Majority of the individuals with hepatitis C virus (HCV) infection in England are people who inject drugs, a vulnerable and disenfranchised cohort with poor engagement with secondary care. Our aim is to describe our experiences in setting up a successful nurse led HCV service at a substance misuse service (SMS).

We justify the need for a community HCV service and review the different community based models. Our experiences in engaging with stakeholders, obtaining funding, service set up, challenges faced and key recommendations are discussed. Finally, a summary of interim clinical outcomes is presented.

A successful community based “one-stop” nurse led HCV service was set up in Dec 2013 at a large SMS. It provides all aspects of care (blood borne virus screening, non-invasive assessment of hepatic fibrosis, Hepatology input, HCV treatment, peer mentor, social and psychiatrist support, and opiod substitution) at one site. Interim clinical data indicate high service uptake with HCV treatment outcomes comparable to secondary care.

The advent of direct acting antivirals provides a unique opportunity for HCV elimination in England by 2030. Our “one-stop” integrated and multidisciplinary community HCV model suggests that HCV care can be successfully delivered outside of a hospital setting and warrants national adoption.

Primary care faces unprecedented challenges. A move towards a more comprehensive, multi-disciplinary service delivery model has been proposed as a means with which to secure more sustainable services for the future. One seemingly promising response has been the implementation of physiotherapy self-referral schemes, however there is a significant gap in the literature regarding implementation.

This evaluation aimed to explore how the professionals and practice staff involved in the delivery of an in-practice physiotherapy self-referral scheme understood the service, with a focus on perceptions of value, barriers and impact.

A qualitative evaluation was conducted across two UK city centre practices that had elected to participate in a pilot self-referral scheme offering ‘physiotherapy-as-a-first-point-of-contact’ for patients presenting with a musculoskeletal complaint.

Individual and focus group interviews were conducted amongst participating physiotherapists, administration/reception staff, general practitioners (GPs) and one practice nurse (in their capacity as practice partner). Interview data were collected from a total of 14 individuals. Data were analysed using thematic analysis.

Three key themes were highlighted by this evaluation. First, the imperative of effecting a cultural change – including management of patient expectation with particular reference to the belief that GPs represented the ‘legitimate choice’, re-visioning contemporary primary care as a genuine team approach, and the physiotherapists’ reconceptualisation of their role and practices. Second, the impact of the service on working practice across all stakeholders – specifically re-distribution of work to ‘unburden’ the GP, and the critical role of administration staff. Finally, beliefs regarding the nature and benefits of physiotherapeutic musculoskeletal expertise – fears regarding physiotherapists’ ability to work autonomously or identify ‘red flags’ were unfounded.

This qualitative evaluation draws on the themes to propose five key lessons which may be significant in predicting the success of implementing physiotherapy self-referral schemes.

To evaluate the possibility of determining predictors of falls in the active community-dwelling elderly from the routine medical records of the general practitioners (GPs).

Time constraints and competing demands in the clinical encounters frequently undermine fall-risk evaluation. In the context of proactive primary healthcare, quick, and efficient tools for a preliminary fall-risk assessment are needed in order to overcome these barriers.

The study included 1220 subjects of 65 years of age or older. Data were extracted from the GPs’ patient records. For each subject, the following variables were considered: age, gender, diseases, and pharmacotherapy. Univariate and multivariable analyses have been conducted to identify the independent predictors of falls.

The mean age of the study population was 77.8±8.7 years for women and 74.9±7.3 years for men. Of the sample, 11.6% had experienced one or more falls in the previous year. The risk of falling was found to increase significantly (P<0.05) with age (OR=1.03; 95% CI=1.01–1.05), generalized osteoarthritis (OR=2.01; 95% CI=1.23–3.30), tinnitus (OR=4.14; 95% CI=1.25–13.74), cognitive impairment (OR=4.12; 95% CI=2.18–7.80), and two or more co-existing diseases (OR=5.4; 95% CI=1.68–17.39). Results suggest that it is possible to identify patients at higher risk of falling by going through the current medical records, without adding extra workload on the health personnel. In the context of proactive primary healthcare, the analysis of fall predictors from routine medical records may allow the identification of which of the several known and hypothesized risk factors may be more relevant for developing quick and efficient tools for a preliminary fall-risk assessment.

To report an evaluation of health professionals’ participation in a distance-learning physical activity training course developed in a low socio-economic region of São Paulo city, Brazil.

In countries with public universal health systems, physical activity promotion in primary health care settings can reap results, particularly given that such interventions have the potential to reach a large percentage of the population. However, few studies proposed physical activity training for health professionals in low- and middle-income countries. Brazil is a continental country and has the Unified Health System which incorporates family health teams in over 85% of Brazilian cities.

The physical activity training was part of the fifth module of an educational intervention throughout a distance-learning course focusing on health professionals at M’Boi Mirim district in São Paulo city. The training totaled 3 h and had five themes of physical activity: (1) concepts, definitions benefits; (2) evaluation; (3) recommendation; (4) interventions; (5) physical activity counseling. The opinion of health professionals was evaluated after training by two open questions.

Out of 106 professionals who took part of the course, only 22.6% (n=24) had accessed the fifth module. These professionals were predominantly female (79.2%), nurses (66.7%) and aged 30 years or older. Responses highlighted the course approach focused on physical activity for improving patient’s quality of life and well-being, disease prevention and health improvements. Regarding the themes for improvement, the health professionals identified that there was a need to experience physical activity classes first-hand, and the need to link physical activity counseling to the local venues that provide structured physical activity programs. We recommend that further training courses can be conducted based on this model for health professionals to promote physical activity to the community in Brazil.

This qualitative study investigates how the Electronic Patient-Reported Outcome (ePRO) mobile application and portal system, designed to capture patient-reported measures to support self-management, affected primary care provider workflows.

The Canadian health system is facing an ageing population that is living with chronic disease. Disruptive innovations like mobile health technologies can help to support health system transformation needed to better meet the multifaceted needs of the complex care patient. However, there are challenges with implementing these technologies in primary care settings, in particular the effect on primary care provider workflows.

Over a six-week period interdisciplinary primary care providers (n=6) and their complex care patients (n=12), used the ePRO mobile application and portal to collaboratively goal-set, manage care plans, and support self-management using patient-reported measures. Secondary thematic analysis of focus groups, training sessions, and issue tracker reports captured user experiences at a Toronto area Family Health Team from October 2014 to January 2015.

Key issues raised by providers included: liability concerns associated with remote monitoring, increased documentation activities due to a lack of interoperability between the app and the electronic patient record, increased provider anxiety with regard to the potential for the app to disrupt and infringe upon appointment time, and increased demands for patient engagement. Primary care providers reported the app helped to focus care plans and to begin a collaborative conversation on goal-setting. However, throughout our investigation we found a high level of provider resistance evidenced by consistent attempts to shift the app towards fitting with existing workflows rather than adapting much of their behaviour. As health systems seek innovative and disruptive models to better serve this complex patient population, provider change resistance will need to be addressed. New models and technologies cannot be disruptive in an environment that is resisting change.

This project evaluated the effectiveness of screening brief intervention and referral for treatment (SBIRT) in primary care in Abu Dhabi to manage patients with problematic substance use. This study aimed to determine whether: (i) training primary care physicians on the SBIRT model increased the identification of patients using substances at a harmful, hazardous or dependent level; (ii) training improved physicians’ knowledge, attitudes and beliefs in self-efficacy in managing substance use.

Substance use is increasing in the United Arab Emirates yet there has been no formal primary care intervention. SBIRT was considered an appropriate model given its endorsement by the WHO.

A controlled trial (two intervention and two matched control clinics) was undertaken. Intervention physicians (n=17) were trained in SBIRT. Physicians’ attitudes were measured before and after training and eight months after implementation. Target recruitment was 900 patients. Inclusion criteria were: consenting UAE national, ⩾18 years, using the ‘walk-in’ primary care clinic. Patient data was collected by physician-administered questionnaire. Prevalence of drug use was measured through electronic patient records.

A total of 906 patients were screened, aged 18–82 years and 496 (55%) were female. Of these, 5.7% reported use of amphetamine, 3.9% alcohol, 3.3%, sedatives, 1.7% opioids and 1.1% cannabis. In all, 21 people had a moderate/high ASSIST score and received a brief intervention, but did not attend follow-up; three high-risk people were referred for specialist treatment. Physicians’ attitudes towards patients with problematic substance use and providing treatment improved after training, but returned to pre-training levels after eight months. Including the 21 individuals identified from intervention screening, the prevalence of substance use increased to 0.208% (95% CI 0.154–0.274), significantly higher than in control clinics (P<0.001).

In conclusion, physicians were generally positive towards SBIRT and SBIRT increased recorded drug related conditions at a practice level. However, poor patient attendance at follow-up requires investigation.

To explore how e-cigarettes are perceived by a group of e-cigarette users and a group of Stop Smoking Advisors (SSAs), what are the risks and benefits they associate with e-cigarettes and how do these understandings shape participants’ attitude towards e-cigarettes?

Face-to-face and phone interviews were conducted with 15 e-cigarette users and 13 SSAs in South East England between 2014 and 2015. Transcribed data were analysed inductively through thematic analysis.

E-cigarettes were used as a therapeutic aid to stop or cut down smoking and as a smoking substitute. A prominent theme is the uncertainty e-cigarettes have generated. This included ambiguity of e-cigarettes’ status and efficacy, and ambiguity of e-cigarettes’ physical and social risks. Different attitudes towards e-cigarettes were identified.

E-cigarettes’ benefits and risks should be continuously evaluated, put into perspective and circulated to avoid ambiguity. Stop smoking services need to recognise the benefits that can be gained by using e-cigarettes as a harm reduction tool.

This study’s objectives were to collate General Practitioners’ (GPs) views and experiences on the barriers and facilitators for providing HIV and sexual health screening in primary care to men who have sex with men.

Men who have sex with men (MSM) are disproportionately effected by sexually transmitted infections and HIV. Some MSM may not attend for testing and primary care may come in contact with this group. There may be varying barriers for MSM accessing services. Primary care can provide an opportunity to offer testing but with limited GPs views on this topic, it is important to understand the potential barriers and facilitators.

A structured online survey was used to gather data and the survey link was emailed to all General Practices in the City of Edinburgh. The total available sample of GPs was 485. The survey used a combination of multiple choice questions and Likert scales rating from 1 to 5. Friedman’s two-way analysis of variation rank was used for data analysis.

In total, 62 GPs from the City of Edinburgh completed the survey with the majority of the sample having over 10 years’ experience in primary care. The most significant barrier was patient preference to access specialist services. The highest rated method to promote HIV and sexual health screening was the use of external promotion.