Does the evidence referenced in NICE guidelines reflect a primary care population?

Scullard, Paul; Abdelhamid, Asmaa; Steel, Nick; Qureshi, Nadeem

doi:10.3399/bjgp11x561177

Cited by 14 publications

(15 citation statements)

References 18 publications

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“…Even NICE guidelines may have limitations when applied to populations in primary care. 25 It may be possible to adapt guidelines to cater for people with multimorbidities-for example, through systematic cross referencing 26 …”

Section: Doctors' Dilemmasmentioning

confidence: 99%

The Quality and Outcomes Framework--where next?

Gillam

Steel

2013

BMJ

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Section: Doctors' Dilemmasmentioning

confidence: 99%

The Quality and Outcomes Framework--where next?

Gillam

Steel

2013

BMJ

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“…[457][458][459][460] In particular, there are concerns about what the contract encourages in the way of public health activity in general practice. There is an important trade-off here: RCT-based 'certainties' around expensive technical interventions versus 'riskier' but potentially more impactful interventions such as, for example, brief interventions for smoking, which have low impact but are very low cost and, while having a small impact, affect a large number of people.…”

Section: Impact Of Changes In the Health And Social Care Act 2012 Andmentioning

confidence: 99%

The organisation and delivery of health improvement in general practice and primary care: a scoping study

Peckham

Falconer

Gillam

et al. 2015

Health Serv Deliv Res

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BackgroundThis project examines the organisation and delivery of health improvement activities by and within general practice and the primary health-care team. The project was designed to examine who delivers these interventions, where they are located, what approaches are developed in practices, how individual practices and the primary health-care team organise such public health activities, and how these contribute to health improvement. Our focus was on health promotion and ill-health prevention activities.AimsThe aim of this scoping exercise was to identify the current extent of knowledge about the health improvement activities in general practice and the wider primary health-care team. The key objectives were to provide an overview of the range and type of health improvement activities, identify gaps in knowledge and areas for further empirical research. Our specific research objectives were to map the range and type of health improvement activity undertaken by general practice staff and the primary health-care team based within general practice; to scope the literature on health improvement in general practice or undertaken by health-care staff based in general practice and identify gaps in the evidence base; to synthesise the literature and identify effective approaches to the delivery and organisation of health improvement interventions in a general practice setting; and to identify the priority areas for research as defined by those working in general practice.MethodsWe undertook a comprehensive search of the literature. We followed a staged selection process involving reviews of titles and abstracts. This resulted in the identification of 1140 papers for data extraction, with 658 of these papers selected for inclusion in the review, of which 347 were included in the evidence synthesis. We also undertook 45 individual and two group interviews with primary health-care staff.FindingsMany of the research studies reviewed had some details about the type, process or location, or who provided the intervention. Generally, however, little attention is paid in the literature to examining the impact of the organisational context on the way services are delivered or how this affects the effectiveness of health improvement interventions in general practice. We found that the focus of attention is mainly on individual prevention approaches, with practices engaging in both primary and secondary prevention. The range of activities suggests that general practitioners do not take a population approach but focus on individual patients. However, it is clear that many general practitioners see health promotion as an integral part of practice, whether as individual approaches to primary or secondary health improvement or as a practice-based approach to improving the health of their patients. Our key conclusion is that there is currently insufficient good evidence to support many of the health improvement interventions undertaken in general practice and primary care more widely.Future ResearchFuture research on health improvement in general practice and by the primary health-care team needs to move beyond clinical research to include delivery systems and be conducted in a primary care setting. More research needs to examine areas where there are chronic disease burdens – cancer, dementia and other disabilities of old age. Reviews should be commissioned that examine the whole prevention pathway for health problems that are managed within primary care drawing together research from general practice, pharmacy, community engagement, etc.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…Otherwise general practitioners (GPs), the end users of the research process, who attempt to practise evidence-based medicine, may have flawed tools, and the guidelines they use may not be applicable to the patients they see or the processes they use. 1,2 Medical research in Australia has mostly been conducted in tertiary hospital settings, but as the majority of illnesses are managed in primary healthcare settings, 3 there is a need for a change in focus. 4 Funding allocated to primary care research has a greater potential population impact, compared with research in other specialties, 5 with 82% of the population visiting their GP in the past 12 months.…”

mentioning

confidence: 99%