Background Prehypertension (blood pressure [BP] 120–139/80–89 mmHg) affects 40% of UK adults, increasing their cardiovascular risk. While BP self-monitoring is effective in hypertension, its feasibility in prehypertension is unclear. Concerns include lack of interest, medicalisation, and unintended consequences, despite evidence suggesting it may empower individuals in risk management and prevention. Aim To determine the feasibility of BP self-monitoring for prehypertension. Design & setting A prospective, non-randomised, mixed-methods, feasibility study across primary care in Lancashire and South Cumbria. Method People with prehypertension were recruited from five general practices, three pharmacies, and one provider that checked BP. Participants received a BP monitor and training, then self-monitored BP on the first 3 days of each month for 6 months. Participants submitted their results to the research team. Outcome data were collected at baseline, 6 months, and 12 months, and analysed mainly using descriptive statistics. Results Of 162 expressions of interest, 80 people were eligible and consented; 78 from general practice, and one each from pharmacy and community providers. Of those recruited, 66 (83%) and 33 (41%) completed the 6-month and 12-month follow-up, respectively, with minimal missing data. No adverse effects were reported. Illness perceptions significantly improved (mean 26.6 [standard deviation {SD} 8.6] versus mean 22.6 [SD 8.7], P = 0.002), with no other significant changes. There was only one participant who did not class their ethnicity as white. Conclusion BP self-monitoring for prehypertension is feasible in general practice, but requires further exploration with pharmacy and community providers. The homogenous sample limits generalisability, highlighting the need for targeted outreach. Findings need confirming in an effectiveness trial.
Background Green social prescribing (GSP) connects individuals with nature-based interventions (NBIs) through healthcare providers, link workers, and social and community networks. While evidence supports the health benefits of NBIs, further research is needed to understand the factors that influence engagement. Aim To explore barriers and enablers to GSP and NBIs for prescribers, service users and community providers. Design & setting A scoping review in primary care and community settings. Method We systematically searched Medline, Embase, CINAHL, Web of Science, and SCOPUS from 2019. We assessed quality using the Critical Appraisal Skills Programme and the Mixed Methods Appraisal Tool. We mapped data to the socioecological framework during synthesis. Results Out of 4864 screened records, 45 studies from 11 countries were included. GSP and NBIs face micro-level barriers such as knowledge gaps, cultural and social issues, time and cost constraints and perceptions of adverse weather; meso-level and macro-level challenges include unequal access, underfunded NBIs, an emphasis on biomedical models, safety concerns, limited training, and insufficient policy support and leadership. Engagement was enabled by flexible, person-centred approaches, tailored NBIs with clear pathways, including link workers, strong cross-sector partnerships, community co-design, and public health campaigns. Conclusion Promoting engagement with GSP and NBIs requires a multi-level approach that addresses systemic barriers through collaboration between prescribers, third-sector organisations and policymakers. Investment in workforce training and sustainable funding models is critical to support long-term success in primary care and community settings. Addressing health inequalities by improving access for people in areas of high socioeconomic deprivation remains a priority.
Background Post-viral sequelae following the COVID-19 pandemic attention to post-viral fatigue and long COVID, but the impact on children and young people’s (CYP) primary care use is unknown. Aim To examine temporal, seasonal, and sociodemographic patterns in primary care consultations for long COVID and PVFS in CYP Design and settings We conducted a retrospective, population-based dynamic cohort study using Clinical Practice Research Datalink Aurum data for CYP aged <18 years in England, between 1 st January 2006 and 31 st December 2022 (from 1 st March 2020 for long COVID); a period covering the influenza A(H1N1)pdm09 and COVID-19 pandemics. Method Consultation rates per 100 000 child-years were calculated for long COVID and post-viral fatigue syndrome (PVFS) by calendar year, month, and sociodemographic characteristics. Trends, seasonal patterns, and differences between pandemic and non-pandemic periods (for PVFS) were described. Negative binomial regression was used to estimate associations with sociodemographic characteristics. Results The cohort included 7,442,572 CYP (3 624 692 registered in primary care during the COVID-19 pandemic). There were 6700 long COVID and 20,440 PVFS consultations. Long COVID consultation rates were highest in 2022 (140.3 per 100,00 child-years). PVFS consultation rates peaked in 2009 and 2022 (during H1N1 and COVID pandemics) with rates of 57.1 and 56.9 per 100 000 child-years, respectively. Consultation rates were highest among older CYP, girls, and those from least deprived areas. Conclusion Long COVID consultations were highest in 2022, and PVFS consultation rates peaked during 2009 and 2022. Our findings that rates were highest in less deprived areas and girls need further investigation.
Background Preventive care uptake in Singapore remains suboptimal despite longstanding national programmes. Healthier SG, launched in July 2023, aims to strengthen primary care through empanelment, continuity, and proactive health planning, but evidence on its effectiveness is limited. Aim To evaluate the association between Healthier SG enrolment and uptake of preventive care services. Design & setting Retrospective cohort study using electronic medical records from National Healthcare Group Polyclinics. Method Adults aged≥40 years with at least two annual visits between January 2018 and September 2024 were included. Outcomes were cervical cancer screening, influenza and pneumococcal vaccination, and cardiovascular risk screening. Quarterly uptake rates were analysed across four periods: pre-COVID-19, COVID-19, post-COVID-19/pre-Healthier SG, and post-Healthier SG. Results Preventive care uptake in Healthier SG enrolees demonstrated more favourable uptake trajectories across all preventive care outcomes. For cervical cancer screening, uptake declined during COVID-19 and recovered thereafter. Following Healthier SG implementation, cervical screening showed a steeper upward trend among enrolees than non-enrolees (quarterly trend change+0.57% versus+0.05%). Although vaccination uptake declined after the post-pandemic peak, reductions were less pronounced among enrolees (influenza: -0.41% versus -2.18%; pneumococcal:+0.07% versus -1.13% per quarter). Cardiovascular risk screening demonstrated a ceiling effect, with a smaller decline among enrolees than non-enrolees (-0.03% vs -0.32%). Among eligible patients, lower enrolment in ethnic minority, single, lower SES housing suggest potential inequities. Conclusion HSG enrolment was associated with greater uptake of selected preventive services. As an observational study restricted to regular primary care users, findings may not be generalisable to less-engaged populations. Continued evaluation is needed to assess long-term impact and equity of preventive care uptake.
Background Chronic breathlessness poses a significant burden for individuals and healthcare systems. Effective symptom-directed approaches, such as breathing and relaxation techniques, require medical optimisation of the underlying long-term condition causing breathlessness. We previously identified nine, predominantly cardiorespiratory, long-term conditions contributing to the greatest burden of breathlessness in primary care. Aim Develop checklists to support primary care in delivering optimal, evidence-based management of conditions causing chronic breathlessness. Design & setting Synthesis of national guidance and stakeholder workshops, using a co-design approach. Method Desktop review of national guidance relating to the management of each condition was synthesised as the basis for the checklists. Virtual workshops and interviews were conducted to further adapt the checklist content with stakeholders (primary care staff, clinical specialists, and representatives from national speciality groups). Workshops were recorded and facilitated by a qualitative researcher with clinical experience. Insights from workshop data were incorporated to produce draft checklists for verification by workshop participants. Checklist contents were refined and agreed in consultation with national specialist groups. Electronic patient record templates were developed to operationalise the checklists. Results Twenty-two national guidelines were reviewed and synthesised into the checklist drafts. Six virtual workshops and nine individual interviews were conducted with 30 key stakeholders (five GPs, four nurses, six physiotherapists, three pharmacists, three dietitians, and nine physicians). Participants directed the checklist format to include safety netting, key diagnostic checks, and optimal management. Conclusion Short, pragmatic, evidence-based checklists were developed for use in primary care to support primary care clinicians in managing the main conditions contributing to chronic breathlessness.
