Integrating health care and early years support, technostress, breast cancer screening and substance use disorder, and group CBT for insomnia
Integrating health care and early years support
There is an increasing drive to integrate health and social care in the community for children. Sparkbrook Children’s Zone (SCZ) is one of several integrated care services being piloted by NHS England in an area of the West Midlands with high levels of diversity, deprivation, infant mortality, and childhood obesity alongside low immunisation uptake. The service has a paediatric nurse, GP, paediatrician, mental health support worker, and family support advisor on site providing management of common conditions, preventive health care, and early years family support. This study reports on the cost- and clinical-effectiveness of SCZ with the main clinical outcome measure of emergency department (ED) attendances.1 Compared with usual primary care, SCZ was cheaper by £44.08 per patient and led to reduced proportion of ED visits by 0.012. This seems like a brilliant local service, with the ability to improve outcomes for our most vulnerable populations. With the abolition of NHS England, we need to ensure programmes like this are not forgotten.
Technostress
As GPs, we deal with a multitude of work streams on a plethora of platforms, communicating with colleagues and patients in an ever-increasing variety of ways. This German study explores ‘technostress’, the stress caused to end-users by extended use of information and communication technologies.2 In a mixed-methods online survey of 114 GPs, quantitative data suggest that the main drivers of technostress were the costs of system maintenance and technical errors within digital systems. Qualitatively, participants reported increased workload secondary to multiple digital platforms. The authors suggest a number of solutions at practice and policy level, but the standout summary is in the discussion: ‘Simplifying administrative tasks would mitigate technostress and enhance overall job satisfaction.’
Breast cancer screening and substance use disorder
Anyone registered as female with a GP in the UK is currently invited for a mammogram every 3 years from age 50–71 years. There is evidence that people with substance use disorders (SUDs) have lower use of cancer screening due to several barriers including distrust of health care and stigma around SUDs. This US retrospective cohort study aimed to determine if SUD is associated with decreased rates of breast cancer screening.3 In an adjusted model, those without an SUD were significantly more likely to have a mammogram than those with an SUD (odds ratio [OR] 1.64, 95% confidence interval [CI] = 1.56 to 1.71). This was heightened when specifically looking at those with stimulant (OR 2.15, 95% CI = 1.86 to 2.47) or opioid (OR 1.93, 95% CI = 1.78 to 2.08) use disorders. Addressing barriers to screening is crucial to reducing this inequity.
Group CBT for insomnia
Insomnia can be a debilitating symptom and is associated with detrimental health outcomes including cardiovascular disease and psychiatric disorders. Cognitive behavioural therapy for insomnia (CBT-I) is a safe and effective intervention, but it is not widely available. One way to improve access is by offering group therapy. This Norwegian multicentre randomised controlled trial aimed to test the effectiveness of group CBT-I delivered in primary care.4 Participants were randomly assigned to either group CBT-I or a waiting list. The intervention consisted of four 2-hour sessions delivered to groups of 5–15 participants. The CBT-I group had a significant reduction in mean insomnia scores compared with the waiting list group at 3- and 6-months post-intervention. They also had a significantly greater reduction in fatigue and mental distress, with significantly greater increases in daytime functioning, sleep quality, and sleep efficiency.
Yonder: a diverse selection of primary care relevant research stories from beyond the main stream biomedical literature
