Learning needs, preferred learning methods and learning challenges of first five general practitioners in NHS Scotland: a qualitative study.

OBJECTIVES: To identify the learning needs and preferred learning methods of First5 general practitioners (GPs) in National Health Service (NHS) Scotland. DESIGN: Qualitative research study using grounded theory methods. First5 GPs were interviewed in small focus groups or individual interviews in-person, or over the telephone depending on their preference. SETTING: General practice in NHS Scotland. PARTICIPANTS: GPs, within the first 5 years of completion of GP training, who were working in NHS Scotland. RESULTS: Thirty-eight First5s were recruited to the study. Participants recognised that gaps in their GP training became apparent in independent practice. Some of this related to NHS appraisal and revalidation, and with the business of general practice. They were interested in learning from an older generation of GPs but perceived that preferred learning methods differed. First5 GPs were less reliant on reading journals to change their practice, preferring to find learning resources that allowed them to gain new knowledge quickly and easily. There were considerations about resilience and of the challenges of learning in remote and rural areas of NHS Scotland. This related to travel costs and time, and to accessibility of learning courses. Participants appreciated collective learning and commented about the logistics and costs of learning. CONCLUSIONS: Preferred learning methods and learning resources differ with First5 GPs compared with those who have been in practice for some years. Learning providers need to recognise this and take these differences into account when planning and preparing learning in the future.

Recently-qualified general practitioners' perceptions and experiences of General Practice Specialty Training (GPST) in deprived areas of NHS Scotland - a qualitative study.

NHS Scotland faces significant challenges in delivering the Scottish Government's 2020 Strategy for Healthcare. GP recruitment and retention are problematic for deprived area practices (DAPs). Recently-qualified GPs are more likely to join practices in areas where they have trained and so it is important to encourage GP training in deprived areas. This study aimed to identify the perceptions and experiences of recently-qualified GPs who had trained in DAPs. A grounded theory approach was used with 14 GPs interviewed in focus groups and in-depth interviews. Six themes were identified: allocation to training practices in deprived areas and anxieties about working there, positive training experiences, attributes of trainers, consultation differences, preferences for large practice teams and health centres, and future career plans. GPs were very positive about their training experiences in DAPs and appreciated their trainer and training practice. One concern was of the limited experience of patient-centred consulting which they felt weakened their performance in the Clinical Skills Assessment (CSA) component of the MRCGP examination. Rotations between affluent and deprived areas would benefit General Practice Specialty Trainees (GPSTs) particularly with the CSA examination. Training authorities should encourage and support practices in deprived areas to become training practices and encourage GPSTs to train there.

A systematic review of interventions by healthcare professionals to improve management of non-communicable diseases and communicable diseases requiring long-term care in adults who are homeless.

OBJECTIVE: Identify, describe and appraise trials of interventions delivered by healthcare professionals to manage non-communicable diseases (NCDs) and communicable diseases that require long-term care or treatment (LT-CDs), excluding mental health and substance use disorders, in homeless adults. DESIGN: Systematic review of randomised controlled trials (RCTs), non-RCTs and controlled before-after studies. Interventions characterised using Effective Practice and Organisation of Care (EPOC) taxonomy. Quality assessed using EPOC risk of bias criteria. DATA SOURCES: Database searches (MEDLINE, Embase, PsycINFO, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Applied Social Sciences Index and Abstracts (ASSIA) and Cochrane Central Register of Controlled Trials), hand searching reference lists, citation searches, grey literature and contact with study authors. SETTING: Community. PARTICIPANTS: Adults (≥18 years) fulfilling European Typology of Homelessness criteria. INTERVENTION: Delivered by healthcare professionals managing NCD and LT-CDs. OUTCOMES: Primary outcome: unscheduled healthcare utilisation. SECONDARY OUTCOMES: mortality, biological markers of disease control, adherence to treatment, engagement in care, patient satisfaction, knowledge, self-efficacy, quality of life and cost-effectiveness. RESULTS: 11 studies were included (8 RCTs, 2 quasi-experimental and 1 feasibility) involving 9-520 participants (67%-94% male, median age 37-49 years). Ten from USA and one from UK. Studies included various NCDs (n=3); or focused on latent tuberculosis (n=4); HIV (n=2); hepatitis C (n=1) or type 2 diabetes (n=1). All interventions were complex with multiple components. Four described theories underpinning intervention. Three assessed unscheduled healthcare utilisation: none showed consistent reduction in hospitalisation or emergency department attendance. Six assessed adherence to specific treatments, of which four showed improved adherence to latent tuberculosis therapy. Three concerned education case management, all of which improved disease-specific knowledge. No improvements in biological markers of disease (two studies) and none assessed mortality. CONCLUSIONS: Evidence for management of NCD and LT-CDs in homeless adults is sparse. Educational case-management interventions may improve knowledge and medication adherence. Large trials of theory-based interventions are needed, assessing healthcare utilisation and outcomes as well as assessment of biological outcomes and cost-effectiveness.

Interventions by healthcare professionals to improve management of physical long-term conditions in adults who are homeless: a systematic review protocol.

INTRODUCTION: People experiencing homelessness are at increased risk of, and have poorer outcomes from, a range of physical long-term conditions (LTCs). It is increasingly recognised that interventions targeting people who are homeless should be tailored to the specific needs of this population. This systematic review aims to identify, describe and appraise trials of interventions that aim to manage physical LTCs in homeless adults and are delivered by healthcare professionals. METHODS AND ANALYSIS: Seven electronic databases (Medline, EMBASE, Cochrane Central Register of Controlled Trials, Assia, Scopus, PsycINFO and CINAHL) will be searched from 1960 (or inception) to October 2016 and supplemented by forward citation searching, handsearching of reference lists and searching grey literature. Two reviewers will independently review titles, abstract and full-texts using DistillerSR software. Inclusion criteria include (1) homeless adults with any physical LTC, (2) interventions delivered by a healthcare professional (any professional trained to provide any form of healthcare, but excluding social workers and professionals without health-related training), (3) comparison with usual care or an alternative intervention, (4) report outcomes such as healthcare usage, physical and psychological health or well-being or cost-effectiveness, (5) randomised controlled trials, non-randomised controlled trials, controlled before-after studies. Quality will be assessed using the Cochrane EPOC Risk of Bias Tool. A meta-analysis will be performed if sufficient data are identified; however, we anticipate a narrative synthesis will be performed. ETHICS AND DISSEMINATION: This review will synthesise existing evidence for interventions delivered by healthcare professionals to manage physical LTCs in adults who are homeless. The findings will inform the development of future interventions and research aiming to improve the management of LTCs for people experiencing homelessness. Ethical approval will not be required for this systematic review as it does not contain individual patient data. We will disseminate the results of this systematic review via conference presentations, healthcare professional networks, social media and peer-reviewed publication. TRIAL REGISTRATION NUMBER: PROSPERO registration number: CRD42016046183.