Accessibility, candidacy, multimorbidity: health services research at the Society of Academic Primary Care conference 2018

Attending the 47th-annual Scientific Meeting of the Society for Academic Primary Care (SAPC) gave me a first-hand look at the breadth of high quality research my colleagues are conducting. The three-day event featured more than 400 talks and posters with various takes on the dual themes of ‘Learning from Europe’ and ‘Populations on the Move’ including the challenges of displacement, homelessness, and accessing primary care in unfamiliar, often under-resourced settings. Yet despite tackling such diverse questions, I was struck by how so many studies shared a similar goal: improving the quality of primary care and making it accessible to everyone.

Understanding the healthcare experiences of the most disadvantaged amongst us was a common theme. Many presenters drew on candidacy theory as a means of understanding access to healthcare by vulnerable groups. Candidacy describes how people's sense of eligibility for healthcare is influenced by themselves, their social contexts and how healthcare services are configured. Our health services constantly redefine when we should seek medical attention, and so this theory helps understand people’s changing perceptions of when seeking medical attention is deemed appropriate. Disadvantaged people can face additional vulnerabilities when their priorities and competencies don’t align with those of the health services available to them.

Prof Anne MacFarlane used candidacy theory to study the health experiences of migrants, especially how migrants are frequently excluded from the conventional healthcare “spaces”. Dr Penny Abbott’s distinguished paper applied candidacy theory to study the healthcare experiences of women in the Australian prison system. These women, who often suffered the dual stigmas of substance misuse and being a prisoner, reported feeling that their claims to care were not legitimate, even if they were seriously ill. In a plenary, Prof Val Wass made a compelling argument for expanding medical education to better account for the generalist needs of displaced and migrant communities. Other talks spoke to the topics of self-harm interventions in developing world settings; support networks for domestic violence survivors; the barriers experienced by homeless women accessing maternity services; difficulties experienced by vulnerable people accessing food banks; and peer support for those experiencing homelessness and health issues.

Distinguished presentations also addressed other pressing questions in health services research. Prof Chris Salisbury from the University of Bristol discussed the 3D cluster randomised controlled trial of a complex, multi-dimensional intervention intended to improve patient-centredness and quality of life for patients with multimorbidity. Though patients’ health-related quality of life (the primary outcome) did not improve after the comprehensive and well-resourced intervention, their experience of healthcare -- particularly patient centredness -- did. I think these results represent the beginning of a new era in multimorbidity research which will see greater focus on the outcomes that are most meaningful to patients, but are amenable to improvement by healthcare professionals.

Dr Yana Vinogradova from the University of Nottingham gave a clear expose of how routinely collected health data (from CPRD and QResearch) can be harnessed to address clinical questions relating to thromboembolic risk and hormone replacement therapy. The winner of this year’s Yvonne Carter award, Dr Andrew Carson-Stevens from Cardiff University, highlighted the value of good health services data for generating learning about patient safety in general practice. Andrew used the National Reporting and Learning System, the largest repository of patient safety incidents in the world, to better understand patient safety incidents occurring in general practice in England and Wales. His comprehensive portfolio of work from this repository has culminated in the generation of a new WHO classification of patient-safety incidents in primary care.

Then it was my chance to present. This was my first opportunity to discuss the work my team at THIS institute and I are doing on operational failures in general practice. Like other healthcare professionals, GPs encounter a number of system-level failures that get in the way of performing their tasks. So we used a critical interpretive synthesis approach to review the primary care literature for evidence of these interruptions. While we found no literature focused specifically on operational failures in general practice, this approach helped us effectively “re-cycle” existing research to generate ideas on what these failures might be. We will be taking this work forward by conducting ethnographic research and spending time with GPs to observe the interruptions they experience.

While our study has a unique focus, our underlying aims of improving healthcare quality and patient experiences are shared with so many of our distinguished colleagues. Hopefully I’ll once again get the chance to join these colleagues and present an update on our study at the next SAPC meeting, which takes place in Exeter in July 2018. Maybe I’ll see you there!