Alison Littlewood

Somatization and health anxiety as predictors of health care use.

Objective To assess whether the number of somatic symptoms and health anxiety are independent predictors of future health care use after adjusting for confounders. Methods In a random sample of the adult UK population, questionnaires assessed the number of somatic symptoms (Somatic Symptom Inventory), health anxiety (Whiteley Index), anxiety/depression (Hospital Anxiety and Depression Scale), the number of physical illnesses and demographic variables. The number of consultations in primary care was obtained from medical records for 1 year before and after questionnaire assessment, and negative binomial regression analyses identified predictors of consultation rate. Results The sample included 961 participants (58.0% response) with complete medical record data for 609 participants. After adjustment for consultation rate in the prior year, the predictors of subsequent consultation rate in primary care were the number of physical illnesses, off work through illness, Whiteley Index (incidence rate ratio [IRR] = 1.22, 95% confidence interval [CI] = 1.09–1.35), and the Whiteley Index–by–Somatic Symptom Inventory interaction term. Reported physical abuse predicted an increased consultation rate in women (IRR = 2.30, 95% CI = 1.08–4.90) but a reduced rate in men (IRR = 0.43, 95% CI = 0.22–0.84), interaction p = 0.003. Conclusions These data raise the possibility that both increased health anxiety and number of bothersome somatic symptoms predict frequent medical consultations. A more complex model of predicting future health care use is needed than has been studied previously, which is potentially relevant to the current discussions of the proposed DSM-V and International Classification of Diseases, 11th Revision, diagnostic guidelines regarding complex somatic symptom disorders. Abbreviations SSI = Somatic Symptom Inventory HADS = Hospital Anxiety and Depression Scale SF-12 = Short Form 12 IRR = incidence rate ratio SD = standard deviation

Common and unique associated factors for medically unexplained chronic widespread pain and chronic fatigue

Objective Chronic widespread pain and chronic fatigue share common associated factors but these associations may be explained by the presence of concurrent depression and anxiety. Methods We mailed questionnaires to a randomly selected sample of people in the UK to identify participants with chronic widespread pain (ACR 1990 definition) and those with chronic fatigue. The questionnaire assessed sociodemographic factors, health status, healthcare use, childhood factors, adult attachment, and psychological stress including anxiety and depression. To identify persons with unexplained chronic widespread pain or unexplained chronic fatigue; we examined participants medical records to exclude medical illness that might cause these symptoms. Results Of 1443 participants (58.0% response rate) medical records of 990 were examined. 9.4% (N = 93) had unexplained chronic widespread pain and 12.6% (N = 125) had unexplained chronic fatigue. Marital status, childhood psychological abuse, recent threatening experiences and other somatic symptoms were commonly associated with both widespread pain and fatigue. No common effect was found for few years of education and current medical illnesses (more strongly associated with chronic widespread pain) or recent illness in a close relative, neuroticism, depression and anxiety scores (more strongly associated with chronic fatigue). Putative associated factors with a common effect were associated with unexplained chronic widespread pain or unexplained chronic fatigue only when there was concurrent anxiety and/or depression. Discussion This study suggests that the associated factors for chronic widespread pain and chronic fatigue need to be studied in conjunction with concurrent depression/anxiety. Clinicians should be aware of the importance of concurrent anxiety or depression.

Primary care based screening for cardiovascular risk factors in patients with psoriasis

Studies assessing cardiovascular disease (CVD) risk factors in patients with psoriasis have been limited by selection bias, inappropriate controls or a reliance on data collected for clinical reasons.

Motivational interviewing-based training enhances clinicians' skills and knowledge in psoriasis: findings from the Pso Well(®) study

Psoriasis is a common long‐term, immune‐mediated skin condition associated with behavioural factors (e.g. smoking, excess alcohol, obesity), which increase the risk of psoriasis onset, flares and comorbidities. Motivational interviewing (MI) is an evidence‐based approach to health‐related behaviour change that has been used successfully for patients with long‐term conditions. This study assessed change in clinicians’ MI skills and psoriasis knowledge following Psoriasis and Wellbeing (Pso Well®) training.

Evaluation of the IMPACT study practitioner training intervention: using motivational interviewing to optimize self-management in psoriasis

PS01 Evaluation of the IMPACT study practitioner training intervention: using motivational interviewing to optimize self-management in psoriasis A. Chisholm, P.A. Nelson, A.J. Littlewood, K. Kane, C. Pearce, A.L. Henry, R. Thorneloe, M. Hamilton, J. Lavallee, M. Lunt, C.E.M. Griffiths, L. Cordingley and C. Bundy Manchester Centre for Dermatology Research; Manchester Centre for Health Economics; School of Nursing, Midwifery and Social Work and Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K. Psoriasis is a common long-term, immune-mediated skin condition that is exacerbated by unhealthy lifestyle factors including smoking, excess alcohol and obesity. These behavioural factors are also linked to cardiovascular disease and depression, and both are associated with psoriasis. Psoriasis management should therefore address these factors, but previous research shows this is rarely done in practice. Motivational interviewing is an evidence-based approach to supporting patients with behaviour change in a range of long-term conditions, but has not been applied to psoriasis management in the clinical setting. We explored the efficacy, feasibility and acceptability of a motivational interviewing-informed training intervention (‘Pso Well ’: Psoriasis and Well-being) for healthcare professionals who manage psoriasis. This training intervention addresses current recommendations for psoriasis care to integrate physical, psychological and behavioural aspects, thereby supporting patients to make behavioural changes leading to improved health and quality of life. This study investigated (i) whether participating in the Pso Well training intervention improves healthcare professionals’ behaviour change skills and knowledge of the behavioural factors related to psoriasis; (ii) whether intervention delivery of this kind is feasible to run within U.K. health settings; and (iii) whether the training content was acceptable to clinicians. Clinicians’ behaviour change skills were assessed before and after training using the Behaviour Change Counselling Index (BECCI) to score audio-recorded practitioner–patient actor consultations. A 22-item questionnaire assessed clinician knowledge of behavioural factors related to psoriasis before and after training. Feasibility and acceptability data were explored via semistructured interviews with practitioners following training and were analysed using an inductive thematic analysis approach. Sixty-one practitioners completed the training (35 dermatology nurses, 23 dermatologists and three general practitioners). Practitioners’ BECCI scores increased significantly post-training [t(54) = 8 37, P < 0 001; g = 0 56], as did their knowledge scores [t(60) = 4 30, P < 0 001]. Practitioners valued the training because it allowed them to examine and reflect upon their own consultation approach, and because it provided them with the skills and confidence to tackle challenging discussions with patients about lifestyle behaviours. Clinicians also highlighted that the training offers a significant shift in the usual consultation approach, and that they would like further training to consolidate these skills. The Pso Well training improved healthcare practitioners’ behaviour change skills in relation to providing holistic psoriasis management. Clinicians judged the training content to be relevant and useful, although further opportunity for skills consolidation may be needed. Investigation of the impact of the intervention on patient outcomes is now required.

Pharmacy Preregistration Handbook

The primary aim or focus of this book is to provide a comprehensive guide to the application of health services research methods utilized in pharmacy practice. It is designed mainly for pharmacy practice researchers in planning, designing, and implementing research projects. This book incorporates numerous approaches and techniques researchers use. It identifies challenges researchers in pharmacy practice face and provides descriptive solutions. The book is well referenced and contains sufficient number of chapters. Skilled pharmacy practice researchers will advocate this book as a vital source of research methodology. Graduate programs can also supplement various sections of this textbook within their curriculum. An important feature of this book is the incorporation of valuable practical experiences of colleagues in pharmacy practice. These practical experiences formulate reliable methods to support and or develop research objectives. Applications of different research methods and techniques are contained in each chapter. The conceptual structure and flow pattern is from chapter to chapter. In Chapters 1 and 2, the author focuses mainly on the application of survey methodology in pharmacy practice. The application of survey methods to the development of theoretical perspectives is discussed in Chapter 3. Qualitative research is reviewed in Chapter 4. Focus groups, discussed in Chapter 5, have been used to identify and explore issues from the perspective of different population groups. Observational studies (studies in which the researcher is present at the study site and for the duration of a study period) are discussed in Chapter 6. Chapter 7 describes triangulation as the combination of different methods, or approaches in a single study. Chapters 8 and 9 provide an overview on the evaluations of both existing and innovative pharmacy services. Chapter 8 reviews the applications of various study designs and framework that evaluate existing and innovative services and interventions. An overview of the development and selection of various measures utilized in the evaluation of pharmacy services is given in Chapter 9. The evaluation process incorporates quantitative methods, qualitative methods, and description of measures. The downfalls of this book appear to be a lack of illustrations, figures, or tables and insufficient statistical evaluations. Pharmacy practice researchers, as described per the author’s conclusion, warrant the practical approach, but must use feasible research methodologies to meet their objectives. This book definitely contains pertinent measures that can impact pharmacy practice research.

Home intravenous antibiotic therapy

Why is Europe lagging behind the United States in the development of this type of therapy?