Health inequalities in the UK are widening, particularly since the COVID-19 pandemic. Community pharmacies are the most visited healthcare provider in England and are ideally placed to provide and ...facilitate access to care for those most disadvantaged.
To explore the experiences and needs of community pharmacy teams in providing care for marginalised groups and how this has changed since the COVID-19 pandemic.
A qualitative study in community pharmacy and across primary care.
Semi-structured interviews were undertaken with members of community pharmacy teams, primary care network (PCN) pharmacists, GPs, and nurses in the North of England.
In total, 31 individuals participated in an interview (26 pharmacy staff, three GPs, and two nurses). Most participants acknowledged that their pharmacy had become busier since COVID-19 because of increased footfall compounded by patient difficulties in navigating remote digital systems. Few participants had received any formal training on working with marginalised communities; however, organisational barriers (such as lack of access to translation facilities) combined with interorganisational barriers (such as lack of integrated care) made it more difficult to provide care for some marginalised groups. Despite this, the continuity of care provided by many pharmacies was viewed as an important factor in enabling marginalised groups to access and receive care.
There are opportunities to better utilise the skills of community pharmacy teams. Resources, such as access to translation services, and interventions to enable better communication between community pharmacy teams and other primary care services, such as general practice, are essential.
Tackling inequalities in health and healthcare is more important than ever. The COVID-19 pandemic starkly illustrated the disproportional impact of the virus on those who already faced disadvantage ...and discrimination. Moreover, there is evidence that the public health measures taken to contain the virus are likely to have longstanding differential impacts across populations. Numerous studies have documented avoidable differences in health, within and between populations. Similarly, studies have consistently shown inequalities in access, use, experience and outcomes from healthcare and public health programmes. The focus has often been on individual determinants, such as gender, age and ethnicity. Less attention has been paid to structural or contextual determinants, except for area-level socioeconomic conditions. In addition, to tackle inequalities, there is a need to move beyond measuring; to understand why inequalities arise and how they can be addressed. This Special Issue sought to extend the parameters of inequalities research in health and healthcare beyond measuring and documenting inequalities. Reviews, observational studies, and quasi-experimental and other evaluation designs (using quantitative, qualitative or mixed methods), focusing on the following were welcomed: • understanding inequalities across health and care systems; • methodological developments to understand drivers of inequalities; • efforts to reduce inequalities, particularly in evidence-based healthcare or public health policy and practice; • understanding and mitigating the adverse impact of the COVID-19 pandemic on inequalities.
Ethnic inequities in heart failure (HF) have been documented in several countries. This study describes New Zealand (NZ) trends in incident HF hospitalisation by ethnicity between 2006 and 2018.
...Incident HF hospitalisations in ≥20-year-old subjects were identified through International Classification of Diseases, 10th Revision-coded national hospitalisation records. Incidence was calculated for different ethnic, sex and age groups and were age standardised. Trends were estimated with joinpoint regression.
Of 116 113 incident HF hospitalisations, 12.8% were Māori, 5.7% Pacific people, 3.0% Asians and 78.6% Europeans/others. 64% of Māori and Pacific patients were aged <70 years, compared with 37% of Asian and 19% of European/others. In 2018, incidence rate ratios compared with European/others were 6.0 (95% CI 4.9 to 7.3), 7.5 (95% CI 6.0 to 9.4) and 0.5 (95% CI 0.3 to 0.8) for Māori, Pacific people and Asians aged 20-49 years; 3.7 (95% CI 3.4 to 4.0), 3.6 (95% CI 3.2 to 4.1) and 0.5 (95% CI 0.4 to 0.6) for Māori, Pacific people and Asians aged 50-69 years; and 1.5 (95% CI 1.4 to 1.6), 1.5 (95% CI 1.3 to 1.7) and 0.5 (95% CI 0.5 to 0.6) for Māori, Pacific people and Asians aged ≥70 years. Between 2006 and 2018, ethnicity-specific rates diverged in ≥70-year-old subjects due to a decline in European/others (annual percentage change (APC) -2.0%, 95% CI -2.5% to -1.6%) and Asians (APC -3.3%, 95% CI -4.4% to -2.1%), but rates remained unchanged for Māori and Pacific people. In contrast, regardless of ethnicity, rates either increased or remained unchanged in <70-year-old subjects.
Ethnic inequities in incident HF hospitalisation have widened in NZ over the past 13 years. Urgent action is required to address the predisposing factors that lead to development of HF in Maori and Pacific people.
Aims
To, firstly, explore student and academic nurse perceptions of classroom content about the assessment and identification of pressure injuries across skin tone diversity and, secondly, to ...describe the impact of classroom content on student nurse understanding of pressure injury in people with dark skin tones.
Design
Qualitative case study employing focus groups and semi‐structured interviews.
Methods
Five higher education institutions in the United Kingdom were purposively chosen. At each of the five‐case sites, one focus group with student nurses and one semi‐structured interview with a nurse academic were conducted between May 2018 and April 2019. The participants’ narratives were transcribed verbatim and analysed via thematic analysis.
Results
Classroom learning was predominately framed through a white lens with white normativity being strongly reinforced through teaching and learning activities. This reinforcement of white normativity was evidenced through two main themes: (i) dominance of whiteness in the teaching and learning of pressure injuries in undergraduate nurse education and (ii) the impact and implications for student nurses of whiteness as the norm in pressure injury teaching.
Conclusion
Nurses responsible for the design and delivery of teaching and learning experiences for nursing students need to ensure meaningful teaching and learning experiences. This learning should assist future nurses to interrogate their complicity in a system of white dominance.
Impact
Nurse education delivered today influences and shapes nurses of the future. Nurses are the cornerstone of healthcare and play a significant role in the delivery of equitable healthcare. Nurse academics have a duty of care to inform and highlight health inequities in nursing and ultimately to enhance equity in care.
Social prescribing involving primary care-based 'link workers' is a key UK health policy that aims to reduce health inequalities. However, the process of implementation of the link worker approach ...has received little attention despite this being central to the desired impact and outcomes.
To explore the implementation process of such an approach in practice.
Qualitative process evaluation of the 'Deep End' Links Worker Programme (LWP) over a 2-year period, in seven general practices in deprived areas of Glasgow.
The study used thematic analysis to identify the extent of LWP integration in each practice and the key factors associated with implementation. Analysis was informed by normalisation process theory (NPT).
Only three of the seven practices fully integrated the LWP into routine practice within 2 years, based on the NPT constructs of coherence, cognitive participation, and collective action. Compared with 'partially integrated practices', 'fully integrated practices' had better shared understanding of the programme among staff, higher staff engagement with the LWP, and were implementing all aspects of the LWP at patient, practice, and community levels of intervention. Successful implementation was associated with GP buy-in, collaborative leadership, good team dynamics, link worker support, and the absence of competing innovations.
Even in a well-resourced government-funded programme, the majority of practices involved had not fully integrated the LWP within the first 2 years. Implementing social prescribing and link workers within primary care at scale is unlikely to be a 'quick fix' for mitigating health inequalities in deprived areas.
People who identify as lesbian, gay, bisexual, and transgender (LGBT+) face inequalities in healthcare and are receiving less palliative and end-of-life care than others with a comparable need. Since ...the global resolution to improve palliative care made by the World Health Assembly, the World Health Organization, and member states, some progress has been made. However, LGBT+ people are discriminated and marginalized, which leads to suboptimal palliative care. Research on the needs of LGBT+ people and their access to palliative care is limited. Therefore, the aim of this discussion article is to scope unique problems around palliative and end-of-life care for LGBT+ people and identify possible solutions to address these problems with direct links to nursing practice.
Journal articles and author experience were used for this discussion article.
Oncology nurses need to be educated in communication skills, specific assessment tools, and awareness of the history of LGBT+ people. Increasing knowledge for cancer nurses is pivotal because this affects their views, needs, and perceptions in providing palliative and end-of-life care.
Oncology nurses have a pivotal role in caring for all cancer patients at the end of their life. LGBT+ patients and their caregivers need competent nurses to support them, especially during transitions. Implementing LGBT+-inclusive education, training, and practice will improve outcomes for LGBT cancer patients and their caregivers, and potentially all patients. More research is needed to implement such training in nursing education. (“LGBT+” has been used throughout the article. There are many arguments in favor of using different variations of the acronym, but for purposes of understanding and ease, LGBT+ is the acronym of choice here.)
Doctor strikes cause major disruption for hospitals and patients. Past attempts to estimate impacts on patients suffer from selection issues due to changing patient composition during strikes. We ...address these issues by exploiting differential hospital exposure to a 2016 ‘junior’ doctor strike in England to estimate the impact of doctor strikes on patient outcomes. Using the pre-strike junior-senior doctor ratio to measure exposure, we show increased strike exposure led to larger reductions in elective volumes, but did not affect volumes, average mortality or readmission rates for emergency patients. However, greater exposure to the strike did lead to higher readmission rates for black emergency patients. This suggests that while hospitals managed to mitigate many of the negative effects of the strikes, disruptions from the strikes still had negative consequences for some minority groups.
Primary care transformation in Scotland aims to improve population health, reduce health inequalities, and reduce GP workload. Two key strategies (formalised in April 2018 in the new Scottish GP ...contract Scottish General Medical Services contract, although started in early 2016) are the expansion of the multidisciplinary team (MDT) and GP cluster working.
To explore progress in the implementation of the GP contract in Scotland in terms of the MDT and cluster working.
Qualitative study with key national primary care stakeholders (PCSs) (
= 6) and cluster quality leads (CQLs) in clusters serving urban high deprivation areas (
= 4), urban mixed areas (
= 4), and remote and rural areas (
= 4).
Semi-structured interviews with thematic analysis.
There was general support for the initial aims of the new GP contract but all interviewees felt that progress on both MDT expansion and cluster working was slow, even before the pandemic. None of the CQLs (and few PCSs) felt that GP workload had reduced significantly, nor that the care of patients with complex needs had improved. Lack of time and poorly developed relationships were key barriers, as was a lack of relevant primary care data, and additional support (including guidance, administration, training, and protected time).
Key PCSs and CQLs in different areas of Scotland report limited progress in primary care transformation, only partly related to the pandemic. There is a need for better workforce planning and support if the new GP contract is to succeed in transforming primary care in Scotland.
Precision medicine (PM) is an emerging approach to individualized care. It aims to help physicians better comprehend and predict the needs of their patients while effectively adopting in a timely ...manner the most suitable treatment by promoting the sharing of health data and the implementation of learning healthcare systems. Alongside its promises, PM also entails the risk of exacerbating healthcare inequalities, in particular between ethnoracial groups. One often-neglected underlying reason why this might happen is the impact of structural racism on PM initiatives. Raising awareness as to how structural racism can influence PM initiatives is paramount to avoid that PM ends up reproducing the pre-existing health inequalities between different ethnoracial groups and contributing to the loss of trust in healthcare by minority groups.
We analyse three nodes of a process flow where structural racism can affect PM's implementation. These are: (i) the collection of biased health data during the initial encounter of minority groups with the healthcare system and researchers, (ii) the integration of biased health data for minority groups in PM initiatives and (iii) the influence of structural racism on the deliverables of PM initiatives for minority groups. We underscore that underappreciation of structural racism by stakeholders involved in the PM ecosystem can be at odds with the ambition of ensuring social and racial justice. Potential specific actions related to the analysed nodes are then formulated to help ensure that PM truly adheres to the goal of leaving no one behind, as endorsed by member states of the United Nations for the 2030 Agenda for Sustainable Development.
Structural racism has been entrenched in our societies for centuries and it would be naïve to believe that its impacts will not spill over in the era of PM. PM initiatives need to pay special attention to the discriminatory and harmful impacts that structural racism could have on minority groups involved in their respective projects. It is only by acknowledging and discussing the existence of implicit racial biases and trust issues in healthcare and research domains that proper interventions to remedy them can be implemented.
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