Yonder: a diverse selection of primary care relevant research stories from beyond the mainstream biomedical literature
Anticipatory medications
Anticipatory medications are those prescribed to deteriorating patients who are approaching end-of-life care and include drugs to relieve pain and control other symptoms that typically occur in the last days of life. Lack of access to such medications at times of need may result in unnecessary hospital admissions and increased patient and family distress in managing palliative care at home. A recent Australian cohort study examined data from 799 palliative care patients in 25 general practice health records across a 10-year period.1 They found that only 13.5% of patients received anticipatory medications through general practice, and subsequent stakeholder consultations showed this could partly be explained by confusion about identifying appropriate patients. The authors suggest that screening tools to help identify patients with palliative care needs might help.
Food insecurity
Tragically, the COVID-19 pandemic has caused much economic and social harm, including a rising number of households with limited or uncertain access to adequate foods — food insecurity (FI). Recognising that primary care services in the US are increasingly trying to screen for FI and refer to appropriate resources, a research team from Colorado recently examined how this process was viewed by patients, healthcare workers, and staff at food assistance organisations.2 They found that although all stakeholders recognised the impact that FI has on health outcomes, perspectives varied on the value of sharing information through referrals, including privacy concerns and uncertainty about whether the process would require significant work and not necessarily improve FI. The guiding principles of confidentiality and respect stood out as being of crucial importance.
Childhood vaccination
Another of the many concerning trends since the COVID-19 pandemic began has been declining routine vaccination rates. A research team from Toronto recently evaluated the impact of the pandemic on early childhood vaccination rates at two sites of an academic family health team.3 They found that the pandemic led to a deterioration in the uptake of routine childhood vaccines, which were suboptimal even before the pandemic. Their data suggest that the lower rates in children aged 12–18 months would be a valuable target for interventions. The authors emphasise that improving vaccination rates will be important as the pandemic continues, as a developing cohort of children with less protection against vaccine-preventable illnesses could further burden already strained public health systems.
Street sex workers
Although street sex workers (SSWs) experience high rates of chronic diseases, including respiratory diseases and substance misuse disorders, and have high reproductive health needs, most clinical services for SSWs focus predominantly on sexual health. A research team from Bristol recently conducted a cross-sectional survey of 50 professionals who work with SSWs in the UK, finding that mainstream general practice and mental health services were found to be largely inaccessible to this group.4 They also found some examples of positive healthcare provision that show that it is possible to provide accessible and responsive health care that meets the needs of SSWs. The authors make a compelling argument that these ‘best practice’ examples should be implemented and evaluated in a more systematic way across the UK.
- © British Journal of General Practice 2022
