Karen Fairhurst

Texting appointment reminders to repeated non-attenders in primary care: randomised controlled study

Background: Failure to attend appointments compromises health service efficiency. Despite considerable interest in using novel technologies to improve attendance, evidence from rigorously conducted controlled studies is lacking. Aim: To evaluate the effectiveness of texting appointment reminders to patients who persistently fail to attend appointments. Design: Randomised controlled study. Setting: Inner city general practice in Lothian, Scotland. Method: We included 415 appointments made by patients (n = 173) who had failed to attend two or more routine appointments in the preceding year. Patients whose appointments were randomised to the intervention group received a text message reminder of the appointment. Patients whose appointments were in the control group received no reminder. Our primary outcome measure was non-attendance rates. We undertook an intention-to-treat analysis and multi-level analysis to take account of the lack of independence of the outcomes of repeated appointments for the same patient. Results: Of the 418 appointments originally included in the study, three were excluded due to clerical error; 189 were randomised to the intervention group and 226 to the control group. Twenty-two appointments (12%) were not attended in the intervention group compared with 39 (17%) in the control group. A chi-square analysis, considering the outcome of appointments as independent from one another, gave a non-significant difference of 5% (95% CI of difference −1.1 to 12.3%, p = 0.13). Multilevel analysis applied to the binary outcome data on non-attendance gave an odds ratio for non-attendance in the intervention group compared with the control group of 0.63 (95% CI 0.36 to 1.1, p = 0.11). Conclusion: Although the intervention showed promise, we failed to demonstrate significant reduction in non-attendance rates, as a result of texting appointment reminders to patients who persistently fail to attend their general practice appointments.

What General Practitioners Find Satisfying in Their Work: Implications for Health Care System Reform

PURPOSE We sought to explore general practitioners’ satisfaction with their patient visits and the congruity between this satisfaction and new models of practice, such as those implicit in the new general medical services contract in the United Kingdom. METHODS We undertook a qualitative study using audio recordings of patient visits and in-depth interviews with 19 general practitioners in Lothian, Scotland. RESULTS Doctors’ reports of satisfying and unsatisfying experiences during consultations were primarily concerned with developing and maintaining relationships rather than with the technical aspects of diagnosis and treatment. In their most satisfying consultations, they used the interpersonal aspects of care, in particular their sense of knowing the patient, to effect a successful outcome. Success was seen in holistic terms—not as the prevention, treatment, or cure of a disease, but as restorative of the person. Positive experiences were implicated in maintaining their identity as “good” doctors. Negative experiences sometimes challenged this identity, and doctors resisted this challenge by finding explanations for unsatisfactory experiences that distanced themselves from their source or cause. CONCLUSION The attributes of a satisfying encounter found in this study derive from a model of practice that prioritizes the distress of patients, which cannot be measured, above the technical and quantifiable in diagnosis and treatment. Preoccupation with that which is technical and measurable in health care system reforms risks defining a model of practice with purpose and meaning not congruent with doctors’ experiences of their work and may result in further destruction of professional morale.

Patient safety in healthcare preregistration educational curricula: multiple case study-based investigations of eight medicine, nursing, pharmacy and physiotherapy university courses

Background We sought to investigate the formal and informal ways preregistration students from medicine, nursing, pharmacy and the allied healthcare professions learn about patient safety. Methods We drew on Erauts framework on formal and informal acquisition of professional knowledge to undertake a series of phased theoretically informed, in-depth comparative qualitative case studies of eight university courses. We collected policy and course documentation; interviews and focus groups with educators, students, health service staff, patients and policy makers; and course and work placement observations. Data were analysed thematically extracting emerging themes from different phases of data collection within cases, and then comparing these across cases. Results We conducted 38 focus groups with a total of 162 participants, undertook 82 observations of practice placements/learning activities and 33 semistructured interviews, and analysed 44 key documents. Patient safety tended to be either implicit in curricula or explicitly identified in a limited number of discrete topic areas. Students were predominantly taught about safety-related issues in isolation, with the consequence of only limited opportunities for interprofessional learning and bridging the gaps between educational, practice and policy contexts. Although patient safety role models were key to student learning in helping to develop and maintain a consistent safety ethos, their numbers were limited. Conclusions Consideration needs to be given to the appointment of curriculum leads for patient safety who should be encouraged to work strategically across disciplines and topic areas; development of stronger links with organisational systems to promote student engagement with organisation-based patient safety practice; and role models should help students to make connections between theoretical considerations and routine clinical care.

Assessing competencies and training needs of pharmacy staff to deliver chlamydia screening in community pharmacies

In the UK community pharmacies have become involved in providing chlamydia testing and treatment (CT&T) to young people. Our objective was to ascertain among pharmacy staff their self‐reported competencies and training needs prior to implementation of a pharmacy‐based CT&T service.

SP6-45 Screening for genital chlamydia for young people in community pharmacies: a meta-analysis of chlamydia prevalence

Background With traditional specialist sexual-health services overstretched, community pharmacies have been deployed to provide chlamydia testing. We have undertaken a systematic-review to estimate prevalence of chlamydia infection among those screened for chlamydia in community pharmacies. We also reviewed the feasibility/acceptability of this service. Methods Systematic searches were conducted in electronic databases and grey literature was solicited from experts. Data were extracted on study population, sample size and prevalence of chlamydia to report pooled proportion of chlamydia infection using random effect model. Results 8 papers and reports which contributed to the final model. The proportional meta-analysis showed a pooled proportion positive for chlamydia of 7.7% (95% CI 5.2% to 10.6%). All the studies were reported on <24 years age group and there was only limited data on males. Hence no separate analyses were performed according to age group or gender. Chlamydia screening programs in community pharmacies tend to be targeted at certain client groups for example, young people, those seeking emergency contraception in pharmacies. Studies reviewed reported that clients and pharmacists find chlamydia services via community pharmacy broadly acceptable. However the uptake of the service was much lower than expected and tended not to include men and ethnic minorities. Conclusion The reported prevalence of chlamydia infection in pharmacy setting is similar to estimates from general practice thus giving wider choice of care to young people. This new approach is acceptable to both young people and pharmacists. Encouraging men and ethnic minorities to access community pharmacy based chlamydia services remains a challenge.