Yonder: a diverse selection of primary care relevant research stories from beyond the mainstream biomedical literature
Home visits
Broadening the primary care workforce to reduce demand on GPs has been a clear policy target in the NHS for some years now, with mixed results. Planned and unscheduled home visits place demand on GP time, and it has been suggested that paramedics, who are accustomed to assessing patients in their own homes, could be ideally placed for primary care home visiting. A recent study in Northern England examined three practices that piloted such a service, finding that it was broadly perceived as positive by patients and clinicians.1 Initial reservations by patients and GPs were overcome by the expertise and interpersonal skills of these ‘emergency care practitioners’, and the authors noted that fostering a culture of collaboration was essential to remodelling professional boundaries at the practice level.
Dentists’ wellbeing
The overwhelming majority of dentistry in the NHS is delivered in primary care, but evidence suggests that morale among ‘coalface’ dentists is poor and reducing, probably worsened at least to some degree by the COVID-19 pandemic. A recent study from King’s College London sought to explore contemporary influences on dentists’ health and wellbeing in England, drawing on their lived experience.2 While health and wellbeing were reported to be more positive among dentists in their later career, those in their early career and/or with high NHS work commitments shared concerns about their physical, psychological, and emotional health. Influences ranged from macro-level issues relating to professional regulation and health systems, through meso-level, notably their workplace and job specification, to micro-level issues relating to their professional careers, relationships, and personal life. The authors outline a vast array of policy solutions, which they argue need to be adopted urgently.
Child mental health
Untreated mental health disorders in children and adolescents are related to adverse academic, social, and health outcomes, and these often persist to adulthood. Early detection and prompt access to professional treatment is, therefore, critically important. A UK research team recently conducted a systematic review to understand why many young people do not seek or access care.3 Almost all studies (96%) reported barriers related to young people’s individual factors, such as limited mental health knowledge. The second most commonly (92%) reported theme related to social factors, for example, perceived social stigma. The third theme captured young people’s perceptions of the therapeutic relationship with professionals (68%) including perceived confidentiality and the ability to trust an unknown person. The fourth theme related to systemic and structural barriers and facilitators (58%), such as financial costs associated with mental health services, and the availability of professional help. The authors suggest that collaboration between schools and mental health services is essential and that mental health professionals should offer young people different ways to access help on their own, including using digital tools.
BetterBack
Like in the UK and many other countries, most patients with low back pain (LBP) in Sweden are treated in primary care. Although many patients improve within a short period, a significant proportion report recurrences or ongoing pain, causing significant disability and distress. The ‘BetterBack’ care model was developed by adapting international guidelines for LBP to the Swedish context, and it aims to encourage clinicians to adopt a more biopsychosocial approach and provide patients with tools to better self-manage LBP episodes. A recent study assessing impacts of the BetterBack model found that it was very well received by patients, who felt it improved their knowledge and confidence, making it easier for them to self-manage their condition.4 As the authors acknowledge, while this is promising, clinical trials and health economics evaluations are needed to support policy decisions about implementing BetterBack more widely.
Podcast of the month
After the recent dramatic and tragic events in Afghanistan, it’s a good time to listen to A Wish for Afghanistan from the BBC; https://www.bbc.co.uk/programmes/w13xtvl0/episodes/downloads.
- © British Journal of General Practice 2021
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