A5023831787- Chronic Disease Management Strategies
- Health Systems, Economic Evaluations, Quality of Life
- Emergency and Acute Care Studies
- Obesity, Physical Activity, Diet
- Nursing Roles and Practices
- Workplace Health and Well-being
- Primary Care and Health Outcomes
- Healthcare cost, quality, practices
- Employment and Welfare Studies
- Healthcare Systems and Technology
- Peripheral Artery Disease Management
- Nutritional Studies and Diet
- Electroconvulsive Therapy Studies
- Resilience and Mental Health
- Psychiatric care and mental health services
- Palliative Care and End-of-Life Issues
- Treatment of Major Depression
- Healthcare Policy and Management
- Delphi Technique in Research
- Venous Thromboembolism Diagnosis and Management
- Diagnosis and Treatment of Venous Diseases
- Health Education and Validation
- Consumer Attitudes and Food Labeling
- 3D Surveying and Cultural Heritage
- Patient-Provider Communication in Healthcare
University of Bristol
2013-2024
University Hospital Llandough
2023-2024
At Bristol
2024
National Institute for Health Research
2019
Primary Health Care
2019
University of Exeter
2015
Cardiff University
2006-2012
Commonwealth Scientific and Industrial Research Organisation
1976
The management of people with multiple chronic conditions challenges health-care systems designed around single conditions. There is international consensus that care for multimorbidity should be patient-centred, focus on quality life, and promote self-management towards agreed goals. However, there little evidence about the effectiveness this approach. Our hypothesis was so-called 3D approach (based dimensions health, depression, drugs) patients would improve their health-related which...
BackgroundTelephone triage is increasingly used to manage workload in primary care; however, supporting evidence for this approach scarce. We aimed assess the effectiveness and cost consequences of general practitioner-(GP)-led nurse-led telephone compared with usual care patients seeking same-day consultations care.MethodsWe did a pragmatic, cluster-randomised controlled trial economic evaluation between March 1, 2011, 31, 2013, at 42 practices four centres UK. Practices were randomly...
To develop and validate a new scale to assess treatment burden (the effort of looking after one's health) for patients with multimorbidity.Mixed-methods.UK primary care.Content the Multimorbidity Treatment Burden Questionnaire (MTBQ) was based on literature review views from patient public involvement group. Face validity assessed through cognitive interviews. The piloted final version tested in 1546 adults multimorbidity (mean age 71 years) who took part 3D Study, cluster randomised...
Background Telephone triage is proposed as a method of managing increasing demand for primary care. Previous studies have involved small samples in limited settings, and focused on nurse roles. Evidence regarding the impact care workload, costs, patient safety experience when used to manage patients requesting same-day consultations general practice. Objectives In comparison with usual (UC), assess GP-led telephone (GPT) nurse-led computer-supported (NT) workload cost, care, health status...
One strategy for examining effects of nutrients on cognitive function is to initially investigate foods that contain many different nutrients. If are demonstrated with these then further studies can address the role specific Breakfast (e.g., cereals, dairy products and fruit) provide important consumption breakfast has been shown be associated beneficial function. Isolating constituents proved more difficult it still unclear what impact real-life performance. The present study provided...
Universal interventions may widen or narrow inequalities if disproportionately effective among higher lower socio-economic groups. The present paper examines impacts of the Primary School Free Breakfast Initiative in Wales on children's dietary behaviours and cognitive functioning.Cluster-randomised controlled trial. Responses were linked to free school meal (FSM) entitlement via Secure Anonymised Information Linkage databank. Impacts evaluated using weighted school-level regression models...
Objectives During a cluster randomised trial, (the 3D study) of an intervention enacting recommended care for people with multimorbidity, including continuity and comprehensive biennial reviews, we examined implementation fidelity to interpret the trial outcome inform future decisions. Design Mixed-methods process evaluation using cross-trial data sample practices, clinicians, administrators patients. Interviews, focus groups review observations were analysed thematically integrated...
Introduction An increasing number of people are living with multimorbidity. The evidence base for how best to manage these patients is weak. Current clinical guidelines generally focus on single conditions, which may not reflect the needs aim 3D study develop, implement and evaluate an intervention improve management multimorbidity in general practice. Methods analysis This a pragmatic two-arm cluster randomised controlled trial. 32 practices around Bristol, Greater Manchester Glasgow will...
Nurse-led telephone triage is increasingly used to manage demand for general practitioner consultations in UK practice. Previous studies are equivocal about the relationship between clinical experience and call outcomes of nurse triage. Most research limited investigating out-of-hours settings.To investigate whether professional characteristics primary care nurses undertaking computer decision supported software related disposition.Questionnaire survey delivering intervention arm ESTEEM...
To undertake further psychometric testing of the Multimorbidity Treatment Burden Questionnaire (MTBQ) and examine whether reversing scale reduced floor effects. Survey. UK primary care. Adults (≥18 years) with three or more long-term conditions randomly selected from four general practices invited by post. Baseline survey: sociodemographics, MTBQ (original version reversed), (TBQ), questions (from QQ-10) on ease completing questionnaires. Follow-up survey (1-4 weeks after baseline): MTBQ,...
There is an extensive literature on the scale of, and risk factors for, stress at work, outcomes associated with negative job characteristics perceived stress.More recently, however, there has been a growing awareness that unemployment harmful to health, work beneficial may be effective way improve health wellbeing.However, little attempt draw together findings from this newer area.This paper gives overview of current perspectives its associations improved well-being.It provides framework...
Background People with multimorbidity experience impaired quality of life, poor health and a burden from treatment. Their care is often disease-focused rather than patient-centred tailored to their individual needs. Objective To implement evaluate intervention improve the management patients in general practice. Design Pragmatic, cluster randomised controlled trial parallel process economic evaluations. Practices were centrally by statistician blind practice identifiers, using...
Background Much recent work extending the field of job characteristics to include positive aspects makes implicit assumption that absence negative is equivalent presence characteristics. Aims To consider effect sizes seen at different ends characteristic dimensions and compare impact in association with mental health well-being outcomes. Methods Data from 8755 workers were analysed impacts or (job demand, extrinsic effort social support) associations both satisfaction) (work-related stress)...
Recent evidence has highlighted the high prevalence and impact of multimorbidity, but base for improving management is limited. We have tested a new complex intervention multimorbidity (the 3D model). The paper describes baseline characteristics practices patients in order to establish external validity trial participants. It also explores current 'usual primary care' against which was tested.Analysis data from cluster-randomised controlled additional practice staff.Primary care UK.Patients...
Objective Patients with multiple chronic health conditions are often managed in a disjointed fashion primary care, annual review clinic appointments offered separately for each condition. This study aimed to determine the cost-effectiveness of 3D intervention, which was developed improve system care. Design Economic evaluation conducted alongside pragmatic cluster-randomised trial. Setting General practices three centres England and Scotland. Participants 797 adults or more were randomised...
The ESTEEM trial was a randomised-controlled of telephone triage consultations in general practice. We conducted exploratory analyses on data from 9154 patients 42 UK practices who returned questionnaire containing self-reported ratings satisfaction with care following request for same-day consultation. Mode identified through case notes review. There were seven main types: GP face-to-face consultation, or nurse consultation no subsequent same day care, nurse. investigated the contribution...
This study investigated prescribing patterns of two cohorts patients treated with selective serotonin reuptake inhibitors (SSRI) in primary care Wales (UK), to better understand drivers for increased usage.