COVID-19 is disproportionately impacting people in low-income communities. Primary care staff in deprived areas have unique insights into the challenges posed by the pandemic. This study explores the impact of COVID-19 from the perspective of primary care practitioners in the most deprived region of England. Deep End general practices serve communities in the region’s most socioeconomically disadvantaged areas. This study used semi-structured interviews followed by thematic analysis. In total, 15 participants were interviewed (11 General Practitioners (GPs), 2 social prescribing link workers and 2 nurses) with Deep End careers ranging from 3 months to 31 years. Participants were recruited via purposive and snowball sampling. Interviews were conducted using video-conferencing software. Data were analysed using thematic content analysis through a social determinants of health lens. Our results are categorised into four themes: the immediate health risks of COVID-19 on patients and practices; factors likely to exacerbate existing deprivation; the role of social prescribing during COVID-19; wider implications for remote consulting. We add qualitative understanding to existing quantitative data, showing patients from low socioeconomic backgrounds have worse outcomes from COVID-19. Deep End practitioners have valuable insights into the impact of social distancing restrictions and remote consulting on patients’ health and wellbeing. Their experiences should guide future pandemic response measures and any move to “digital first” primary care to ensure that existing inequalities are not worsened.

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ObjectivesThe purpose of this systematic review is to explore whether health equity audits (HEAs) are effective in improving the equity of service provision and reducing health inequalities.DesignThree databases (Ovid Medline, Embase, Web of Science) and grey literature (Opengrey, Google Scholar) were systematically searched for articles published after 2000, reporting on the effectiveness of HEA. Title and abstracts were screened according to an eligibility criteria to identify studies which included a full audit cycle (eg, initial equity analysis, service changes and review). Data were extracted from studies meeting the eligibility criteria after full text review and risk of bias assessed using the ROBINS-I tool.ResultsThe search strategy identified 596 articles. Fifteen records were reviewed in full text and three records were included in final review. An additional HEA report was identified through contact with an author. Three different HEAs were included from one peer-reviewed journal article, two published reports and one unpublished report (n=4 records on n=3 HEAs). This included 102 851 participants and over 148 practices/pharmacies (information was not recorded for all records). One study reviewed health equity impacts of HEA implementation in key indicators for coronary heart disease, type 2 diabetes and chronic obstructive pulmonary disease. Two HEAs explored Stop Smoking Services on programme access and equity. All reported some degree of reduction in health inequalities compared with prior HEA implementation. However, impact of HEA implementation compared with other concurrent programmes and initiatives was unclear. All included studies were judged to have moderate to serious risk of bias.ConclusionsThere is an urgent need to identify effective interventions to address health inequalities. While HEAs are recommended, we only identified limited weak evidence to support their use. More evidence is needed to explore whether HEA implementation can reduce inequalities and which factors are influencing effectiveness.Trial registration numberThe study was registered prior to its conduction in PROSPERO (CRD 42020218642).

Objectives: Common mental disorders (CMDs), particularly depression, are major contributors to the global mental health burden. South Asia, while diverse, has cultural, social, and economic challenges, which are common across the region, not least an aging population. This creates an imperative to better understand how CMD affects older people in this context, which relies on valid and culturally appropriate screening and research tools. This review aims to scope the availability of CMD screening tools for older people in South Asia. As a secondary aim, this review will summarize the use of these tools in epidemiology, and the extent to which they have been validated or adapted for this population. Design: A scoping review was performed, following PRISMA guidelines. The search strategy was developed iteratively in Medline and translated to Embase, PsychInfo, Scopus, and Web of Science. Data were extracted from papers in which a tool was used to identify CMD in a South Asian older population (50+), including validation, adaptation, and use in epidemiology. Validation studies meeting the criteria were critically appraised using the Quality Assessment of Diagnostic Accuracy Studies – version 2 (QUADAS-2) tool. Results: Of the 4694 papers identified, 176 met the selection criteria at full-text screening as relevant examples of diagnostic or screening tool use. There were 15 tool validation studies, which were critically appraised. Of these, 10 were appropriate to evaluate as diagnostic tests. All of these tools assessed for depression. Geriatric Depression Scale (GDS)-based tools were predominant with variable diagnostic accuracy across different settings. Methodological issues were substantial based on the QUADAS-2 criteria. In the epidemiological studies identified (n = 160), depression alone was assessed for 82% of the studies. Tools lacking cultural validation were commonly used (43%). Conclusions: This review identifies a number of current research gaps including a need for culturally relevant validation studies, and attention to other CMDs such as anxiety.