs on self-harm including attempted suicide episodes were secondary outcomes. Analyses were done in Stata. Results Twenty-four trials of TIs consisting of 3470 randomised adolescents were included. The pooled risk difference for mortality of participants in the TI group was 0.002 (95% CI −0.003 to 0.008, p = 0.42). There were 6 deaths in the TI group compared to 15 deaths in the comparator group. The pooled risk difference for TI on repeat self-harm was −0.07 (95% CI −0.132 to −0.007, p = 0.028), and −0.05 (95% CI −0.086 to −0.007, p = 0.022) for suicide attempts compared to comparator. Conclusions This review found no significant impact of TIs on future mortality in adolescents. We also demonstrated that TIs can reduce suicide attempts which can lead to substantial benefits for adolescents, families, and clinical services.

plaTform fOr Urinary tract infection diagnostiC evAluatioN (TOUCAN): a protocol for a prospective diagnostic accuracy study of point-of-care testing in patients suspected of acute uncomplicated urinary tract infection in primary care clinics in England

Abstract Introduction Acute uncomplicated urinary tract infection (UTI) is a common condition with potentially serious sequelae that is mostly diagnosed and managed in primary care settings. Around half of all women have a UTI in their lifetime, and a quarter experience an infection caused by organisms resistant to more than one antibiotic. Reducing inappropriate prescribing of antibiotics is a core tenet of antimicrobial stewardship. However, current diagnostics for UTI are unfit for purpose in acute (highest prescribing) settings, being too slow to inform the required immediate decision-making and often confounded by sample contamination. Rapid point-of-care diagnostic tests (POCTs) that facilitate timely decision-making are potential solutions to this problem. Several such tests have reached advanced stages of technology readiness, but their diagnostic performance has not been evaluated in primary care with clinical users. To progress novel tests towards implementation, a diagnostic field study is required, to allow for parallel and sequential evaluation of multiple tests in a primary care population. Methods and analysis We will recruit participants assigned female at birth from primary care clinics in England who contact their clinic with symptoms of acute uncomplicated UTI. Eligible participants will complete a short questionnaire to capture symptoms and symptom severity and will provide a urine sample. Samples will be split and initially tested using novel index tests (POCTs) and conventional urinalysis ‘dipstick’ at the primary care clinic. The second part of the sample will be processed at a National Health Service-based reference laboratory using a modified reference standard including microscopy, microbiological culture, pathogen speciation and antimicrobial susceptibility testing. The UTI reference standard culture, although based on the national methods, is modified to provide accurate bacterial counts, better to define a microbiological diagnosis of UTI. Susceptibility testing will be performed using ‘gold-standard’ methods, not usually performed in diagnostic laboratories. The primary outcome will be the diagnostic performance (sensitivity, specificity, positive and negative predictive values) of POCTs for detection of UTI and antimicrobial susceptibility for POCTs that include antimicrobial susceptibility testing. Secondary outcomes will include the symptom profile of patients presenting with uncomplicated UTI, a theoretical determination of how use of POCT results might change prescribing, an understanding of POCT failure rate and qualitative capture of the experiences of those using the POCT to deliver the study in primary care clinics. Ethics and dissemination Ethical approval was received from the London Central Research Ethics Committee (23/LO/0371) and the UK Health Research Authority. We will publish the findings of The plaTform fOr Urinary tract infection diagnostiC evAluatioN evaluations in peer-reviewed medical journals and more broadly following a dissemination plan formulated by a communications specialist in consultation with patients and the public.

Do community-based digital health inclusion programmes contribute to tackling health inequalities in disadvantaged population groups?: a qualitative study of experiences of a city-wide programme in the North of England.

Background Advances in digital healthcare and health information provide benefits to the public. However, lack of digital skills together with access, confidence, trust and motivation issues present seemingly insurmountable barriers for many. Such digital health exclusion exacerbates existing health inequalities experienced by older people, people with less income, less education or who don’t have English as a first language. This study examines the role of a city-wide digital inclusion programme in the North of England, which works with Voluntary Sector Community Organisations (VCSOs) to provide digital support to disadvantaged communities (Digital Health Hubs). The aim was to explore if and how Digital Health Hubs contribute to tackling health inequalities, with a specific focus on impacts on service-users and how these impacts are produced. Methods We used qualitative semi-structured interviews to explore the experiences of service-users receiving digital support, and perspectives of staff working for organisations coordinating or providing digital support (n = 30). Results Inductive thematic analysis was used to identify four major themes and mapped to ‘Consolidated Framework for Implementation Research’ constructs. These were: programme components, recipient-centred support, impacts on service-users and system-level barriers to digital health services. Findings suggest moderators of implementation are provision of community spaces, social activities and devices and Wi-fi, and recipient-centred support through community understanding, personalised regular support and trusting relationships. Impacts on service-users include improved social and emotional resilience and basic digital skills. Health system-level barriers to digital health services, such as inconsistency in service provision, were also identified. Conclusions Themes highlight the importance of recipient-centred support by Voluntary and Community Sector Organisations (VCSOs) which centres the unique needs of specific communities. Our data provide policymakers with a model for implementation that could be replicated and scaled-up. Our data add to the public health, primary care and digital health research by proposing an initial programme theory for how Digital Health Hubs may reduce health inequalities, and recommendations for evaluation which consider short-, medium- and long-term outcomes, and contextual factors which are likely to be crucial to Digital Health Hubs’ effectiveness.

Temporal trends and practice variation of paediatric diagnostic tests in primary care: retrospective analysis of 14 million tests

Abstract Objective: The primary objective was to investigate temporal trends and between-practice variability of paediatric test use in primary care. Methods and analysis: This was a descriptive study of population-based data from Clinical Practice Research Datalink Aurum primary care consultation records from 1 January 2007 to 31 December 2019. Children aged 0-15 who were registered to one of the eligible 1464 general practices and had a diagnostic test code in their clinical record were included. The primary outcome measures were (1) temporal changes in test rates measured by the average annual percent change, stratified by test type, gender, age group and deprivation level and (2) practice variability in test use, measured by the coefficient of variation. Results: 14 299 598 diagnostic tests were requested over 27.8 million child-years of observation for 2 542 101 children. Overall test use increased by 3.6%/year (95% CI 3.4 to 3.8%) from 399/1000 child-years to 608/1000 child-years, driven by increases in blood tests (8.0%/year, 95% CI 7.7 to 8.4), females aged 11-15 (4.0%/year, 95% CI 3.7 to 4.3), and children from the most socioeconomically deprived group (4.4% /year, 95% CI 4.1 to 4.8). Tests subject to the greatest temporal increases were faecal calprotectin, fractional exhaled nitric oxide and vitamin D. Tests classified as high-use and high-practice variability were iron studies, coeliac testing, vitamin B12, folate, and vitamin D. Conclusions: In this first nationwide study of paediatric test use in primary care, we observed significant temporal increases and practice variability in testing. This reflects inconsistency in practice and diagnosis rates and a scarcity of evidence-based guidance. Increased test use generates more clinical activity with significant resource implications but conversely may improve clinical outcomes. Future research should evaluate whether increased test use and variability are warranted by exploring test indications and test results and directly examine how increased test use impacts on quality of care.

Developing a quality framework for community pharmacy: a systematic review of international literature

Abstract Background We conducted a mixed methods evaluation to assess whether implementing a primary care quality improvement (QI) programme utilising a digital call-and-recall tool improved timely receipt and equity of first measles, mumps and rubella (MMR) and diphtheria tetanus, pertussis and polio-containing (DTaP /IPV) vaccinations. Methods 138,133 and 136,952 children were eligible to receive first MMR and DTaP/IPV respectively between 1st January 2019 and 31st January 2024 in North East London. We compared proportions with timely first MMR or DTaP/IPV receipt (by ages 18 and six months respectively) pre- and post-implementation using an interrupted time series analysis. We calculated change in the Slope Index of Inequality (SII) by an area-level deprivation measure. We conducted ‘Think Aloud’ exercises and semi-structured interviews with users. Findings The proportion of children with timely first MMR receipt increased by 5·3 % (Rate Ratio [RR]:1·053, 95 % confidence interval [CI]:1·033–1·073), equating to an absolute increase in timely MMR receipt of 4·1 % - from 77·7 % to 81·8 % - and for first DTaP/IPV by 0·9 % (RR:1·009, 95 % CI:1·003–1·015). There was no significant change in SII for either vaccine. Users reported improved recall with tool use, but identified practice-level and systemic barriers, including staff dynamics and unachievable national targets, limiting its consistent use. Interpretation In a real-world setting, a call-and-recall tool within a primary care QI programme improved timely first MMR receipt. Sustained improvement requires additional support including by incentivising achievable targets and improving staff capacity and training.

The prevalence and determinants of health anxiety during the covid-19 pandemic: A systematic review and meta-analysis

Abstract The coronavirus disease 2019 (COVID-19) pandemic subjected the global population to a situation that aroused disproportionate Health Anxiety (HA). However, this association has not been explored in a systematic review or meta-analysis. The aim of this systematic review was to assess the prevalence and determining factors of HA in the general adult population during the COVID-19 pandemic. A systematic search was conducted across the databases MEDLINE, PsychINFO, Embase and Web of Science. Observational studies using the 18-item Short Health Anxiety Inventory to measure HA during the pandemic were included. A narrative synthesis and meta-analysis summarised HA levels in the general adult population, subgroups and by associated factors. Out of 4088 studies, 12 met the inclusion criteria. Meta-analyses revealed a mean HA score of 15.16 (SE = 0.415). Significantly higher HA levels were observed among females, unmarried individuals, and those with pre-existing health conditions. The HA score of 15.16 suggests elevated HA during the COVID-19 pandemic compared to pre-pandemic studies. Understanding which groups may be more affected by HA during pandemics and health crises will enable us to develop more tailored public health strategies to mitigate the psychological effects of future public health crises. Further research is needed to establish causal and longitudinal relationships.

Service delivery and the role of clinical pharmacists in UK primary care for older people, including people with dementia: a scoping review

Abstract Objective As populations age globally, there is increasing prevalence of multiple long-term conditions, such as dementia, leading to many challenges. The burden on health and care services, economic pressures, and the necessity for innovative policies to better support older people and people with dementia becomes paramount. This review explores how clinical pharmacists working in UK primary care support older people and people with dementia. Design Scoping review. Method This review was conducted following the framework for scoping reviews in accordance with the Joanna Briggs Institute (JBI) methodology. The search of Scopus, EMBASE, CINAHL, Web of Science, PsycINFO, and Cochrane was initially conducted in September 2022, and updated in August 2024. Searches included literature exploring the landscape of clinical pharmacy services for older people in the UK, focusing on roles and services delivered, perceptions, and experiences. Results A total of 30 articles were included. These detail the multifaceted responsibilities of clinical pharmacists in primary care for older people. Stakeholder perspectives, including healthcare professionals and patients, emphasised the positive outcomes of clinical pharmacist involvement, from reducing other practitioners’ workloads to improving patient safety. However, communication gaps, concerns about competence from other healthcare professionals, and the need for clear role definitions emerged as challenges. Research focused on the experiences of underserved groups, such as people with dementia or from minority ethnic backgrounds, is lacking. Conclusions and implications The review enhances our understanding of the primary care clinical pharmacist service in the UK and identifies gaps in evidence, emphasising the need for empirical studies on the experiences of older people with cognitive impairment and those from minority ethnic backgrounds. It provides insights into what makes an effective clinical pharmacist service, such as training and communication, which may help to inform international policy and practice and improve service provision globally.

The role of Black-led community organisations in supporting Black mental health: a Black emancipatory action research project

ABSTRACT Objective To explore the role of Black-led community organisations in supporting Black mental health and wellbeing in the UK. Design A qualitative, Black Emancipatory Action Research Framework was adopted. Framework application involved adequately compensating community organisations for their consultancy role; having ‘research conversations’ rather than interviewing participants; and focusing outputs on community benefit. Eight individual and group research conversations took place with nine Black directors, employees and volunteers working with Black-led community organisations, aged between 19 and 62, living in the UK. Reflexive thematic analysis was used to analyse conversations. Results Three themes were developed in relation to what Black-led community organisations do for Black mental health. These are: identify and respond to mental health needs; selectively build relationships with mainstream services; and drive social and systemic improvements. Findings revealed that Black-led community organisations uniquely identify and address mental wellbeing by offering respite from racism, hosting activities, and meeting urgent needs. They navigate and facilitate access to health and social systems, protect communities from harmful services, and advocate for social and systemic change. Drawing on the study design, findings, and the broader literature, we propose three key changes to current funding, community, and research practices. These are a reconsideration of how Black-led organisations’ work is valued and measured, a forging of greater collaboration between these organisations, and bolder consideration of how research practice can benefit Black communities. Conclusions Black-led organisations play multiple roles in supporting individual and collective mental health, crucial for mediating the effects of racism and mitigating ethnic inequalities. To our knowledge, this is the first study to both illuminate the critical role of community organisations in promoting Black mental health in the UK and to prioritise participant, and community, benefit throughout the research process.

Risk of Parkinson’s disease in people aged ≥50 years with new-onset anxiety: a retrospective cohort study in UK primary care

Abstract Background A history of anxiety is more common in people with Parkinson’s disease (PD). The prospective risk of PD in those newly presenting with anxiety and factors that increase the risk of PD in patients with anxiety have not been investigated. Aim To investigate the incidence of PD in people with anxiety aged ≥50 years and clinical features associated with later diagnosis of PD in people with anxiety. Design and setting A retrospective cohort study using UK primary care data between 2008 and 2018, assessing patients with new-onset anxiety aged ≥50 years. Method Weibull survival regression models were fitted and hazard ratios (HRs) for modelling time-to-PD was estimated in those with and without anxiety, and when determining the risk of developing PD in those with anxiety. Results were adjusted for sociodemographic and lifestyle factors, and relevant physical and mental health conditions. Results The risk of PD increased two-fold compared with the non-anxiety group after adjustment for age, sex, social deprivation, lifestyle factors, severe mental illness, head trauma, and dementia (HR 2.1, 95% confidence interval = 1.9 to 2.4). In those with anxiety, the presence of depression, hypotension, tremor, rigidity, balance impairment, constipation, sleep disturbance, fatigue, and cognitive impairment were associated with an increased risk of developing PD. Conclusion The risk of developing PD was at least doubled in people with anxiety compared with those without. The clinical features of those who developed PD can help identify patients presenting with anxiety who are in the prodromal phase of PD.