Summary Objective The impact of abolishing prescription charges on asthma medication use and clinical outcomes is uncertain. We aimed to investigate whether removing prescription charges improves asthma medication use, adherence and clinical outcomes. Design Systematic review. Scopus, Web of Science and PubMed were searched for articles published between 1 January 2005 and 2 October 2025. Studies were screened, data extracted and risk of bias appraised. Findings were narratively synthesised by outcome domain. Setting Free prescription policy interventions. Participants Asthma or mixed respiratory chronic disease populations affected by free prescription policies. Main outcome measures Asthma medication prescribing or dispensing, adherence or persistence and severe outcomes (asthma-related emergency department attendances and hospital admissions). Results Of 122 identified records, five met the inclusion criteria, ranging from a 2259-patient UK-matched cohort to a Swedish population-level study of 485,665 children. All were observational and heterogeneous in policy exposure, population and outcome definition. Four studies reported prescribing or dispensing. Evidence was mixed: paediatric dispensing increased after fee removal in Sweden, from 46.3 to 51.1 defined daily doses per child per month, and a Canadian study reported an increase in controller days’ supply among low-income patients of 1.50 days per month (95% CI 0.61 to 2.40). However, two UK studies showed no consistent policy-attributable changes in asthma controller or reliever use. For adherence or persistence, two person-level studies from the UK and Canada found no improvement in adherence, whereas a Swedish before-and-after analysis showed paediatric asthma medication persistence increased from 48.3% to 52.2%. Four studies reported severe outcomes, but only two were asthma-specific, and causal attribution was limited. Conclusions Evidence on free prescriptions policy on asthma outcomes is sparse and heterogeneous. These policies may improve asthma controller access in some settings, but the limited evidence available does not indicate consistent improvements in adherence or reductions in severe outcomes.
Lesson Consider central venous catheters as a mechanical trigger for new or escalating supraventricular tachycardia- radiographically correct positioning does not preclude arrhythmogenicity.
Summary Objectives To estimate the prevalence of multiple long-term conditions (MLTC) among people accessing hospital care in North East England, and to assess associations with age, sex, ethnicity and neighbourhood deprivation. Design Analysis of electronic health records. Setting Secondary care. Participants All adults, 18 years and above, with ≥ 1 admission to Newcastle upon Tyne Hospitals NHS Foundation Trust (NuTH) between July 2018 and June 2019 (N = 88,117, 51% women) or between July 2021 and June 2022 (N = 83,036, 51% women). Main outcome measures MLTC; ≥2 long-term conditions. Results Between July 2018 and June 2019, overall prevalence of MLTC was 49.6%, and between July 2021 and June 2022 it was 61.0%. Older age and living in a more deprived neighbourhood were consistently associated with increased risk of MLTC, whereby people living in the most deprived neighbourhoods had a prevalence of MLTC equivalent to people from the least deprived neighbourhoods a decade older. Associations between neighbourhood deprivation and increased MLTC risk were stronger in younger adults; relative risk of MLTC was 1.74 (95% confidence interval: 1.49–2.02) when comparing people aged 30–39 living in the most and least deprived neighbourhoods. Conclusions Among adults accessing inpatient hospital care in North East England, the prevalence of MLTC is high in all age groups, has increased since the COVID-19 pandemic and has a greater impact on younger adults from more deprived neighbourhoods. This highlights the sheer scale of the challenge that MLTC present in hospitals and the value of harnessing information at a local level as we look to redesign hospital care fit for the future.
Summary Objectives To assess how UK postgraduate medical organisations have responded to calls for action on structural racism, and to examine the extent to which anti-racism is embedded in postgraduate medical curricula and learning outcomes. Design We conducted a review of publicly available statements and commitments from organisations responsible for postgraduate medical education, and a content analysis of all General Medical Council (GMC)-approved postgraduate curricula. Search terms related to racism, ethnicity, religion and discrimination were used, with double-coding of extracted data and inductive thematic analysis of relevant learning outcomes. Settings United Kingdom. Participants Twenty-one organisations responsible for postgraduate medical training and all 102 GMC-approved postgraduate medical curricula. Main outcome measures Presence of explicit anti-racism commitments, inclusion of education-related actions and accountability mechanisms, and representation of racism and its impacts on health within assessed curricular competencies. Results Sixteen organisations (76%) had public commitments addressing racism or related issues, with ten (48%) including education-related measures and five (24%) specifying accountability mechanisms. Across 102 curricula, only 11 (11%) mentioned racism, and just 10 included it in learning outcomes, largely confined to three specialities. Mentions of race, ethnicity and religion were more common but often lacked reference to structural drivers of health inequalities. No curricula addressed xenophobia, Islamophobia, antisemitism or decolonisation. Conclusions Despite widespread institutional commitments, anti-racism is minimally represented in UK postgraduate medical curricula. There is an urgent need to integrate explicit anti-racism competencies into training to equip doctors with the knowledge and skills required to address structural determinants of health and reduce inequalities.
Summary Objective To develop the conceptual framework for an MLTC-specific patient-reported outcome measure (PROM), the Symptom Burden Questionnaire™ for MLTC (SBQ™-MLTC). Design Mixed-methods study: (1) symptom list generation; (2) assessment of list face validity; and (3) construction of a conceptual framework. Setting Concept elicitation and conceptual framework development using existing PROMs identified through the Mapi Research Trust PROQOLID eCOA database and AI-generated symptom lists. Participants Fifty-one condition-specific PROMs with evidence of patient involvement during concept elicitation were included for symptom extraction. ChatGPT-4 generated symptom lists for 24 conditions prevalent in MLTC. Seventeen healthcare practitioners reviewed symptom relevance and contributed to refinement of the conceptual framework. Main outcome measures Identification, refinement, and organisation of relevant MLTC symptoms into body system and functional domains, and development of the SBQ™-MLTC's conceptual framework. Results ePROVIDE searches in July and August 2023 identified 51 condition-specific PROMs for 24 conditions prevalent in MLTC. ChatGPT-4 was prompted to generate a list of 75 symptoms for each condition. A merged list of 2202 symptoms was iteratively reduced to 190 symptoms for healthcare practitioner review. The final conceptual framework included 151 symptoms spanning 18 body system and functional domains. Conclusions This study represents the first phase in the development of an MLTC-specific PROM of symptom burden. Generative AI output triangulated with content from existing PROMs and healthcare practitioner review proved a feasible approach to concept elicitation. Planned cognitive debriefing will confirm content validity of the SBQ™-MLTC for people with lived experience. In the future, the SBQ™-MLTC could support integrated, symptom-led approaches for clinical management of MLTC.
