Month: October 2022

Multidisciplinary Team Meetings to Manage Patients with Multimorbidity in Primary Care

Our new paper in the International Journal of Integrated Care reviews the role of multidisciplinary team (MDT) meetings in the management of multimorbidity in primary care. MDTs bring together professionals to work together to improve health outcomes for patients. MDT meetings are often recommended as a critical aspect of integrated care in guidance and opinion pieces, but it is not clear how and to what extent their use improves outcomes for patients with multimorbidity. Our review aimed to fill this knowledge gap.

We found limited evidence that supports the implementation of MDT meetings in primary care settings for individuals with multimorbidity. There were also substantial problems with the methodological rigour of previous studies on MDT meetings in primary care. Although MDT meeting are a key strategy for delivering comprehensive integrated care, there is a lack of evidence concerning the efficacy of MDT meetings in primary care. The complexity of interventions meant that causality cannot be attributed to the MDT meeting alone.

There is an urgent need generate more evidence about MDT meetings in primary care. Future research should focus on a broader set of participant characteristics, contextual adaptation, and innovation. Decision makers and clinicians should also take advantage of the recent technological progress in healthcare.

20 Tips on How to Stay Healthy and Well this Winter

With England’s NHS under immense pressure even before the full onset of winter, here are 20 tips on how you can make the most of the NHS, use health services more appropriately, and obtain the care you and your family need to protect your health and wellbeing.

1. Attend for appointments for medication reviews and for the management of long-term conditions when invited.
2. Take-up the offer of Covid-19 and flu vaccinations if you are eligible. Make sure you are up to date with any other vaccinations you are eligible for. Attend for health screening appointments when invited.
3. Use the NHS app to book appointments, view your GP medical record and order repeat prescriptions.
4. Be aware of the range of options for NHS care – including opticians, pharmacists, self-referral services (e.g. podiatry, IAPT, smoking cessation), and NHS 111.
5. Use the NHS electronic prescription service so that your prescription is sent directly to a pharmacy.
6. For queries about hospital care, contact the hospital PALS team rather than your GP.
7. Apply for online access to your hospital records if this is available.
10. Don’t Smoke.
11. Exercise regularly including outdoors so that you get some sunlight exposure. This will also help with seasonal affective disorder (SAD).
12. Eat 5 portions of fruit & vegetables every day and eat plenty of high-fibre foods.
14. Limit your sugar & salt intake.
15. Limit your alcohol intake to a safe level.
16. Take time to improve your mental health; including by meeting regularly with friends and family.
17. Check your own blood pressure.
18. Take your medication as prescribed.
19. Get a good night’s sleep.
20. Listen to experts on health issues and not random people on social media.

Factors influencing COVID-19 vaccine hesitancy among South Asians

Our new study in JRSM Open led by Dr Raj Chandok and Dr Poonam Madar examines factors influencing Covid-19 vaccine hesitancy among South Asians in London. Vaccines have a key role in suppressing serious illnesses, hospitalisations and deaths from Covid-19. London has amongst the lowest Covid-19 vaccination rates in the UK and it’s important to understand the factors behind this so we can work better with local communities to address this key public health challenge. This includes looking at factors such as confidence in Covid-19 vaccines, complacency about the severity of illness arising from Covid-19, communication about vaccines in both the mainstream media and social media, and the context in which people live and work.

Why is FIT important for people with lower gastrointestinal symptoms?

If you consult your doctor about bowel symptoms, they may speak about getting FIT. What is FIT? In this context, it is nothing to do with exercise or how far you can run. FIT stands for faecal immunochemical test, which aims to detect blood in your faeces. The test is highly sensitive.

People with lower bowel symptoms such as a change in their bowel habits will understandably be concerned about the possibility of bowel cancer. The risk of colorectal cancer in people with a negative FIT, a normal examination and normal full blood count is <0.1%. This is lower than the general population risk of colorectal cancer. So this combination of clinical findings allows your doctor to conclude that you are very unlikely to have bowel cancer. However, many people with lower GI symptoms still do not undergo FIT before referral to a specialist.

Patients with a FIT of fHb <10μg Hb/g, a normal full blood count, and no ongoing clinical concerns do not need to be referred on a lower GI urgent cancer pathway but can be managed in primary care or referred on an alternative pathway with suitable safety netting if symptoms change. FIT can improve patient management. By fully implementing the use of FIT in people with lower GI symptoms in primary care, we can spare patients unnecessary colonoscopies, releasing capacity to ensure the most urgent symptomatic patients are seen more quickly in specialist clinics.

There are some patients for whom FIT is not suitable, such as those with iron deficiency anaemia, a rectal or anal mass, or anal ulceration. See below for further guidance on the use of FIT in people with lower GI symptoms.