38 research outputs found
Barriers and facilitators to HIV testing in people age 50 and above: a systematic review
No full textBackground: Approximately 13% of people living with HIV in the UK are unaware of their infection. New diagnoses among people =50 years is increasing. Unique factors may be associated with testing in this group. This review aims to identify patient and clinician-related barriers/facilitators to HIV testing in people aged =50 years. Methods: A systematic electronic search was conducted. Papers were assessed for eligibility and data from eligible studies were extracted. Barriers/facilitators were grouped, and number of times reported was noted. Due to considerable heterogeneity, a narrative approach has been undertaken to synthesise data. Findings: 17 studies were included. Main barriers to testing were low perceived risk, and clinicians’ preconceptions about older people. Main facilitators were regular use of healthcare services or being offered/encouraged to test by a healthcare provider. Interpretation: Although being encouraged to test was a common facilitator, clinicians’ preconceptions about older people was the biggest barrier, showing a divide between clinicians’ preconceptions and patient’s expectations, which may impact on testing rates. This review is an important first step to identify potential barriers/facilitators for further study or to be addressed in the design of future interventions
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An audit of HIV testing practice in people aged 50 years and over presenting with a known clinical indicator condition in secondary care
No full textObjectives: To evaluate HIV testing of patients aged =50 years presenting to secondary care with clinical indicator conditions (CICs) for HIV. Methods: Retrospective audit of electronic records for patients aged =50 years discharged from hospital between January 1st and July 31st 2019 who had at least one documented CIC. Patient demographics and HIV testing data were collected from clinical systems (excluding sexual health databases). Results: 2478 patients with a CIC were identified. 222 (9.0%) received an HIV test within 31 days of discharge. Patients receiving a test were significantly younger (mean 68.6 versus 75.3 years; P < 0.001) and significantly more men underwent testing than women (60.4% versus 39.6%; P = 0.001). 32 CICs were identified across nine disease systems. By system, those with a haematological CIC were significantly more likely to undergo testing compared with all other CICs combined (P < 0.001). Of individual CICs, patients with Kaposi's sarcoma, hepatitis C, neutropenia, lymphadenopathy, pyrexia of unknown origin and thrombocytopenia (P < 0.001), and seborrhoeic dermatitis, hepatitis B, other unexplained blood dyscrasia, and non-Hodgkin's lymphoma (P < 0.05) were more likely to undergo testing than those presenting with other CICs. Patients with dementia and lung cancer were less likely to undergo testing (P < 0.001). Patients presenting with a greater number of CICs were significantly more likely to undergo testing (P = 0.002). Conclusions: HIV testing among patients aged =50 years presenting to secondary care with a CIC is low. Work is needed to improve HIV testing practice in this patient group
An audit of HIV testing practice in people aged 50 years and over presenting with a known clinical indicator condition in secondary care
No full textObjectives: To evaluate HIV testing of patients aged =50 years presenting to secondary care with clinical indicator conditions (CICs) for HIV. Methods: Retrospective audit of electronic records for patients aged =50 years discharged from hospital between January 1st and July 31st 2019 who had at least one documented CIC. Patient demographics and HIV testing data were collected from clinical systems (excluding sexual health databases). Results: 2478 patients with a CIC were identified. 222 (9.0%) received an HIV test within 31 days of discharge. Patients receiving a test were significantly younger (mean 68.6 versus 75.3 years; P < 0.001) and significantly more men underwent testing than women (60.4% versus 39.6%; P = 0.001). 32 CICs were identified across nine disease systems. By system, those with a haematological CIC were significantly more likely to undergo testing compared with all other CICs combined (P < 0.001). Of individual CICs, patients with Kaposi's sarcoma, hepatitis C, neutropenia, lymphadenopathy, pyrexia of unknown origin and thrombocytopenia (P < 0.001), and seborrhoeic dermatitis, hepatitis B, other unexplained blood dyscrasia, and non-Hodgkin's lymphoma (P < 0.05) were more likely to undergo testing than those presenting with other CICs. Patients with dementia and lung cancer were less likely to undergo testing (P < 0.001). Patients presenting with a greater number of CICs were significantly more likely to undergo testing (P = 0.002). Conclusions: HIV testing among patients aged =50 years presenting to secondary care with a CIC is low. Work is needed to improve HIV testing practice in this patient group
Barriers and facilitators to HIV testing in people age 50 and above: a systematic review
No full textBackground: Approximately 13% of people living with HIV in the UK are unaware of their infection. New diagnoses among people =50 years is increasing. Unique factors may be associated with testing in this group. This review aims to identify patient and clinician-related barriers/facilitators to HIV testing in people aged =50 years. Methods: A systematic electronic search was conducted. Papers were assessed for eligibility and data from eligible studies were extracted. Barriers/facilitators were grouped, and number of times reported was noted. Due to considerable heterogeneity, a narrative approach has been undertaken to synthesise data. Findings: 17 studies were included. Main barriers to testing were low perceived risk, and clinicians’ preconceptions about older people. Main facilitators were regular use of healthcare services or being offered/encouraged to test by a healthcare provider. Interpretation: Although being encouraged to test was a common facilitator, clinicians’ preconceptions about older people was the biggest barrier, showing a divide between clinicians’ preconceptions and patient’s expectations, which may impact on testing rates. This review is an important first step to identify potential barriers/facilitators for further study or to be addressed in the design of future interventions
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Barriers and facilitators to HIV testing in people age 50 and above: a systematic review
No full textBackground: Effective therapy means HIV-positive individuals can now experience near normal life expectancy. Despite these advances in treatment, about one in six people living with HIV in the UK are unaware of their infection. Although overall number of new HIV diagnoses have decreased, the number of people diagnosed aged 50 and over is increasing. It may be that there are unique factors associated with the decision to test in this group. This systematic review aims to identify patient and clinician related barriers and facilitators to HIV testing in people aged 50 and above. Methods: A systematic electronic search of MEDLINE, Embase, PsychINFO and CINAHL was conducted on 07/04/2016. Search terms included combinations of words describing HIV, old age, and testing. Papers were assessed for eligibility (published since 01/01/1997, describing barriers/facilitators to testing, research in people =50 years, written in English). Data from eligible studies were extracted (including study design, sample size and characteristics, analysis and reported barriers/facilitators to testing). Reported barriers/facilitators were grouped into themes and number of times each was reported was noted. Findings: Electronic searches identified 1752 articles, of which 14 primary studies met the inclusion criteria. A further 3 eligible papers were identified from reference and citation searching. Seventeen papers were included in the review. Most of the studies (n=14) were from the US. The main patient-barriers to non-test were low perceived risk and not being offered/encouraged to test by a healthcare professional (HCP) (reported 5 and 3 times respectively). The main clinician-barrier was preconceptions about older people and discomfort discussing sexuality and risk, reported 5 times. Main facilitators of test were being offered/encouraged to test by a HCP, previous interactions with healthcare services and high perceived risk (all reported >5 times). Interpretation: Clinicians’ beliefs that people =50 years are not at risk, or will feel uncomfortable discussing risk and sexuality, were among the most commonly cited barriers to test offer. However, being offered or encouraged to test by a healthcare professional was the most commonly cited facilitator to testing. This shows a divide between clinicians’ preconceptions and patient’s expectations, which may impact on testing rates
The acceptability of routine HIV testing in general medical admissions using a sexual health advisor/healthcare assistant model.
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7861 Understanding demographic variations in a paediatric asthma, allergy, eczema clinics at a tertiary children’s hospital: a service evaluation
No full textWhy did you do this work? Asthma is prevalent among children and young people in the UK. Many have poorly controlled asthma, reducing quality of life and increasing service demands. Attributes such as ethnicity or deprivation may influence clinical outcomes. Improving understanding of outcomes of marginalised groups could improve the evidence base to inform practice, decreasing health disparities.The objective of this work was to evaluate NHS electronic medical records (EMR) to understand demographic variations among patients attending children’s clinics managing asthma, allergy and eczema in the context of service engagement and common clinical outcomes.What did you do? The study was approved by the local Trust NHS Audit and Risk Committee. EMR from October 2023-January 2024 from three paediatric clinics (clinics for allergy/asthma, respiratory/allergy, and the asthma nurse-led clinic) were retrospectively reviewed. Demographic information and clinical outcomes (including medications and clinic appointments) were documented. Postcode data were used to calculate indices of deprivation scores. National Institute for Health and Care Excellence (NICE) and British Thoracic Society Guidelines was used to ascertain level of asthma medicine use.What did you find? EMR for 355 patients were reviewed. Comparisons between ethnic groups, and between the socioeconomic status of patients were performed. 270(76%) patients reported white ethnicity, 46 (17.8%) patients reported minority ethnicity, and 29 (6.2%) did not have their ethnicity stated.Number of clinic appointments in the previous 12 months ranged from 1–11 (mean 2.34; median 2). There were no differences based on ethnicity or deprivation score. Children had 0–8 attendances (mean 0.7; median 0) to the Emergency Department (ED) over this period. Patients from white backgrounds and Asian backgrounds had a trend towards fewer ED attendances (range 0–8; mean 0.68; median 0 and range 0–2; mean 0.72; median 0 respectively) compared to children from other ethnic groups. No differences were found in number of ED attendances based on deprivation scores.Children were prescribed 0–8 medicines (mean 2.36; median 2). Patients reporting ‘other’ ethnic group exhibited a trend towards more prescribed medicines (range 2–4; mean 3.0; median 3) compared to white patients (range 0–8; mean 2.36; median 2). Patients from areas of increased deprivation showed a general trend towards more prescribed medicines.What does it mean? Number of clinic visits and prescribed medicines varied widely between patients attending these clinics. Despite the retrospective study design and relatively small sample size, results indicated children from marginalised communities may experience a greater disease burden, which may be reduced through targeted support. Further research is needed to validate these findings. Results will inform future work in this area exploring experiences of underrepresented groups’ with atopic disease.</p
Barriers and facilitators to HIV testing in people age 50 and above: a systematic review
No full textBackground: Effective therapy means HIV-positive individuals can now experience near normal life expectancy. Despite these advances in treatment, about one in six people living with HIV in the UK are unaware of their infection. Although overall number of new HIV diagnoses have decreased, the number of people diagnosed aged 50 and over is increasing. It may be that there are unique factors associated with the decision to test in this group. This systematic review aims to identify patient and clinician related barriers and facilitators to HIV testing in people aged 50 and above. Methods: A systematic electronic search of MEDLINE, Embase, PsychINFO and CINAHL was conducted on 07/04/2016. Search terms included combinations of words describing HIV, old age, and testing. Papers were assessed for eligibility (published since 01/01/1997, describing barriers/facilitators to testing, research in people =50 years, written in English). Data from eligible studies were extracted (including study design, sample size and characteristics, analysis and reported barriers/facilitators to testing). Reported barriers/facilitators were grouped into themes and number of times each was reported was noted. Findings: Electronic searches identified 1752 articles, of which 14 primary studies met the inclusion criteria. A further 3 eligible papers were identified from reference and citation searching. Seventeen papers were included in the review. Most of the studies (n=14) were from the US. The main patient-barriers to non-test were low perceived risk and not being offered/encouraged to test by a healthcare professional (HCP) (reported 5 and 3 times respectively). The main clinician-barrier was preconceptions about older people and discomfort discussing sexuality and risk, reported 5 times. Main facilitators of test were being offered/encouraged to test by a HCP, previous interactions with healthcare services and high perceived risk (all reported >5 times). Interpretation: Clinicians’ beliefs that people =50 years are not at risk, or will feel uncomfortable discussing risk and sexuality, were among the most commonly cited barriers to test offer. However, being offered or encouraged to test by a healthcare professional was the most commonly cited facilitator to testing. This shows a divide between clinicians’ preconceptions and patient’s expectations, which may impact on testing rates
Medical student confidence to care for a dying patient and their family: a systematic review
No full textBackground: The General Medical Council expects medical graduates to care for dying patients with skill, clinical judgement and compassion. UK surveys continually demonstrate low confidence and increasing distress amongst junior doctors when providing care to the dying. Aim: This systematic review aims to determine what has been evidenced within worldwide literature regarding medical undergraduate confidence to care for dying patients. Design: A systematic electronic search was undertaken. Data extraction included measurements of baseline confidence, associated assessment tools, and details of applied educational interventions. Pre/post-intervention confidence comparisons were made. Factors influencing confidence levels were explored. The review was prospectively registered via PROSPERO (CRD42019119057). Data sources: MEDLINE, CINAHL, EMBASE, ISI Web of Science, ERIC, PsychINFO, British Education Index and Cochrane Review databases were accessed, with no restrictions on publication year. Eligible studies included the terms ‘medical student’, ‘confidence’, and ‘dying’, alongside appropriate MeSH headings. Study quality was assessed using the Mixed Methods Appraisal Tool. Results: Fifteen eligible studies were included, demonstrating a diversity of assessment tools. Student confidence was low in provision of symptom management, family support, and psycho-spiritual support to dying patients. Eight interventional studies demonstrated increased post-interventional confidence. Lack of undergraduate exposure to dying patients and lack of structure within undergraduate palliative care curricula were cited as factors responsible for low confidence. Conclusion: This review clarifies the objective documentation of medical undergraduate confidence to care for the dying. Identifying where teaching fails to prepare graduates for realities in clinical practice will help inform future undergraduate palliative care curriculum planning
