scholarly journals Linking questionnaires to primary care records: factors affecting consent in older people

2005 ◽  
Vol 59 (4) ◽  
pp. 336-338 ◽  
Author(s):  
T. Harris
Keyword(s):  
Primary Care ◽  
Older People ◽  
Factors Affecting

scholarly journals An external pilot cluster randomised controlled trial of a theory-based intervention to improve appropriate polypharmacy in older people in primary care (PolyPrime): study protocol

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Audrey Rankin ◽  
◽  
Cathal A. Cadogan ◽  
Heather E. Barry ◽  
Evie Gardner ◽  
...  
Keyword(s):  
Primary Care ◽  
Randomised Controlled Trial ◽  
Older People ◽  
Usual Care ◽  
Controlled Trial ◽  
Cluster Randomised Controlled Trial ◽  
Online Video ◽  
Link Type ◽  
Cluster Randomised ◽  
Randomised Controlled

Abstract Background The use of multiple medications (polypharmacy) is a concern in older people (≥65 years) and is associated with negative health outcomes. For older populations with multimorbidity, polypharmacy is the reality and the key challenge is ensuring appropriate polypharmacy (as opposed to inappropriate polypharmacy). This external pilot cluster randomised controlled trial (cRCT) aims to further test a theory-based intervention to improve appropriate polypharmacy in older people in primary care in two jurisdictions, Northern Ireland (NI) and the Republic of Ireland (ROI). Methods Twelve GP practices across NI (n=6) and the six counties in the ROI that border NI will be randomised to either the intervention or usual care group. Members of the research team have developed an intervention to improve appropriate polypharmacy in older people in primary care using the Theoretical Domains Framework of behaviour change. The intervention consists of two components: (1) an online video which demonstrates how a GP may prescribe appropriate polypharmacy during a consultation with an older patient and (2) a patient recall process, whereby patients are invited to scheduled medication review consultations with GPs. Ten older patients receiving polypharmacy (≥4 medications) will be recruited per GP practice (n=120). GP practices allocated to the intervention arm will be asked to watch the online video and schedule medication reviews with patients on two occasions; an initial and a 6-month follow-up appointment. GP practices allocated to the control arm will continue to provide usual care to patients. The study will assess the feasibility of recruitment, retention and study procedures including collecting data on medication appropriateness (from GP records), quality of life and health service use (i.e. hospitalisations). An embedded process evaluation will assess intervention fidelity (i.e. was the intervention delivered as intended), acceptability of the intervention and potential mechanisms of action. Discussion This pilot cRCT will provide evidence of the feasibility of a range of study parameters such as recruitment and retention, data collection procedures and the acceptability of the intervention. Pre-specified progression criteria will also be used to determine whether or not to proceed to a definitive cRCT. Trial registration ISRCTN, ISRCTN41009897. Registered 19 November 2019. ClinicalTrials.gov, NCT04181879. Registered 02 December 2019.

scholarly journals Improving mobility and participation of older people with vertigo, dizziness and balance disorders in primary care using a care pathway: feasibility study and process evaluation

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Eva Seckler ◽  
Verena Regauer ◽  
Melanie Krüger ◽  
Anna Gabriel ◽  
Joachim Hermsdörfer ◽  
...  
Keyword(s):  
Primary Care ◽  
Data Collection ◽  
Older People ◽  
Process Evaluation ◽  
Feasibility Study ◽  
Health Professionals ◽  
Implementation Strategy ◽  
Care Pathway ◽  
Main Trial ◽  
Telephone Helpline

Abstract Background Community-dwelling older people are frequently affected by vertigo, dizziness and balance disorders (VDB). We previously developed a care pathway (CPW) to improve their mobility and participation by offering standardized approaches for general practitioners (GPs) and physical therapists (PTs). We aimed to assess the feasibility of the intervention, its implementation strategy and the study procedures in preparation for the subsequent main trial. Methods This 12-week prospective cohort feasibility study was accompanied by a process evaluation designed according to the UK Medical Research Council’s Guidance for developing and evaluating complex interventions. Patients with VDB (≥65 years), GPs and PTs in primary care were included. The intervention consisted of a diagnostic screening checklist for GPs and a guide for PTs. The implementation strategy included specific educational trainings and a telephone helpline. Data for mixed-method process evaluation were collected via standardized questionnaires, field notes and qualitative interviews. Quantitative data were analysed using descriptive statistics, qualitative data using content analysis. Results A total of five GP practices (seven single GPs), 10 PT practices and 22 patients were included in the study. The recruitment of GPs and patients was challenging (response rates: GP practices: 28%, PT practices: 39%). Ninety-one percent of the patients and all health professionals completed the study. The health professionals responded well to the educational trainings; the utilization of the telephone helpline was low (one call each from GPs and PTs). Familiarisation with the routine of application of the intervention and positive attitudes were emphasized as facilitators of the implementation of the intervention, whereas a lack of time was mentioned as a barrier. Despite difficulties in the GPs’ adherence to the intervention protocol, the GPs, PTs and patients saw benefit in the intervention. The patients’ treatment adherence to physical therapy was good. There were minor issues in data collection, but no unintended consequences. Conclusion Although the process evaluation provided good support for the feasibility of study procedures, the intervention and its implementation strategy, we identified a need for improvement in recruitment of participants, the GP intervention part and the data collection procedures. The findings will inform the main trial to test the interventions effectiveness in a cluster RCT. Trial registration Projektdatenbank Versorgungsforschung Deutschland (German registry Health Services Research) VfD_MobilE-PHY_17_003910, date of registration: 30.11.2017; Deutsches Register Klinischer Studien (German Clinical Trials Register) DRKS00022918, date of registration: 03.09.2020 (retrospectively registered).

scholarly journals Do statins reduce mortality in older people? Findings from a longitudinal study using primary care records

2021 ◽  
Vol 9 (2) ◽  
pp. e000780
Author(s):  
Lisanne Andra Gitsels ◽  
Ilyas Bakbergenuly ◽  
Nicholas Steel ◽  
Elena Kulinskaya
Keyword(s):  
Primary Care ◽  
Older People ◽  
Clinical Information ◽  
Cardiac Risk ◽  
Health Improvement ◽  
Network Database ◽  
Statin Prescription ◽  
The Health Improvement Network ◽  
Care Practices ◽  
Primary Care Practices

ObjectiveAssess whether statins reduce mortality in the general population aged 60 years and above.DesignRetrospective cohort study.SettingPrimary care practices contributing to The Health Improvement Network database, England and Wales, 1990–2017.ParticipantsCohort who turned age 60 between 1990 and 2000 with no previous cardiovascular disease or statin prescription and followed up until 2017.ResultsCurrent statin prescription was associated with a significant reduction in all-cause mortality from age 65 years onward, with greater reductions seen at older ages. The adjusted HRs of mortality associated with statin prescription at ages 65, 70, 75, 80 and 85 years were 0.76 (95% CI 0.71 to 0.81), 0.71 (95% CI 0.68 to 0.75), 0.68 (95% CI 0.65 to 0.72), 0.63 (95% CI 0.53 to 0.73) and 0.54 (95% CI 0.33 to 0.92), respectively. The adjusted HRs did not vary by sex or cardiac risk.ConclusionsUsing regularly updated clinical information on sequential treatment decisions in older people, mortality predictions were updated every 6 months until age 85 years in a combined primary and secondary prevention population. The consistent mortality reduction of statins from age 65 years onward supports their use where clinically indicated at age 75 and older, where there has been particular uncertainty of the benefits.

scholarly journals Treatment Fidelity of an Evidence-Based Nurse-Led Intervention in a Proactive Primary Care Program for Older People

2016 ◽  
Vol 13 (1) ◽  
pp. 75-84 ◽  
Author(s):  
Nienke Bleijenberg ◽  
Valerie H. ten Dam ◽  
Irene Drubbel ◽  
Mattijs E. Numans ◽  
Niek J. de Wit ◽  
...  
Keyword(s):  
Primary Care ◽  
Older People ◽  
Care Program ◽  
Treatment Fidelity ◽  
Evidence Based ◽  
Primary Care Program

Factors Affecting the Extent and Quality of Nature Engagement of Older Adults Living in a Range of Home Types

2018 ◽  
Vol 52 (8) ◽  
pp. 799-829 ◽  
Author(s):  
Yolanda van Heezik ◽  
Claire Freeman ◽  
Yvette Buttery ◽  
Debra L. Waters
Keyword(s):  
Older Adults ◽  
Older People ◽  
Health Issues ◽  
Factors Affecting ◽  
Frailty Status ◽  
Nature Contact ◽  
Nature Connectedness ◽  
Nature Experience ◽  
Access To Nature

Nature interaction is seen as a potentially inexpensive intervention to address many health issues. Aging is associated with declining health and mobility. Older people are known to benefit from nature contact; however, less is known about how aging limits access to nature. We investigated older adults occupying family, downsized, and rest homes to determine factors driving changes in nature engagement, and the quality of available nature. Less time was spent in natural places as people aged, depending on the extent of nature connectedness, frailty status, home type, and whether they lived alone or not. Most reported reduced nature engagement and expressed feelings of sadness, frustration, and anger. Gardens assumed an important role in enabling nature contact to continue, in that time spent in gardens was unrelated to age or frailty. Garden variability meant the quality of the nature experience was likely lower for those living in downsized and rest homes.

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