Addressing social determinants of noncommunicable diseases in primary care: a systematic review.

OBJECTIVE: To explore how primary care organizations assess and subsequently act upon the social determinants of noncommunicable diseases in their local populations. METHODS: For this systematic review we searched the online databases of PubMed®, MEDLINE®, Embase® and the Health Management Information Consortium from inception to 28 June 2019, along with hand-searching of references. Studies of any design that examined a primary care organization assessing social determinants of noncommunicable diseases were included. For quality assessment we used Cochrane's tool for assessing risk of bias in non-randomized studies of interventions. We used narrative data synthesis to appraise the extent to which the assessments gathered data on the domains of the World Health Organization social determinants of health framework. FINDINGS: We identified 666 studies of which 17 were included in the review. All studies used descriptive study designs. Clinic-based and household surveys and interviews were more commonly used to assess local social determinants than population-level data. We found no examples of organizations that assessed sociopolitical drivers of noncommunicable diseases; all focused on sociodemographic factors or circumstances of daily living. Nevertheless, the resulting actions to address social determinants ranged from individual-level interventions to population-wide measures and introducing representation of primary care organizations on system-level policy and planning committees. CONCLUSION: Our findings may help policy-makers to consider suitable approaches for assessing and addressing social determinants of health in their domestic context. More rigorous observational and experimental evidence is needed to ascertain whether measuring social determinants leads to interventions which mitigate unmet social needs and reduce health disparities.

Ethnic minority disparities in progression and mortality of pre-dialysis chronic kidney disease: a systematic scoping review.

BACKGROUND: There are a growing number of studies on ethnic differences in progression and mortality for pre-dialysis chronic kidney disease (CKD), but this literature has yet to be synthesised, particularly for studies on mortality. METHODS: This scoping review synthesized existing literature on ethnic differences in progression and mortality for adults with pre-dialysis CKD, explored factors contributing to these differences, and identified gaps in the literature. A comprehensive search strategy using search terms for ethnicity and CKD was taken to identify potentially relevant studies. Nine databases were searched from 1992 to June 2017, with an updated search in February 2020. RESULTS: 8059 articles were identified and screened. Fifty-five studies (2 systematic review, 7 non-systematic reviews, and 46 individual studies) were included in this review. Most were US studies and compared African-American/Afro-Caribbean and Caucasian populations, and fewer studies assessed outcomes for Hispanics and Asians. Most studies reported higher risk of CKD progression in Afro-Caribbean/African-Americans, Hispanics, and Asians, lower risk of mortality for Asians, and mixed findings on risk of mortality for Afro-Caribbean/African-Americans and Hispanics, compared to Caucasians. Biological factors such as hypertension, diabetes, and cardiovascular disease contributed to increased risk of progression for ethnic minorities but did not increase risk of mortality in these groups. CONCLUSIONS: Higher rates of renal replacement therapy among ethnic minorities may be partly due to increased risk of progression and reduced mortality in these groups. The review identifies gaps in the literature and highlights a need for a more structured approach by researchers that would allow higher confidence in single studies and better harmonization of data across studies to advance our understanding of CKD progression and mortality.

Developing a 'buddy scheme' for foundation doctors.

BACKGROUND: Changes in working practices have resulted in disruption of the traditional team structure and work patterns. The need for support for juniors during the transition from medical school led to a buddying programme for foundation trainees at the Royal Bournemouth Hospital (RBH). METHODS: In phase 1, a programme was evaluated using a questionnaire consisting of 12 questions, some of which took the format of a five-point Likert scale. Areas for improvement were identified and implemented in phase 2. Outcomes were re-evaluated using the same questionnaire format. RESULTS: Compared with phase 1, more foundation year-1 doctors (FY1s) felt that they benefited from an FY2 buddy (68 versus 17%; p = 0.0025), and that the buddy had helped to smooth the transition from student to doctor (39 versus 17%; p = 0.20), in phase 2. First contact was initiated by the FY2 (90 versus 43%, p = 0.02), and occurred as a face-to-face meeting (68 versus 29%, p = 0.09). FY1s felt that buddies were more accessible (89 versus 24%, p = 0.0001), developed a better rapport (84 versus 31%, p = 0.002) and felt more likely to get involved in buddying in the future (55 versus 22%, p = 0.05). DISCUSSION: Our buddy scheme improved on previous models, and was effective and well received. The committee responsible for organising and overseeing the scheme is thought to have contributed to this improvement. In order for any such scheme to be successful it is important to constantly evaluate and adapt the scheme.