scholarly journals What works and why in the identification and referral of adults with comorbid obesity in primary care: A realist review

2019 ◽  
Vol 21 (4) ◽  
Author(s):  
David N. Blane ◽  
Sara Macdonald ◽  
Catherine A. O'Donnell
Keyword(s):  
Primary Care ◽  
Realist Review ◽  
What Works

scholarly journals Conversations about FGM in primary care: a realist review on how, why and under what circumstances FGM is discussed in general practice consultations

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e039809
Author(s):  
Sharon Dixon ◽  
Claire Duddy ◽  
Gabrielle Harrison ◽  
Chrysanthi Papoutsi ◽  
Sue Ziebland ◽  
...  
Keyword(s):  
Primary Care ◽  
Grey Literature ◽  
Relevant Literature ◽  
Theory Development ◽  
Realist Review ◽  
Primary Outcome Measure ◽  
Mandatory Reporting ◽  
Programme Theory ◽  
Genital Mutilation ◽  
The Impact

ObjectivesLittle is known about the management of female genital mutilation (FGM) in primary care. There have been significant recent statutory changes relevant to general practitioners (GPs) in England, including a mandatory reporting duty. We undertook a realist synthesis to explore what influences how and when GPs discuss FGM with their patients.SettingPrimary care in England.Data sourcesRealist literature synthesis searching 10 databases with terms: GPs, primary care, obstetrics, gynaecology, midwifery and FGM (UK and worldwide). Citation chasing was used, and relevant grey literature was included, including searching FGM advocacy organisation websites for relevant data. Other potentially relevant literature fields were searched for evidence to inform programme theory development. We included all study designs and papers that presented evidence about factors potentially relevant to considering how, why and in what circumstances GPs feel able to discuss FGM with their patients.Primary outcome measureThis realist review developed programme theory, tested against existing evidence, on what influences GPs actions and reactions to FGM in primary care consultations and where, when and why these influences are activated.Results124 documents were included in the synthesis. Our analysis found that GPs need knowledge and training to help them support their patients with FGM, including who may be affected, what needs they may have and how to talk sensitively about FGM. Access to specialist services and guidance may help them with this role. Reporting requirements may complicate these conversations.ConclusionsThere is a pressing need to develop (and evaluate) training to help GPs meet FGM-affected communities’ health needs and to promote the accessibility of primary care. Education and resources should be developed in partnership with community members. The impact of the mandatory reporting requirement and the Enhanced Dataset on healthcare interactions in primary care warrants evaluation.PROSPERO registration numberCRD42018091996.

scholarly journals Efficiency over thoroughness in laboratory testing decision-making in primary care: findings from a realist review

BJGP Open ◽  
2020 ◽  
pp. bjgpopen20X101146
Author(s):  
Claire Duddy ◽  
Geoff Wong
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Laboratory Testing ◽  
Laboratory Tests ◽  
Secondary Data ◽  
Realist Review ◽  
Future Research ◽  
Underlying Causes ◽  
Important Means ◽  
Test Ordering

Background: Existing research demonstrates significant variation in test-ordering practice, and growth in the use of laboratory tests in primary care. Reviews of interventions designed to change test-ordering practice report heterogeneity in design and effectiveness. Improving understanding of clinicians’ decision making in relation to laboratory testing is an important means of understanding practice patterns and developing theory-informed interventions. Aim: To develop explanations for the underlying causes of patterns of variation and increasing use of laboratory tests in primary care and make recommendations for future research and intervention design. Design and setting: Realist review of secondary data from primary care. Method: Diverse evidence including data from qualitative and quantitative studies was gathered via systematic and iterative searching processes. Data was synthesised according to realist principles to develop explanations accounting for clinicians’ decision-making in relation to laboratory tests. Results: 145 documents contributed data to the synthesis. Laboratory test ordering can fulfil many roles in primary care. Decisions about tests are incorporated into practice heuristics and tests are deployed as a tool to manage patient interactions. Ordering tests may be easier than not ordering tests in existing systems. Alongside high workloads and limited time to devote to decision-making, there is a common perception that laboratory tests are relatively inconsequential interventions. Clinicians prioritise efficiency over thoroughness in decision-making about laboratory tests. Conclusions: Interventions to change test-ordering practice can be understood as aiming to preserve efficiency or encourage thoroughness in decision-making. Intervention designs and evaluations should consider how testing decisions are made in real-world clinical practice.

scholarly journals Supporting bereavement and complicated grief in primary care: a realist review

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0008
Author(s):  
Caroline Pearce ◽  
Geoff Wong ◽  
Isla Kuhn ◽  
Stephen Barclay
Keyword(s):  
Primary Care ◽  
Complicated Grief ◽  
Realist Review ◽  
Physical And Mental Health ◽  
Prolonged Grief ◽  
Causal Explanations ◽  
Primary Care Settings ◽  
Grief Responses ◽  
Bereavement Care

BackgroundBereavement can have significant impacts on physical and mental health, and a minority of people experience complicated and prolonged grief responses. Primary care is ideally situated to offer bereavement care, yet UK provision remains variable and practitioners feel uncertain how best to support bereaved patients.AimTo identify what works, how, and for whom, in the management of complicated grief (CG) in primary care.Design & settingA review of evidence on the management of CG and bereavement in UK primary care settings.MethodA realist approach was taken that aims to provide causal explanations through the generation and articulation of contexts, mechanisms, and outcomes.ResultsForty-two articles were included. Evidence on the primary care management of complicated or prolonged grief was limited. GPs and nurses view bereavement support as part of their role, yet experience uncertainty over the appropriate extent of their involvement. Patients and clinicians often have differing views on the role of primary care in bereavement. Training in bereavement, local systems for reporting deaths, practitioner time, and resources can assist or hinder bereavement care provision. Practitioners find bereavement care can be emotionally challenging. Understanding patients’ needs can encourage a proactive response and help identify appropriate support.ConclusionBereavement care in primary care remains variable and practitioners feel unprepared to provide appropriate bereavement care. Patients at higher risk of complicated or prolonged grief may fail to receive the support they need from primary care. Further research is required to address the potential unmet needs of bereaved patients.

Developing programme theories to understand’first contact physiotherapy’ in primary care: a rapid realist review (FRONTIER)

Physiotherapy ◽  
2020 ◽  
Vol 107 ◽  
pp. e12
Author(s):  
H. Stott ◽  
S. Halls ◽  
F. Cramp ◽  
R. Thomas ◽  
J. Jagosh ◽  
...  
Keyword(s):  
Primary Care ◽  
Realist Review ◽  
Rapid Realist Review

scholarly journals 72 Adult Safeguarding, Abuse of Vulnerable Adults and Mandatory Reporting: A Rapid Realist Review of the Literature

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Sarah Donnelly
Keyword(s):  
Older People ◽  
Realist Review ◽  
Mandatory Reporting ◽  
Professional Judgment ◽  
Policy And Practice ◽  
Institutional Settings ◽  
What Works ◽  
The Individual ◽  
Vulnerable Adults ◽  
Rapid Realist Review

Abstract Background The continuing evolution of adult safeguarding legislation, policy and practice in relation to the abuse of vulnerable adults reflects a growing awareness of the nature and extent of such abuse in Ireland. The Adult Safeguarding Bill, 2017 represents a progressive step in safeguarding older people and vulnerable adults. The intention of the Bill is to put in place additional protections for adults, in particular, for those who may be unable to protect themselves, such as older people or those lacking capacity. Part 3 provides for mandatory reporting by specified/named persons/professionals. This paper sets out to critically analyse the concept of mandatory reporting within adult safeguarding using international comparators as case studies. Methods A rapid realist review of adult safeguarding reporting typologies and systems in five key jurisdictions: Australia, Canada, England, Northern Ireland and Scotland, were explored to answer the question: ‘what works, for whom and in what circumstances?’ [1] Results Jurisdictions differ as to who the mandated reporters are, the scope and powers of mandatory reporting, and the types of abuse subject to reporting. Of significance is that the debate on mandatory reporting has increasingly focused on institutional settings, rather than more broadly across services. Key concepts identified are those of protection, empowerment and proportionality. Adult safeguarding legislation must therefore ensure that interventionist and compulsory measures to protect do not excessively restrict the rights of the individual. Conclusion Mandatory reporting may offer professionals increased powers to prevent and reduce the abuse of adults and older people, but this could also change the dynamic of relationships within families, and between families and professionals. Ultimately, the success of any legal approach will rest with professional judgment in balancing autonomy with protection.

scholarly journals The Role of Trust and Hope in Antipsychotic Medication Reviews in Primary Care Settings: A Realist Review. 

2021 ◽  
Author(s):  
Lisa Marie Grünwald ◽  
Claire Duddy ◽  
Richard Byng ◽  
Nadia Crellin ◽  
Joanna Moncrieff
Keyword(s):  
Primary Care ◽  
Antipsychotic Medication ◽  
Perceived Risk ◽  
Secondary Care ◽  
Realist Review ◽  
Service Users ◽  
Programme Theory ◽  
Primary Care Settings ◽  
Low Expectations ◽  
Medication Reviews

Abstract Background: Increasing number of service users diagnosed with schizophrenia and psychosis are being discharged from specialist secondary care services to primary care, many of whom are prescribed long-term antipsychotics. It is unclear if General Practitioners have the confidence and experience to appropriately review and adjust doses of antipsychotic medication without secondary care support.Aim: To explore barriers and facilitators of conducting antipsychotic medication reviews in primary care for individuals with no specialist mental health inputDesign & Setting: Realist review in general practice settings. Method: A realist review has been conducted to synthesise evidence on antipsychotic medication reviews conducted in primary care with service users diagnosed with schizophrenia and/or psychosis. Following initial scoping searches and discussions with stakeholders, a systematic search and iterative secondary searches were conducted. Articles were systematically screened and analysed to develop a realist programme theory explaining the contexts (C) and mechanisms (M) which facilitate or prevent antipsychotic medication reviews (O) in primary care settings, and the potential outcomes of medication reviews.Results: Antipsychotic medication reviews may not occur for individuals with only primary care medical input. Several, often mutually reinforcing, mechanisms have been identified as potential barriers to carrying out meaningful reviews, including low expectations of recovery for people with severe mental illness, a perceived lack of capability to understand and participate in medication reviews, linked with a lack of information shared in appointments between GPs and Service Users, and perceived risk and uncertainty regarding antipsychotic medication and illness trajectory. Conclusions: The review identified reciprocal and reinforcing stereotypes affecting both GPs and service users. Possible mechanisms to counteract these barriers are discussed, including realistic expectations of medication, and the need for increased information sharing and trust between GPs and service users.

scholarly journals What Works in Integrated Care Programs for Older Adults with Complex Needs? A Realist Review

2017 ◽  
Vol 17 (5) ◽  
pp. 107
Author(s):  
Jennifer Im ◽  
Maritt Kirst ◽  
Tim Burns ◽  
Jodeme Goldhar ◽  
Patricia O'Campo ◽  
...  
Keyword(s):  
Older Adults ◽  
Integrated Care ◽  
Realist Review ◽  
Complex Needs ◽  
What Works

scholarly journals Developing core economic parameter sets for asthma studies: a realist review and an analytical framework

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e037889
Author(s):  
Chris Roukas ◽  
Zahidul Quayyum ◽  
Anita Patel ◽  
Deborah Fitzsimmons ◽  
Ceri Phillips ◽  
...  
Keyword(s):  
Primary Care ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Emergency Care ◽  
Secondary Care ◽  
Work Productivity ◽  
Realist Review ◽  
Analytical Framework ◽  
Economic Parameter ◽  
Economic Parameters

ObjectiveTo develop a standardised set of economic parameters (core economic parameter set) for economic evaluations in asthma studies.DesignA systematic literature review and an analytical framework.Outcome measuresEconomic parameters used to evaluate costs and cost-effectiveness of healthcare interventions for people with asthma.Data sourcesPubMed, the Cochrane Database of Systematic Reviews, the National Health Service Economic Evaluation Database, the Database of Abstracts of Reviews of Effects and the Health Technology Aaaessment Library starting from 1990.Review methodsResearch methods were based on the realist review methodology and included a number of non-sequential, iterative and overlapping components, such as developing an analytical framework for the realist review; systematic literature review of economic parameters; identifying and categorising economic parameters; producing preliminary list of core economic parameters.ResultsDatabase searches found 2531 publications of which 224 were included in the systematic review. We identified 65 economic parameters that were categorised into 11 groups to enable the realist synthesis. Parameters related to secondary care, primary care, medication use, emergency care and work productivity comprised 84% of all economic parameters. An analytical framework was used to investigate the rationale behind the choices of economic parameters in these studies. The main framework domains included type of intervention, research population, study design, study setting and a stakeholder’s perspective.ConclusionPast research thus suggests that in asthma study parameters depicting the use of secondary care, primary care, medication, emergency care and work productivity can be considered as core economic parameters, since they apply to different types of studies. Parameters including diagnostics, healthcare delivery, school activity, informal care, medical devices and health utility apply to a particular type of study (or research question), and thus can be recommended as supplemental parameters.PROSPERO registration numberCRD42017067867.

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