Search results

Social Return on Investment (SROI) Evaluation of Citizens Advice on Prescription: A Whole-Systems Approach to Mitigating Poverty and Improving Wellbeing

Abstract Citizens Advice on Prescription (CAP), a Liverpool (UK)-based service, provides welfare advice and link worker social prescription support to people experiencing and at risk of experiencing financial or social hardship. CAP, which receives referrals from healthcare and third-sector services, aims to improve service users’ financial security, health, and wellbeing. A mixed-methods social return on-investment (SROI) analysis was used to evaluate this service. Between May 2022 and November 2023, a subset of service users (n = 538) completed the Short Warwick–Edinburgh Mental Wellbeing Survey (SWEMWBS) at baseline and a 2-month follow-up. Supporting quantitative and qualitative economic data were also collected (February 2023–February 2024) through semi-structured interviews (n = 16). Changes in social value were determined by comparing pre- and post-SWEMWBS scores. These scores were then mapped to monetary values using the Mental Health Social Value Bank (MHSVB). SROI ratios were then calculated by dividing the change in social value by the associated service provision costs. The mean social value change per person ranged from GBP 505.70 to GBP 697.52, and the mean service provision cost was GBP 148.66 per person. The overall study reported a positive SROI return range of GBP 1: GBP 3.40–GBP 4.69. The results indicate that non-clinical support services, like CAP, may be an effective intervention for addressing the wider determinants of health and wellbeing.

The Effectiveness of Social Media Campaigns in Improving Knowledge and Attitudes Toward Mental Health and Help-Seeking in High-Income Countries: Scoping Review

Background: The prevalence of mental health problems is increasing, particularly among young people, making the prevention of mental health problems and improvements in care a public health priority. Social media, with its wide reach and low-cost information dissemination, has emerged as an important tool for public mental health campaigns in high-income countries. However, there is a limited understanding of the reach of public mental health social media campaigns and their impact on mental health knowledge, attitudes, stigma, and behaviors, such as help-seeking. Objective: This review aimed to assess the effectiveness of social media campaigns in high-income countries in improving knowledge and attitudes toward mental health, reducing stigma, promoting help-seeking behavior, and reaching underserved communities. Methods: A scoping review was conducted, involving a comprehensive search of 5 databases (MEDLINE, Embase, PsycINFO, Web of Science, and CINAHL) and gray literature from January 2004 to May 2024. We included quantitative evaluations of social media public mental health campaigns from high-income countries with comparable social media use and public health care systems. A narrative synthesis summarized the study characteristics, campaign exposure, reach, and effectiveness by outcomes. Results: The review included 26 studies for analysis. Less than half of the studies (11/26, 42%) reported on the reach of mental health campaigns, but for those that did, younger age groups and women were more likely to be aware of campaigns. The most frequently reported outcomes were attitudes about mental health (17/23, 74%) and stigma (17/23, 74%), followed by mental health knowledge (16/23, 70%) and behavior change (15/23, 65%), such as seeking help for a mental health condition. While stigma and attitudes showed the most improvement before and after the campaigns (5/11, 45%), behavior change showed the least positive change over time (1/8, 13%). However, behavior change was the most improved outcome for those who were campaign aware compared to those unaware (12/12, 100%), whereas positive attitudes often did not differ. In fact, some studies showed campaign awareness was associated with negative stereotypes. Conclusions: The evidence highlights the potential of social media campaigns in improving mental health knowledge, attitudes, stigma, and behavior change. However, due to the methodological limitations of these evaluations, it is challenging to determine if the positive changes in these outcomes are a result of the campaigns or other factors. Campaign awareness seems to be important for initiating behavior change, but these changes are often short-lived. Sustainable impact on mental health requires both individual behavior change and service improvements. Targeting more mental health campaigns at underserved groups could help to reduce stigma and raise awareness in these groups, which could lead to timelier access to services. Consistent measurement of campaign reach and behavior change outcomes could help to understand and maximize campaign impact.

Ethical challenges confronted in non-clinical, public health research with young people in England

Abstract This opinion piece emerged from a collaboration of mental health researchers working on the National Institute of Health Research 3-schools mental health programme in underserved communities. The aim is to encourage debate and reflection on the challenges encountered with university research ethics committees when undertaking qualitative research with vulnerable young people. We explore the tension between principles of safeguarding and protection of research participants, on the one hand, and the potential for this oversight to become obstructive and thus to effectively stifle the voices and experiences of an already marginalised population, on the other hand.

Diabetes complications in people with alcohol use disorder and type 2 diabetes

Abstract Background People living with alcohol use disorder (AUD) who develop type 2 diabetes (T2DM) may be at higher risk of diabetes complications. Aim Our aim was to compare diabetes monitoring and incidence of diabetes complications between people with and without AUD prior to T2DM diagnosis attending primary care in England. Design & setting We used the Clinical Practice Research Datalink Aurum linked with Hospital Episode Statistics and Office for National Statistics mortality data. The target population was people with incident T2DM diagnosed between 2004 and 2019. Method We defined AUD from codes indicating i) clinical diagnosis; ii) alcohol withdrawal; or iii) chronic alcohol-related harm. Outcomes were end-stage renal disease (ESRD), lower limb amputation, myocardial infarction (MI), stroke, cardiovascular disease (CVD) mortality, and all-cause mortality. We compared yearly HbA1c, creatinine, and cholesterol monitoring activities for the first 5 years post T2DM diagnosis. Results The study population was 543 509 people, of whom 15 237 (2.8%) had a code for AUD. Adjusting for measured confounders, people with AUD had higher rates of ESRD ( incidence rate ratio [IRR] 1.95, 95% confidence intervals [CI] = 1.71 to 2.23), lower limb amputation (IRR 1.78, 95% CI = 1.50 to 2.21), stroke (IRR 1.36, 95% CI = 1.25 to 1.47), CVD mortality (IRR 1.74, 95% CI = 1.63 to 1.86), and all-cause mortality (IRR 2.10, 95% CI = 2.04 to 2.17) but not MI (IRR 0.91, 95% CI = 0.82 to 1.00) compared with people without AUD. Laboratory diabetes monitoring was high in people with (83.5–91.1%) and without (83.7–92.4%) AUD. Conclusion People with AUD had nearly double the rates of most of the diabetes complications investigated compared with people without AUD.

“I am not a priority”: ethnic minority experiences of navigating mental health support and the need for culturally sensitive services during and beyond the pandemic

Background Existing health inequalities and the lack of timely and appropriate support have long been a reality for many ethnic minority individuals living with mental health conditions, even before the pandemic. Limited access to services and the absence of culturally or religiously embedded care have led to increased severity of mental health problems. Objective To explore the complexity of interactions between ethnic minorities and mental health services and their experiences of seeking and receiving mental health support throughout the pandemic. Methods Semi-structured interviews with purposive and snowball sampling of ethnic minorities aged over 18 (n=32) across North East and North West in England were analysed using a framework approach. Findings Five themes were generated. Cultural stigma attached to mental health could lead to fear and reluctance to seek support. Individuals struggled to engage with non-culturally sensitive health services. Instead, they indicated a strong preference for wider community support, which continued through the pandemic despite interrupted health services. A collaboration between mental health services and ethnic minority communities was advocated to shape services to cultural contexts and improve patient-centred service delivery. Conclusions Ethnic minorities with mental health face significant challenges and disparities in seeking and engaging in mental health services. They often seek support from multicultural community settings even though the support is not specifically targeted at addressing mental health issues. Understanding cultural beliefs, religious influences and family and community structures are necessary components of culturally appropriate care. Clinical implications Culturally sensitive mental health services need to be integrated into existing systems through initiating collaborations with ethnic minority communities that tailor services to meet the needs of diverse populations, improving overall engagement and experiences.

The power of words: respectful language in ADHD research

Language is powerful. It reflects and shapes our understanding of the difficulties people face, the paradigms in which researchers and clinicians conduct research and practice while also influencing public perceptions and the expectations of people with lived experiences. Here, we aim to start a constructive dialogue around language use (ie, language that is respectful, not stigmatising, or discriminatory) related to ADHD, to encourage researchers, clinicians, and others to consider the potential impact of their words. A greater awareness of the impact of language and a much-needed shift towards more compassionate and respectful language can positively affect individuals with ADHD, clinical practice, and research, by fostering a more accurate and nuanced understanding of ADHD and associated needs of people with ADHD.

‘We’re all doing different things’: Qualitative study exploring primary care practitioners’ perspectives of managing distress

Background: Distinguishing emotional distress from mental health problems such as anxiety and depression can be difficult for clinicians. Both commonly present and are managed in primary care. There are likely important differences in the management of emotional distress compared with depression/anxiety, but the current nature of assessment and management is unclear. Aim: Our aim was to explore how emotional distress is understood and how people are managed by a range of practitioners in primary care settings in the UK. Design and Setting: We conducted a qualitative study using semi-structured interviews with primary care practitioners in the UK. Method: Online interviews were conducted with practitioners who directly assess patients with mental health symptoms, including General Practitioners (GPs), Nurse Practitioners, Social Prescribers, and Mental Health Practitioners. Recruitment was via a digital poster circulated by Research Delivery Networks. Interviews covered how practitioners understood and identified distress, support provided to patients, and challenges to assessing and managing emotional distress. Verbatim transcriptions were analysed using an inductive thematic approach. Results: Twenty-nine interviews were conducted and four themes developed in collaboration with the wider team, including public contributors: ‘The multifaceted nature of distress’, ‘We’re all doing very different things’, ‘Managing and understanding distress is challenging’, and ‘De-medicalising distress in the face of increasing societal pressures’. Complexity was driven by the wide-ranging professionals involved, complex patient circumstances, systemic challenges, and societal contexts. Conclusion: Identifying and managing emotional distress is complex, variable and challenging. Complexity appears to be increasing through the systemic challenges and range of professionals involved.

Association of strong opioids and antibiotics prescribing with GP burnout: a retrospective cross-sectional study

Abstract Background Prescribing of strong opioids and antibiotics impacts patient safety, yet little is known about the effects GP wellness has on overprescribing of both medications in primary care. Aim To examine associations between strong opioid and antibiotic prescribing and practice- weighted GP burnout and wellness. Design and setting A retrospective cross-sectional study was undertaken using prescription data on strong opioids and antibiotics from the Oxford- Royal College of General Practitioners Research and Surveillance Centre linking to a GP wellbeing survey overlaying the same 4-month period from December 2019 to April 2020. Method Patients prescribed strong opioids and antibiotics were the outcomes of interest. Results Data for 40 227 patients (13 483 strong opioids and 26 744 antibiotics) were linked to 57 practices and 351 GPs. Greater strong opioid prescribing was associated with increased emotional exhaustion (incidence risk ratio [IRR] 1.19, 95% confidence interval [CI] = 1.10 to 1.24), depersonalisation (IRR 1.10, 95% CI = 1.01 to 1.16), job dissatisfaction (IRR 1.25, 95% CI = 1.19 to 1.32), diagnostic uncertainty (IRR 1.12, 95% CI = 1.08 to 1.19), and turnover intention (IRR 1.32, 95% CI = 1.27 to 1.37) in GPs. Greater antibiotic prescribing was associated with increased emotional exhaustion (IRR 1.19, 95% CI = 1.05 to 1.37), depersonalisation (IRR 1.24, 95% CI = 1.08 to 1.49), job dissatisfaction (IRR 1.11, 95% CI = 1.04 to 1.19), sickness–presenteeism (IRR 1.18, 95% CI = 1.11 to 1.25), and turnover intention (IRR 1.38, 95% CI = 1.31 to 1.45) in GPs. Increased strong opioid and antibiotic prescribing was also found in GPs working longer hours (IRR 3.95, 95% CI = 3.39 to 4.61; IRR 5.02, 95% CI = 4.07 to 6.19, respectively) and in practices in the north of England (1.96, 95% CI = 1.61 to 2.33; 1.56, 95% CI = 1.12 to 3.70, respectively). Conclusion This study found higher rates of prescribing of strong opioids and antibiotics in practices with GPs with more burnout symptoms, greater job dissatisfaction, and turnover intentions; working longer hours; and in practices in the north of England serving more deprived populations.

Providing inclusive care and empowering people with dementia as a clinical pharmacist: a qualitative study of clinical pharmacist’s experiences

Abstract Objectives Dementia is a growing global health concern, significantly impacting primary care settings, where the majority of care for people with dementia is provided. Underserved and vulnerable groups, who often face disparities in access to care are at greater risk of this strain. Clinical pharmacists are well-positioned to provide care but their potential contribution to enhancing person-centred and inclusive care for people with dementia is largely unexplored. The aims are to explore the views and experiences of primary care based clinical pharmacists in providing inclusive care to people with dementia in the community. Method We conducted 13 semi-structured interviews with primary care clinical pharmacists in England in 2023–2024, which were analysed using reflexive thematic analysis. Results Two overarching themes were developed from the interviews: 1) involving patients in decision-making, ensuring person-centered care and 2) the prevalence of health inequalities and the impact on patient care. Conclusion Taking a personalised and person-centred approach clinical pharmacists can engage with patients and carers in decision-making. This can empower people, particularly those from minoritised or disadvantaged groups, to take an active role in their care. This may help with medication adherence but also build trust, potentially leading to better quality and more equitable care. Personalised care should consider cultural beliefs and preferences to reduce misunderstandings or stigma and improve the overall experience for individuals, helping to reduce disparities.

Trends in full-time working in general practice: a repeated cross-sectional study

Background There is little evidence and no agreement on what constitutes full-time working for GPs. This is essential for workforce planning, resource allocation, and accurately describing GP activity. Aim To clarify the definition of full-time working for GPs, how this has changed over time, and whether these changes are explained by GP demographics. Design and setting Data were obtained from repeated cross-sectional national surveys for GPs, which were conducted between 2010 and 2021. Method A comparison was undertaken of three measures of working time commitments (hours and sessions per week and hours per session) plus a measure of workload intensity across survey years. Multiple regression was used to adjust the changes over time for age, sex, ethnicity, contract type, area deprivation, and rurality. Unadjusted hours and sessions per week were compared with definitions of full-time working. Results Average hours and sessions per week reduced from 40.5 (95% confidence interval [CI] = 38.5 to 42.5) to 38.0 (95% CI = 36.3 to 39.6) and 7.3 (95% CI = 7.2 to 7.3) to 6.2 (95% CI = 6.2 to 6.3) between 2010 and 2021, respectively. In 2021, 54.6% of GPs worked at least 37.5 hours per week and 9.5% worked at least nine sessions. Hours per session increased from 5.7 (95% CI = 5.7 to 5.7) to 6.2 (95% CI = 6.2 to 6.3) between 2010 and 2021. Partners worked more hours, sessions, and hours per session. Adjustments expanded the increase in hours per session from 0.54 to 0.61. Conclusion At the current average duration of sessions, six sessions per week aligns with the NHS definition of full-time hours. However, hours per week is a more consistent way to define full-time work for GPs.

Exploring patient and professional perspectives on implementing pharmacogenomic testing in the UK primary care setting and estimating the cost-effectiveness: a mixed-methods study protocol

Abstract Introduction Pharmacogenomic testing could potentially reduce the number of adverse drug reactions and improve treatment outcomes through tailoring treatment to an individual’s genetic makeup. Despite its benefits and the ambitions to integrate into routine care, the implementation of pharmacogenomic testing in primary care settings remains limited. This study aims to qualitatively explore the views of healthcare professionals (HCPs) and patients on implementing pharmacogenomic testing in the UK National Health Service (NHS) primary care setting and to estimate the cost-effectiveness of service-delivery implementation by comparing different HCPs’ models of care. Method This study consists of three workstreams (WS). WS1 is semi-structured interviews with General Practitioners, pharmacists, nurses and patients (24 participants) to explore implementation issues, including the perceived barriers and facilitators to delivering a pharmacogenomic service. WS2 consists of focus groups (between 24–36 participants) with genomic experts to develop practical pharmacogenomic-guided clinical pathways for primary care. WS3 will estimate the cost-effectiveness of implementing pharmacogenomic testing when led by different HCPs incorporating parameters from the literature, expert opinions, as well as data from WS1 and WS2. Analysis Thematic analysis will be used to analyse the qualitative data from WS1 and WS2, mapping findings onto the Consolidated Framework for Implementation Research domains, which will also be used as the theoretical framework. WS3 will be a decision-analytic model developed in Microsoft Excel to compare the cost-effectiveness of pharmacist-led, GP-led, nurse-led or multidisciplinary pathways.

Risk factors for pancreatic cancer in electronic health records: an umbrella review of systematic reviews and meta-analyses

Background Pancreatic cancer has poor survival because of predominantly advanced-stage diagnosis. One strategy for improving outcomes is earlier identification, possibly achievable by enhanced surveillance or improved risk prediction modelling. This umbrella review updates previous evidence with a comprehensive assessment of factors which could inform risk assessments. Methods Database searches were performed in MEDLINE and EMBASE via Ovid and the Science Citation Index Expanded of the Web of Science Core collection from inception to March 2025. Systematic reviews and meta-analyses of factors associated with altered risk of pancreatic cancer, available in a coded electronic healthcare record, were included. Participants in component studies were adults, and we compared exposed/not exposed/differentially exposed participants. There was no geographical restriction. The main outcome was potential risk factors for pancreatic cancer, categorised by degree of association. The study was registered with PROSPERO, registration number CRD42024526338. Findings 2386 abstracts and 449 full texts were dual screened, resulting in 168 studies included in the review, comprising 365 meta-analyses of individual risk factors or strata and >2,255,495 pancreatic cancer cases. 21 meta-analyses reported gender-disaggregated data which were extracted and reported separately. Of the 80 potential risk factors identified, 38 were associated with an increased pancreatic cancer risk, 11 with a protective effect, and 31 had no significant association with pancreatic cancer. Major newly found risk factors were autoimmune liver disease, BRCA gene mutation, co-infection with hepatitis B and C, and insulin use. Interpretation This comprehensive umbrella review of pancreatic cancer risk factors provides an up-to-date summary useful for identifying prevention and surveillance approaches, and for developing risk prediction models and directing future research.

A heterogeneity analysis of health-related quality of life in early adults born very preterm or very low birthweight across the sociodemographic spectrum

Abstract Preterm birth and very low birthweight (VP/VLBW) are associated with poorer health-related quality of life (HRQoL) outcomes extending into adulthood, yet it remains unclear how these effects differ across sociodemographic subgroups. This study aimed to identify heterogeneity in the association of VP/VLBW on HRQoL in early adulthood, specifically examining maternal age, education, and ethnicity. Individual-level data from three longitudinal cohorts within the Research on European Children and Adults Born Preterm Consortium were analysed, including adults born VP (< 32 weeks’ gestation) or VLBW (< 1500g), compared to term-born or normal birthweight controls. HRQoL was assessed using the Health Utilities Index Mark 3 (HUI3) at mean ages of 18–26 years. Bayesian Causal Forest and Shrinkage Bayesian Causal Forest methodologies were employed to estimate conditional average treatment effects. Results indicated significant heterogeneity in the effects of VP/VLBW birth on HRQoL by maternal age and education. Individuals born to mothers aged ≤25 years experienced the largest decrement in HUI3 scores (−0.08; 95 % CI −0.13, −0.02), compared to minimal or no decrements for individuals born to mothers aged ≥26 years. Similarly, lower maternal education was associated with larger decrements (−0.05; 95 % CI −0.09, −0.01), whereas high maternal education showed negligible impact (0.01; 95 % CI −0.04, 0.06). These findings highlight maternal sociodemographic characteristics as critical modifiers of VP/VLBW impacts on adult HRQoL, emphasizing the need for targeted health interventions for disadvantaged groups. Future research is warranted to examine whether modern neonatal care and changes in socioeconomic conditions can mitigate these HRQoL disparities across the life course.

Practitioners’ views on the measurement and management of postural hypotension in general practice: a qualitative inquiry

Background: Postural hypotension (PH) is associated with cognitive decline, falls and allcause mortality, representing a substantial burden on the NHS. PH is often asymptomatic, making detection and treatment difficult. Currently, there is no systematic approach to measuring and managing PH in UK general practice. Aim: To explore barriers and facilitators to improving PH measurement and management. Design and Setting: Qualitative interview study with healthcare practitioners in general practices in England. Methods: We conducted individual, remote, semi-structured interviews with a range of healthcare practitioners (HCPs) who measure blood pressure (BP) in general practice, to explore their views and experiences of measuring and managing PH. Participants were identified from expressions of interest during a national survey. Interviews were video and audio-recorded, transcribed verbatim and analysed thematically. Results: 26 HCPs in 24 practices across nine Clinical Research Networks in England were interviewed between March and July 2023. HCPs checked for PH when patients were older, reported dizziness, fatigue or had chronic conditions. Despite awareness of clinical guidelines, various diagnostic definitions were provided and measurement protocols varied between participants. Sit-to-stand rather than supine-to-stand measurements were considered more feasible due to time constraints and patient mobility. Education and training, as well as incentives and specialist clinics, were suggested as methods to improve PH measurement and management. Conclusions: This is the first study to explore barriers to, and facilitators of, PH measurement in English general practice. Findings suggest a more systematic approach to measurement is needed to improve detection and management of PH in general practice.

Identifying novel biomarkers suitable for early detection of Intrathoracic cancers in primary care: a systematic review.

Review objectives Are there any novel biomarkers for detection and diagnosis of intrathoracic cancers that are suitable for use in primary care? To address this review question, we will identify and describe existing validated biomarkers for the detection/diagnosis of intrathoracic (primary lung/bronchus/trachea, mesothelioma, and thymoma) cancers, focusing on their: • Diagnostic performance across different population groups (such as setting, symptomatology, health behaviors, or other patient characteristics) • Classification based on sample source (such as blood, saliva, breath, or sputum) and molecular function (such as proteins, volatile organic compounds, microRNAs, and others) • Potential relevance to populations such as primary care where cancer prevalence is low compared to specialist settings.

Inter-arm blood pressure difference and cardiovascular risk estimation in primary care: a pilot study

Abstract Background Systolic inter-arm differences (IAD) in blood pressure (BP) contribute independently to cardiovascular risk estimates. This can be used to refine predicted risk and guide personalised interventions. Aim To model the effect of accounting for IAD in cardiovascular risk estimation in a primary care population free of pre-existing cardiovascular disease. Design & setting A cross-sectional analysis of people aged 40–75 years attending NHS Health Checks in one general practice in England. Method Simultaneous bilateral BP measurements were made during health checks. QRISK2, atherosclerotic cardiovascular disease (ASCVD), and Framingham cardiovascular risk scores were calculated before and after adjustment for IAD using previously published hazard ratios. Reclassification across guideline-recommended intervention thresholds was analysed. Results Data for 334 participants were analysed. Mean (standard deviation) QRISK2, ASCVD, and Framingham scores were 8.0 (6.9), 6.9 (6.5), and 10.7 (8.1), respectively, rising to 8.9 (7.7), 7.1 (6.7), and 11.2 (8.5) after adjustment for IAD. Thirteen (3.9%) participants were reclassified from below to above the 10% QRISK2 threshold, three (0.9%) for the ASCVD 10% threshold, and nine (2.7%) for the Framingham 15% threshold. Conclusion Knowledge of IAD can be used to refine cardiovascular risk estimates in primary care. By accounting for IAD, recommendations of interventions for primary prevention of cardiovascular disease can be personalised and treatment offered to those at greater than average risk. When assessing elevated clinic BP readings, both arms should be measured to allow fuller estimation of cardiovascular risk.

Blood test result communication in primary care: mixed-methods systematic review protocol

Abstract Background: After testing, ensuring test results are communicated and actioned is important for patient safety, with failure or delay in diagnosis the most common cause of malpractice claims in primary care worldwide. Identifying interventions to improve test communication from the decision to test through to sharing of results has important implications for patient safety, GP workload, and patient engagement. Aim: To assess the factors around communication of blood test results between primary care providers (for example GPs, nurses, reception staff) and their patients and carers. Design & setting: A mixed methods systematic review including primary studies involving communication of blood test results in primary care. Method: The review will use a segregated convergent synthesis method. Qualitative information will be synthesised using a meta-aggregative approach, and quantitative data will be meta-analysed or synthesised if pooling of studies is appropriate and data are available. If not, data will be presented in tabular and descriptive summary form. Conclusion: This review has the potential to provide conclusions about blood test result communication interventions and factors important to stakeholders, including barriers and facilitators to improved communication. Keywords: Blood tests; communication; hematological tests; patient satisfaction; patient-centred care.

Associations between burnout and career disengagement factors among general practitioners: a path analysis

Violence and Abuse towards General Practice Staff by Patients and the Public: A Scoping Review

Abstract Background General practice is the gatekeeper to secondary care in many countries. This unique role may expose general practice staff to violence and abuse by patients and the public, yet violence and abuse in secondary care receives more attention than that in general practice. Existing reviews on primary care do not distinguish the perpetrators of violence. A scoping review on violence and abuse by patients and the public towards general practice staff was conducted. Aim: to analyse the evidence on: 1. The extent, characteristics and impact of violence and abuse by patients or the public towards general practice staff. 2. Practices in violence and abuse prevention and support in general practice at individual and organisational levels. Design and Setting This scoping review followed the updated Joanna Briggs Institute guidelines and the PRISMA ScR guidelines. Method Six bibliographic databases, Google and Google Scholar were systematically searched. De-duplicated citations (N=19,519) were independently screened by two reviewers. Data were extracted with a bespoke extraction form. Results Fifty studies from 24 countries were included. Past-year rates for violence and abuse by patients and the public towards general practice staff ranged from 13.8% to 90.3% while career-long estimates were 18.3% to 91%. Long waiting times and unmet patient demands were the most common reasons. It impacted staff mental health and turnover intention and service capacity. No evaluated prevention or support interventions were reported. Conclusion Violence and abuse towards general practice staff is widespread, impacting both individuals and service delivery. However, interventions are under researched.

Arm Based on LEg blood pressures (ABLE-BP): can systolic ankle blood pressure measurements predict systolic arm blood pressure? An individual participant data meta-analysis from the INTERPRESS-IPD Collaboration

Abstract Objectives To determine associations between arm and ankle systolic blood pressures (SBPs), develop and validate a multivariable model predicting arm SBP from ankle SBP, and investigate associations between ankle SBP, cardiovascular disease and mortality. Design Ankle-arm SBP differences were examined in two-stage individual participant data (IPD) meta-analyses using multivariable hierarchical linear regression models. Models were used to derive and validate a prediction model for arm SBP based on ankle SBP. Model performance was assessed using area under the receiver operating characteristic (AUROC) curve analyses. Prognostic associations of ankle SBP with outcomes were examined using Cox proportional hazards models. Data sources Searches identified cohorts for the Inter-arm Blood Pressure Difference IPD (INTERPRESS-IPD) Collaboration from Medline, Old Medline, Medline in process, Embase and CINAHL databases from inception until January 2017; unpublished data were also sought. Required primary outcomes were all-cause mortality, cardiovascular mortality, and/or fatal and non-fatal cardiovascular events. Eligibility criteria Prospective studies from community, primary care or general clinic settings, without language restriction, that recorded SBP in both arms were eligible. Adults aged ≥18 years with SBP measured in all four limbs, in a supine position, were included in the current analyses. People with peripheral artery disease were excluded. Data extraction and synthesis Anonymised datasets were individually cleaned and then combined into a single dataset for the INTERPRESS-IPD Collaboration. Results The current dataset included 33 710 participants from 14 studies; mean age 58 years, 45% female, mean baseline arm blood pressure 138/80 (SD: 20/12) mm Hg. Mean ankle SBP was 12.0 mm Hg (95% CI 8.8 to 15.2) higher than arm SBP. The multivariable model predicting arm SBP from ankle SBP demonstrated excellent performance (AUROC curves, sensitivities and specificities were >0.82, 0.80 and 0.82, respectively, at all BP thresholds from 130 to 160 mm Hg). Model performance was superior to existing arithmetic formulae. Ankle SBP was neither associated with all-cause nor cardiovascular mortality (HR 1.000 (0.997 to 1.002; p=0.682) and 1.001 (0.996 to 1.005; p=0.840), respectively). However, lower-reading ankle SBP was associated with fatal or non-fatal cardiovascular events (HR 1.005 (1.002 to 1.007; p<0.001). Conclusions On average, ankle SBP is 12 mm Hg higher than arm SBP. Estimating individual arm SBP from ankle SBP measurements with a multivariable model is more accurate than existing fixed arithmetic formulae. This model, operationalised in an online calculator (https://ablebp.research.exeter.ac.uk/), could facilitate hypertension management and cardiovascular care for people unable to have arm SBP measured.