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ECR Pechakucha (3 minute) presentation

Since the introduction of the GMS contract in 2004 many studies examined the quality and inequality in management of chronic disease, but there are limited reviews in this area that specifically focus of diabetes care.

Trent Regional SAPC Spring Meeting Tuesday 15 March College Court Conference Centre and Hotel, Knighton Road, Leicester, LE2 3UF Title of the abstract: Exploring Service User and practitioner perspectives of QCancer use in primary care consultations Author(s): Akanuwe JN, Siriwardena AN, Black S and Owen S Institution: Community and Health Research Unit, University of Lincoln Contact Details (email): 11357484@students.lincoln.ac.uk Abstract Introduction: QCancer is a novel cancer risk assessment tool that combines risk factors and symptoms to estimate an individual’s risk of developing cancer within two years. This study explored the perspectives of service users and primary care practitioners about using QCancer in the primary care consultation. Methods: We used qualitative methods to conduct individual and focus group interviews with service users recruited from the general public and primary care practitioners (GPs and nurses) recruited from general practices in Lincolnshire (a large rural county in England) until data saturation was achieved. The qualitative data were transcribed verbatim and analysed using the Framework approach. Results: Thirty-six participants, 19 service users and 17 practitioners, were interviewed. They expressed a range of views about the implications of quantifying cancer risk using QCancer including potential conflict with current cancer guidelines or that high risk symptoms would need referral for further investigation whatever the quantified risk. Participants, both service users and providers, agreed that QCancer was useful for consultations for cancer in: quantifying risk; supporting decision-making; identifying, raising awareness of and modifying health behaviours; improving processes and speed of assessment and treatment; and personalising care. Participants also raised the need to address communication issues related to use of QCancer such as tailoring visual representation of risk; openness and honesty; informing and involving pa

Workshop presentation for GP Educators conference- 14/01/16 Workshop on service user and practitioner perspectives of QCancer use in primary care consultations Researchers: Joseph Akanuwe, PhD Student, Community and Health Research Unit, University of Lincoln. Professor Niro Siriwardena, Professor of Primary and Pre Hospital Health Care and Director of the Community and Health Research Unit, University of Lincoln. Dr Sharon Black, Director of Nurse Education, University of Lincoln Professor Sarah Owen, Pro Vice Chancellor and Head of the College of Social Science, University of Lincoln. Introduction QCancer is a novel cancer risk assessment tool that combines risk factors and symptoms to estimate an individual’s risk of developing cancer within two years. This study explored the perspectives of patients and primary care practitioners about using QCancer in the primary care consultation. Methods We used qualitative methods to conduct individual and focus group interviews with service users recruited from the general public and primary care practitioners (GPs and nurses) recruited from general practices in Lincolnshire (a large rural county in England) until data saturation was achieved. The qualitative data were transcribed verbatim and analysed using the Framework approach. Results Thirty-six participants, 19 service users (aged between 21-71 years) and 17 practitioners (aged between 33 and 55 years) were interviewed. They expressed a range of views: Implications of quantifying cancer risk using QCancer including: • Potential conflict with current cancer guidelines • High risk symptoms would need referral for further investigation whatever the quantified risk. QCancer is potentially useful for cancer consultations • Quantifying cancer risk • Supporting decision-making • Identifying, raising awareness of and modifying health behaviours • Improving processes and speed of assessment and treatment, and • Personalising care. Need to address communication issues related t

COLLEGE OF SOCIAL SCIENCE Summer Research Conference 2016) Akanuwe JNA Siriwardena AN Black S, Owen S Community and Health Research Unit, School of Health and Social Care EXPLORING SERVICE USER AND PRACTITIONER PERSPECTIVES OF QCANCER USE IN PRIMARY CARE CONSULTATIONS Introduction: This study explored perspectives of service users and primary care practitioners about using QCancer, a cancer risk assessment tool, in primary care consultations. Methods: Individual and focus group interviews with data analysed using the Framework approach. Results: 36 participants, 19 service users and 17 practitioners, were interviewed until data saturation was achieved. Participants expressed a range of views about the implications of quantifying cancer risk using QCancer including: potential conflict with current cancer guidelines and, high risk symptoms would need referral for further investigation whatever the quantified risk. Participants agreed that QCancer would be useful in a number of ways including: helping to identify and raise awareness for modifying health behaviours and personalising patient care. Participants discussed communication needs when using QCancer, which will add to knowledge in terms of how best to improve communication of cancer risk during the consultation. Potential challenges to uptake of QCancer were also identified. Conclusion: Participants perceived that QCancer would be potentially useful but communication needs of users and potential barriers for both users and practitioners need to be considered when planning QCancer use in general practice consultations.

THE IMPACT OF QOF ON INEQUALITIES IN THE PROCESS AND OUTCOME OF DIABETES CARE: A SYSTEMATIC REVIEW Authors: Akanuwe J, Goyder E, O’Hara R, Julious S School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK. Abstract Background: Since the introduction of the GMS contract in 2004 many studies examined the quality and inequality in management of chronic disease, but there are limited reviews in this area that specifically focus of diabetes care. Aim: To review literature for evidence of the impact of QOF on inequalities in diabetes care in the UK. Method: For the Study selection, Medline, CINAHL, Scopus, Cochrane and King’s Fund databases were searched for relevant studies published before and after the introduction of QOF (between 2000 and 2011). Results: We found ten studies that met our inclusion criteria. Three studies published before the introduction of QOF all indicated that inequalities existed. Six studies that used data only from the first year of the QOF (2004-5) also indicated that inequalities in diabetes care existed. Four more recent studies, which used the first two, three and four years of QOF data, indicated a reduction in practice-level inequalities in diabetes care. Conclusion: Evidence from the studies that analysed data from the second, third and fourth years of QOF data suggest that practice-level inequalities in diabetes care in primary care settings have improved.

P05 Exploring the impact of the quality and outcomes framework on the quality of diabetes care and health care inequalities in England 1. J Akanuwe, 2. E Goyder, 3. R O'Hara, 4. S Julious +Author Affiliations 1. School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK Abstract Introduction Previous analyses suggest that over the first 3 years of the national Quality and Outcomes Framework (QOF) quality of care has improved and inequalities in diabetes care between practices have significantly reduced. In this study, we have reviewed the literature and undertook an exploratory analysis of the first 5-year QOF data with practices ranked by deprivation tertiles to assess the impact of QOF on the quality of diabetes care and health care inequalities. Objectives To use data from QOF to assess whether the quality of diabetes care has continued to improve between its introduction in 2004/2005 and 2008/2009, whether the gap between practices in the most deprived and the least deprived tertiles has closed, and whether the national patterns are also seen in a city with significant geographical inequalities. Design Exploratory analysis of the QOF data from 2004/2005 to 2008/2009. Participants All general practices in England and practices in the city of Sheffield. Main Outcome Measure Trends in the process and outcome measures of diabetes care and in the gap between the most deprived and the least deprived tertiles. Results In England the mean proportions of patients with HbA1c, blood pressure (BP) and cholesterol reviewed and the mean proportions of those achieving outcome targets for HbA1c (7.5%), BP (145/85) and cholesterol (5 mmol/l) were noted to be higher than the QOF upper thresholds of 90% and 60% for the process and outcome indicators, respectively, and these increased over time with most practices levelling off by 2008/2009. A comparison of these increasing trends between practices in the most deprived and least deprived areas revealed t

Aim: Retrospective case record reviews (RCRR) have been widely used to assess quality of care but evidence for their use in prehospital ambulance settings is limited. We aimed to review case records of potentially avoidable deaths related to ambulance care. Method: We identified patients who were transported to hospital or died using linked ambulance-hospital-mortality data from one UK ambulance service over 6 months in 2013. Death rates (within 3 days) for patient groups (based on age, dispatch code and urgency) were determined; 3 patients calling in-hours and 3 out-of-hours were selected from categories with the lowest death rates. Five reviewers (GP, nurse, 2 paramedics and medical health service manager) assessed anonymised patient records for quality of care and avoidable mortality. Results: We selected 29 linked records from 1 50 003 focussing on patients not transported to distinguish pre-hospital from hospital causes. Overall 8 cases out of 29 (27.6%) scored between 2.4 and 2.8 (1=Definitely avoidable, 2=Strong evidence of avoidability), 8 cases (27.6%) scored between 3.0 and 4.6 (3=Probably avoidable, 4=Possibly avoidable), and the remaining 13 cases (44.8%) between 4.0 and 5.8 (5=Slightly avoidable or 6=Definitely not avoidable). Variation between raters was satisfactory with ICC 0.84 (95% CI: 0.73 to 0.92). Common themes among cases with strong evidence of avoidability were symptoms or physical findings indicating a potentially serious condition and refusal by patients or their carers to be transported to hospital. RCRRs require linked ambulance, hospital and mortality data to ensure accurate assessment in light of the diagnosis and cause of death. Conclusion: Retrospective case record reviews (RCRR) have been widely used to assess quality of care but evidence for their use in prehospital ambulance settings is limited. We aimed to review case records of potentially avoidable deaths related to ambulance care.