Welfare advice in GP surgeries – what is the impact on GP’s workload and patients’ health and wellbeing

GPs are often faced with patients seeking help and advice on non-clinical issues such as debt, unemployment and housing. Though these issues undoubtedly impact patients’ health and wellbeing, health professionals are not always the best qualified people to tackle them.

We investigated the impact of putting welfare advice, and welfare advisers in GP surgeries on

  • the ability of low income groups to secure financial support they are entitled to
  • patients’ anxiety and stress associated with financial related social worries;
  • and, to GP time spent managing non-clinical issues

New CLAHRC BITEs offer a summary of two papers investigating the impact –

  1. A qualitative study to identify the processes by which co-located services can improve outcomes for GP practices

Key Findings

Co-location of welfare services has many benefits to patients including:

  1. Offering a signposting option for staff in contact with patients with ‘non-clinical’ social needs.
  2. Helping to address underlying patient social issues.
  3. Providing an alternative option for patients seeking help for such issues.
  4. Reducing bureaucratic pressures and time demands on practice staff.

Read the BITE

Co-located welfare advice in GP surgeries: part I

  2. A quantitative study, using a controlled comparison, assessing the impact on mental health and service use of co-located welfare advice.

Key Findings – service users receiving welfare advice versus control group

  • Had the advice service not been at the practice, nearly half of the advice group would not have sought help or consulted their GP instead.
  • The majority of advice recipients reported improved circumstances after advice (e.g., stress, income, housing etc.)

Compared to those who did not get advice, after 3 months:

  • Those in the advice group whose circumstances improved experienced a bigger improvement in their well-being.
  • Those in the advice group experienced a bigger reduction in financial strain, reduced credit card and overdraft use.
  • Those in the advice group experienced a bigger reduction in symptoms of common mental disorder, especially among recipients who were female, those who identified as Black and those who reported that their circumstances improved as a result of advice.
  • There was, however no evidence for a reduced frequency of GP consultations.
  • For every £1 of investment by funders, those receiving co-located advice gained £15 in entitlements on average

Read the BITE

Co-located welfare advice in GP surgeries: part II

 

Beyond searching- supporting NHS colleagues to contribute to systematic reviews

We recently collaborated with colleagues at Peninsula CLAHRC to deliver a successful ‘Beyond Searching’ course.

Members of the PenCLAHRC Evidence Synthesis Team (EST) travelled to London to work with CLAHRC North Thames’ Dr Antonio Rojas–Garcia in delivering the workshop to 19 librarians from the NHS and various universities.

Beyond Searching was devised 5 years ago by members of the EST who have been running annual workshops ever since. The course is designed to show health information professionals that they already have the skills to effectively contribute to systematic reviews –  reviews aiming to find as much as possible of the research relevant to the particular research question, and to identify what can reliably be said on the basis of these studies. The training gives them the confidence to get involved in the process and to advise others.

Librarians and other information professionals are highly skilled and motivated individuals with a drive to learn about new technologies and ways of working. They already have the skills needed to contribute to systematic reviews so our course is more about how they apply those skills. ‘It is always a joy to teach this workshop – often we learn a lot ourselves in the process – and it was particularly good this time to get the chance to collaborate with colleagues from CLAHRC North Thames.’

Morwenna Rogers (EST member)

This was the second year that the course followed a flipped classroom model, which EST members learned about during their visit to the University of Michigan two years ago. The model frees up classroom time for discussions and active learning, by making some of the foundation lectures and reading material available to participants in advance.

Attendees were asked to complete a series of online tasks prior to the course, which introduced them to key concepts of systematic reviewing and comprehensive searching. This enabled attendees to focus on more detailed aspects of search techniques during the workshop.

Guest speaker Claire Stansfield from the EPPI-Centre was also invited to discuss the use of automation (employing machines, computers, or robots to help researchers identify relevant papers), and its implication for reviews in the future.

The beyond searching team were delighted with the positive feedback they received. One attendee said that it was:

The best training [they] have ever attended

Another attendee planned to use the knowledge she had gained to change practice in her own place of work, and another thought that the flipped classroom model was excellent preparation for the face to face teaching day.

Dr Rojas – Garcia (below) praised the cross CLAHRC co-operation behind the delivery of this workshop, remarking:

It was great to spend the day collaborating with colleagues from PenCLAHRC. I considered it a very positive experience, it has been really encouraging to see how other colleagues teach about systematic reviews.’

To read more about the Beyond Searching workshop  collaboration, visit the EST blog.

Engaging school programme to reduce high levels of poorly managed asthma in young people

CLAHRC researchers based at Queen Mary University of London launched the My Asthma in School programme this week – an initiative that aims to improve the self-management of the respiratory condition by school children.

Developed by researchers at the University’s Blizard Institute, the programme will use films and apps in educational workshops and theatre performance to improve asthma control and peer support for asthma in London secondary schools.

The programme has been approved and supported by Sadiq Khan, Mayor of London, who himself lives with the condition.

He said: “The Greater London Authority and I believe that the ‘My Asthma in School’ programme is likely to promote the necessary education young people require to effectively self-manage their asthma.”

He added: “I encourage all London secondary schools to take part in this programme.”

Asthma affects approximately 1 in 11 children and young people in the UK; and young people with asthma have higher rates of school absences and visits to their doctor or the hospital. According to the data collected for the study, nearly half of young people (aged 11-18 years) with asthma did not have good control over their condition [Harris K et al,J Asthma 2017,54(10):1033-1040].

Dr Gioia Mosler, Outreach and Learning Manager for the ‘My asthma in school project’ (below, left) was at the launch event and said:

The number of deaths from asthma in the UK rank among the highest in the EU. Many of these deaths could be prevented with better self-management.

She added: “We want to improve the ability and motivation of young people to self-manage their asthma so they can take control of their condition.”

The research team’s results showed that young people with asthma often faced many barriers to addressing their condition, including lack of knowledge, or embarrassment to use their asthma inhaler in front of others. Based on these findings, as well as behavioural change theories, the researchers involved young people to develop a series of engaging teaching elements for an intervention, including several games, apps and videos: www.myhealthinschool.org.

The intervention will also deliver an interactive theatre performance, lasting approximately two hours, to help raise awareness of asthma among peers. The performance has been developed with partners at Greenwich and Lewisham Young People’s Theatre [Mosler G et al,Lancet 2017,391(10118):303–304].

 

Dr Mosler added: “The theatre intervention addresses asthma from a new angle, focusing on peer awareness and support around young people with asthma. The theatre addresses barriers related to a perceived stigma around asthma in peers, young people with asthma reported during our initial data collection.”

My asthma in School is one of the first school-based interventions for asthma self-management in the UK. Similar trials have been undertaken outside the UK, however, given that the health and education systems differ, results from these interventions may not be transferable to a UK setting.

The intervention will be trialled in London during the next few months. Given a positive result of this intervention it could be adopted as a wider programme to improve asthma in young people.

The programme is run as part of the My Health in School initiative based at the Blizard Institute within Queen Mary University of London which aims to improve life and health of young people at school. The team works with Professor Jonathan Grigg, who leads several studies about asthma and lung health in children and young people.

Schools are encouraged to get in touch to join our research –  email: info@myhealthinschool.org.

Website: www.myhealthinschool.org

Twitter: @SchoolsAsthma

References

Harris, K.; Mosler, G.; Williams S. A.; et al. (2017): Asthma control in London secondary school children. Journal of Asthma; 23: 1–8.

Harris KM, Kneale D, Lasserson TJ, McDonald VM, Grigg J, Thomas J. School-based self-management interventions for asthma in children and adolescents: a mixed methods systematic review. Cochrane Database Syst Rev. 2015;(4)

Mosler G. & Euba T.  (2017): Taking control through drama. Lancet; 391: 10118, p303–304.