Kidney transplant
Medical students that I supervise on primary care placements are often surprised to see that transplant recipients often see their own GPs and are not managed exclusively by hospital transplant teams. In fact, the outcomes after transplantation are largely determined by the capacity of transplant recipients to engage with a complex and continuous self-management regime to minimise the risks of complications and comorbidities. In order to describe kidney transplant recipient patients’ attitudes towards self-management, an international research team conducted a systematic review and thematic analysis of qualitative studies.1 The review included 50 studies with a total of 1238 participants over 19 countries. The five dominant themes in these papers were: empowerment through autonomy, prevailing fear of consequences, burdensome treatment and responsibilities, overmedicalising life, and social accountability. The authors conclude that medication adherence for these patients can be physically and mentally taxing so interventions to promote self-management should be personalised and multifaceted.
Supraventricular tachycardia
SVT is a generic term for cardiac arrhythmias that originate at an atrial level. Symptoms and episode durations can vary widely and treatment options include pharmacological and interventional therapies. A recent Swedish study sought to describe the impact of SVT episodes on a person’s daily life.2 They interviewed patients who were recruited from a waiting list for ablation therapy of SVT at a county hospital in southern Sweden. The patients described an inhibited existence due to demands to give up things that they had previously been doing, in case the unpredictable episodes of SVT would occur. The episodes caused fatigue and worry, and patients constantly needed to find short-term and long-term strategies to prevent new episodes from happening. The authors conclude that the impact of SVT is so complex and profound that it more or less takes over a person’s daily life, and, as such, healthcare services should improve the patient pathway, particularly in acute settings.
Contraception
Although teenage pregnancy rates are coming down in many Western countries, most pregnancies that do occur in this age group are unintended and preventable. As long-acting reversible contraceptives (LARCs) are highly effective at preventing pregnancy and do not require user action when placed, they are particularly suitable for adolescents. However, in the US, they remain significantly underutilised in this group and a recent Washington study sought to understand why.3 Their interviews of 30 adolescent females aged between 14 and 18 years found that individuals had strong preferences about device-specific characteristics, were often exposed to misinformation about LARCs from peers, and varied in their access to LARCs due to family or healthcare setting circumstances. Paediatric primary care providers, the authors state, are ideally positioned to promote LARC use in adolescents but will need to recognise the unique counselling needs of these individuals.
Dog walking
This activity can potentially have a whole array of benefits for human health ranging from the physical activity benefits to the higher levels of social and emotional wellbeing that it can bring. On the basis that seated interviews and focus groups are not ideally suited to capture the experience of such a dynamic activity, researchers from New Zealand completed a study that used the dog-walk-along interview method to capture the views of 10 healthy dog walkers.4 Three themes were identified: participants had an ‘Emotional Connection’ with their dog; dog walking led to ‘Healthy Interactions’ (social and environmental interactions); and participants had come to value dog walking for its aggregate benefits for ‘Psychological Wellbeing’. The emotional connection between human and dog, the authors conclude, strengthens an intrinsic motivation to exercise. They argue that health promotion advocates should use these findings to refine dog-walking-related advice, programmes, and initiatives.
- © British Journal of General Practice 2017