The British journal of general practice : the journal of the Royal College of General Practitioners
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NICE guidance states new patients aged 15-59 registering at a primary care centre in a high-risk area for HIV, should be offered testing. First, this allows for prompt initiation of antiretroviral therapy, improving the individual's morbidity and mortality while reducing community transmission. Second, increasing the breadth of the population offered tests would help normalise testing, reducing stigma and increasing uptake. AIM: To retrospectively audit adherence to HIV testing guidance in new patients registering at a GP in Walsall, where HIV risk is categorised as high, and to make recommendations based on the results. ⋯ The guidance for screening for HIV in this primary care centre is therefore not followed due to a lack of awareness of the guideline and HIV risk in the area. We recommend that this audit is conducted across more primary care centres in HIV high-risk areas to assess if this outcome is representative of general adherence to guidance.
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Hypertensive disorders of pregnancy (HDP) affect approximately 10-15% of pregnancies and pre-eclampsia affects 3-5% of pregnancies. Women with previous pre-eclampsia or HDP are at increased risk of hypertension (2 to 5 times) and major cardiovascular disease (1.5 to 3 times). There is little guidance on how to reduce this risk. ⋯ Further research needs to explore potential interventions and optimal timing of interventions to reduce cardiovascular risk. Women also need to be consulted about their preferences for discussions about cardiovascular risk and potential interventions.
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The principle of epistemic justice (EJ) recognises the need for a person's voice to be both heard (testimonial) and understood (hermeneutic) in the generation of meaning. Funding bodies now require all research to have embedded patient and public involvement (PPI) - an active partnership between patients, carers, and the public with researchers, which influences and shapes research. ⋯ This study suggests ways in which current PPI methods can be used to best advantage. The authors' ongoing research is discussed to understand further how EJ concepts might help shape the future of PPI in health research.
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Comparative Study
A retrospective, comparative analysis of A&E attendance paserns in Irish Traveller versus non-Traveller general practice patients.
Very little is known about Gypsy, Roma, and Traveller health, or access to and utilisation of health care. They are not coded in NHS data systems and there are multiple barriers including illiteracy, digital exclusion, and discrimination. ⋯ This work throws light on health service utilisation patterns by Irish Travellers. A&E attendances may have been more suited to a non-emergency setting and there may have been missed opportunities for contact with primary care or NHS 111, which may have an impact on continuity, onward referral, and quality of care.
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Vulval lichen sclerosus (VLS) is a skin condition which causes pain, itching, anatomical changes, and increases vulval cancer risk by up to 22 times. VLS is treatable, with use of topical steroids allowing symptom resolution and complication prevention. Diagnostic delay and misdiagnosis of VLS is common. Previous studies found that women attribute this to poor interactions with and knowledge of clinicians. Most VLS is diagnosed in primary care. ⋯ This study illuminates the multiple barriers to diagnosis and treatment of VLS. The results confirm that clinicians share patient concerns that knowledge is poor, highlight the importance of developing clear diagnostic criteria, and will allow us to target training to those lacking in confidence.