
Chris SalisburyUniversity of Bristol | UB · Population Health Sciences
Chris Salisbury
MD, MSc FRCGP
About
408
Publications
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Introduction
Additional affiliations
January 1998 - present
January 1998 - present
Publications
Publications (408)
Background Treatment burden represents the work patients undertake because of their healthcare, and the impact of that effort on the patient. Most research has focused on older adults (65+) with multiple long-term conditions (MLTC-M) but there are more younger adults (18-65) living with MLTC-M and they may experience treatment burden differently. U...
Opinion: It is more than 10 years since landmark UK studies underlined the “new normal” of multiple morbidity. More people now live with several health problems at an earlier age and health inequalities have increased, but most clinical services remain geared towards management of single diseases. Research systems have reinforced these distortions,...
Introduction: Polypharmacy is increasingly common, and associated with undesirable consequences. Polypharmacy management necessitates balancing therapeutic benefits and risks, and varying clinical and patient priorities. Current guidance for managing polypharmacy is not supported by high quality evidence. The aim of the Improving Medicines use in P...
Background
Exploring treatment burden at a population level can provide evidence of the types of patients who need special attention and support. We aimed to determine factors associated with high perceived treatment burden in a population-based survey of adults living in the Central Denmark Region (23% of the Danish population).
Methods
The Danis...
Background
Emergency care is facing a steadily rising demand. In response, hospitals have implemented new models of care that locate general practitioners in or alongside the emergency department.
Objectives
We aimed to explore the effects of general practitioners working in or alongside the emergency department on patient care, the primary care a...
Objectives:
To examine the effect of general practitioners (GPs) working in or alongside the emergency department (GPED) on patient outcomes and experience, and the associated impacts of implementation on the workforce.
Design:
Mixed-methods study: interviews with service leaders and NHS managers; in-depth case studies (n=10) and retrospective o...
Objectives
To investigate whether better continuity of care is associated with increased prescribing of clinically relevant medication and improved medication adherence.
Setting
Random sample of 300 000 patients aged 30+ in 2017 within 83 English general practitioner (GP) practices from the Clinical Practice Research Datalink.
Design
Patients wer...
Background : Use of telephone, video and e-consultations is increasing. These can make consultations more transactional, potentially missing patients’ concerns. This study aimed to develop a complex intervention to address patients’ concerns more comprehensively in general practice and test the feasibility of this in a cluster-randomised framework....
Objective:
Blood tests are commonly used in primary care as a tool to aid diagnosis, and to offer reassurance and validation for patients. If doctors and patients do not have a shared understanding of the reasons for testing and the meaning of results, these aims may not be fulfilled. Shared decision-making is widely advocated; yet, most research...
Objectives
Multimorbidity, typically defined as having two or more long-term health conditions, is a common patient characteristic that is associated with reduced wellbeing and life expectancy. Understanding the determinants of multimorbidity may help with the design and prioritisation of interventions to prevent multimorbidity. This study examined...
Background
Rates of blood testing in primary care are rising. Communicating blood test results generates significant workload for patients, GPs, and practice staff.
Aim
To explore GPs’ and patients’ experience of systems of blood test communication.
Design and setting
Qualitative interviews with patients and GPs in UK primary care in both urban a...
Background:
Around 43% of emergency department (ED) attendances can be managed in general practice. Strategies to address this include directing appropriate patients to GPs working in or alongside EDs (GPED). Views of GPs choosing to work in GPED roles may inform planning and implementation of GPED services as well as wider general practice provis...
Background : Use of telephone, video and online consultations in general practice is increasing. This can lead to transactional consultations which make it harder for patients to describe how symptoms affect their lives, and confusion about plans for future care. The aim of this study was to test the feasibility of a randomised control trial (RCT)...
Context: Shared decision making is widely advocated, however most research focuses on treatment decisions. Evidence for shared decision-making in relation to diagnostic testing is limited to specific tests such as prostate specific antigen, screening and genetic tests. There is a lack of evidence regarding the relevance of shared decision-making to...
Background : Use of telephone, video and e-consultations is increasing. These can make consultations more transactional. This study aimed to develop a complex intervention to address patients’ concerns more comprehensively in general practice and test the feasibility of this in a cluster-randomised framework.
The complex intervention used two techn...
Background : Use of telephone, video and e-consultations is increasing. These can make consultations more transactional, potentially missing patients’ concerns. This study aimed to develop a complex intervention to address patients’ concerns more comprehensively in general practice and test the feasibility of this in a cluster-randomised framework....
Objective
To validate the Danish Multimorbidity Treatment Burden Questionnaire (MTBQ) and obtain a population-based evaluation of treatment burden.
Design
Mixed-methods.
Setting
Danish population-based survey.
Participants
Translation by professional translators and an expert group. The scale was tested by 13 407 participants (aged ≥25 years) in...
Background
The information given to people considering taking part in a trial needs to be easy to understand if those people are to become, and then remain, trial participants. However, there is a tension between providing comprehensive information and providing information that is comprehensible. User-testing is one method of developing better par...
Background
In March 2020 the COVID-19 pandemic required a rapid reconfiguration of UK general practice to minimise face-to-face contact with patients to reduce infection risk. However, some face-to-face contact remained necessary and practices needed to ensure such contact could continue safely.
Aim
To examine how practices determined when face-to...
Background
Most patients who present with depression are treated in primary care by general practitioners (GPs). Relapse of depression is common (at least 50% of patients treated for depression will relapse after a single episode) and leads to considerable morbidity and decreased quality of life for patients. The majority of patients will relapse w...
Objectives:
To explore the potential impacts of introducing General Practitioners into Emergency Departments (GPED) from the perspectives of service leaders, health professionals and patients. These 'expectations of impact' can be used to generate hypotheses that will inform future implementations and evaluations of GPED.
Design:
Qualitative stu...
Background:
Systems to detect and minimise unwarranted variation in clinician practice are crucial to ensure increasingly multidisciplinary healthcare workforces are supported to practice to their full potential. Such systems are limited in English general practice settings, with implications for the efficiency and safety of care.
Aim:
To evalua...
Background
Emergency Department attendance is increasing internationally, of which a significant proportion could be managed in general practice. In England, policies backed by substantial capital funding require patients attending Emergency Departments be directed or ‘streamed’ to general practitioners working in or parallel to Emergency Departmen...
Objectives
To investigate how the COVID-19 pandemic affected the number of people aged 50+ years presenting to primary care with features that could potentially indicate cancer, and to explore how reporting differed by patient characteristics and in face-to-face vs remote consultations.
Design, setting and participants
A retrospective cohort study...
Objectives: To explore the potential impacts of introducing General Practitioners into Emergency Departments (GPED) from the perspectives of service leaders, health professionals and patients. These ‘expectations of impact’ can be used to generate hypotheses that will inform future implementations and evaluations of GPED. Design: Qualitative study...
Background
This study aimed to investigate general factors associated with prognosis regardless of the type of treatment received, for adults with depression in primary care.
Methods
We searched Medline, Embase, PsycINFO and Cochrane Central (inception to 12/01/2020) for RCTs that included the most commonly used comprehensive measure of depressive...
Objective
Most current cardiovascular disease (CVD) risk stratification tools are for people without CVD, but very few are for prevalent CVD. In this study, we developed and validated a CVD severity score in people with coronary heart disease (CHD) and evaluated the association between severity and adverse outcomes.
Methods
Primary and secondary c...
Background
In March 2020 the COVID-19 pandemic required a rapid reconfiguration of UK general practice to minimise face-to-face contact with patients to reduce infection risk. However, some face-to-face contact remained necessary and practices needed to ensure such contact could continue safely.AimTo examine how practices determined when face-to-fa...
Background
To reduce contagion of COVID-19, in March 2020 UK general practices implemented predominantly remote consulting via telephone, video, or online consultation platforms.
Aim
To investigate the rapid implementation of remote consulting and explore impact over the initial months of the COVID-19 pandemic.
Design and setting
Mixed-methods st...
Background
The complexity of general practice consultations may be increasing and varies in different settings. A measure of complexity is required to test these hypotheses.
Aim
To develop a valid measure of general practice consultation complexity applicable to routine medical records.
Design and setting
Delphi study to select potential indicato...
Background
Continuity of care is a core principle of primary care related to improved patient outcomes and reduced healthcare costs. Evidence suggests continuity of care in England is declining.
Aim
To confirm reports of declining continuity of care, explore differences in decline according to practice characteristics, and examine associations bet...
Background In March 2020, the World Health Organisation declared COVID-19 a pandemic.
Aim To investigate how the pandemic affected presentation to primary-care with features potentially indicating cancer, and explore how reporting differed by patient characteristics and in face-to-face vs. remote consultations.
Design and setting Retrospective coho...
Background: To reduce contagion of COVID-19, in March 2020 UK general practices implemented predominantly remote consulting via telephone, video or online consultation platforms.
Aim: To investigate the rapid implementation of remote consulting and explore impact over the initial months of the COVID-19 pandemic.
Design and Setting: Mixed-methods st...
Objectives
Identification of patients at increased mortality risk is important in the context of increasing multimorbidity and an ageing population, to help facilitate the planning and delivery of services. The aim of this study was to examine 1-year all-cause mortality in a cohort of primary care patients in whom inflammatory markers including C r...
Objective: To systematically review the studies of prevalence, patterns and consequences of multimorbidity reported from South Asia. Design: Systematic review. Setting: South Asia. Data sources: Articles were retrieved from two electronic databases (PubMed and Embase) and from the relevant references lists. Methodical data extraction according to P...
Background
Despite the benefits of relational continuity of care, particularly for patients with multimorbidity, the traditional model of continuity is changing. Revisiting what patients with ongoing problems want from relational continuity could encourage initiatives to achieve these within a modern healthcare system.
Aim
To examine the attribute...
Background: This study aimed to identify and examine systematic review evidence of health and social care interventions for the community-dwelling older population regarding unplanned hospital admissions, timely hospital discharge and patient well-being.
Methods: A meta-review was conducted using Joanna Briggs and PRISMA guidance. A search strategy...
Objective
Clinically applicable diabetes severity measures are lacking, with no previous studies comparing their predictive value with glycated hemoglobin (HbA 1c ). We developed and validated a type 2 diabetes severity score (the DIabetes Severity SCOre, DISSCO) and evaluated its association with risks of hospitalization and mortality, assessing i...
Unstructured:
In many countries, private companies provide primary care services based predominantly on offering video-consultations via smartphone. One example is Babylon GP at Hand, which offers video-consultations to NHS patients, 24 hours a day, and has grown very rapidly in London over the last three years. The development of this type of ser...
UNSTRUCTURED
In many countries, private companies provide primary care services based predominantly on offering video consultations via smartphones. One example is Babylon GP at Hand (BGPaH), which offers video consultations to National Health Service patients, 24 hours a day, and has grown rapidly in London over the last 3 years. The development o...
Background:
Health services in many countries are promoting digital-first models of access to general practice based on offering online, video, or telephone consultations before a face-to-face consultation. It is claimed that this will improve access for patients and moderate the workload of doctors. However, improved access could also potentially...
BACKGROUND
Health services in many countries are promoting digital-first models of access to general practice based on offering online, video, or telephone consultations before a face-to-face consultation. It is claimed that this will improve access for patients and moderate the workload of doctors. However, improved access could also potentially i...
Objective
This study aimed to develop a risk prediction model identifying general practices at risk of workforce supply–demand imbalance.
Design
This is a secondary analysis of routine data on general practice workforce, patient experience and registered populations (2012 to 2016), combined with a census of general practitioners’ (GPs’) career int...
Objective
Patients with multiple chronic health conditions are often managed in a disjointed fashion in primary care, with annual review clinic appointments offered separately for each condition. This study aimed to determine the cost-effectiveness of the 3D intervention, which was developed to improve the system of care.
Design
Economic evaluatio...
Objectives
During a cluster randomised trial, (the 3D study) of an intervention enacting recommended care for people with multimorbidity, including continuity of care and comprehensive biennial reviews, we examined implementation fidelity to interpret the trial outcome and inform future implementation decisions.
Design
Mixed-methods process evalua...
Objectives:
To establish how quality indicators used in English community nursing are selected and applied, and their perceived usefulness to service users, commissioners and service providers.
Methods:
A qualitative multi-site case study was conducted with five commissioning organizations and their service providers. Participants included commi...
With the recent publication of the NHS Long Term Plan1 and the renewal of the GP Contract,2 it is timely to consider what we value within general practice. In this article we consider normative ways of thinking about general practice and the implications for primary healthcare organisation and funding. We examine some of the opportunities and chall...
Objective To investigate whether the introduction of a named general practitioner (GP, family physician) improved patients’ healthcare for patients aged 75 and over in England.
Setting Random sample of 27 500 patients aged 65 to 84 in 2012 within 139 English practices from the Clinical Practice Research Datalink linked with Hospital Episode Statis...
Background:
The United Kingdom (UK) is experiencing a general practitioner (GP) workforce retention crisis. Research has focused on investigating why GPs intend to quit, but less is known about the acceptability and effectiveness of policies and strategies to improve GP retention. Using evidence from research and key stakeholder organisations, we...
Background and aims: Type 2 diabetes (T2DM) prevalence is increasing
worldwide. But, a validated and clinically applicable T2DM severity
measure derived from medical data is lacking. We aimed to: 1) develop
and validate a disease severity score (DISSCO) in T2DM patients using
electronic health data, 2) evaluate the score's association with risks of...
Background:
Past studies have demonstrated how single non-communicable diseases (NCDs) affect health care utilisation and quality of life (QoL), but not how different NCD combinations interact to affect these. Our study aims to investigate the prevalence of NCD dyad and triad combinations, and the implications of different NCD dyad combinations on...
Objectives. Determine the optimal, licensed, first-line anticoagulant for prevention of ischemic stroke in patients with non-valvular atrial fibrillation (AF) in England and Wales from the UK National Health Service (NHS) perspective and estimate value to decision making of further research. Methods. We developed a cost-effectiveness model to compa...
Background:
Inflammatory markers (C-reactive protein, erythrocyte sedimentation rate, and plasma viscosity) are commonly used in primary care. Though established for specific diagnostic purposes, there is uncertainty around their utility as a non-specific marker to rule out underlying disease in primary care.
Aim:
To identify the value of inflam...
Background:
Research comparing C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and plasma viscosity (PV) in primary care is lacking. Clinicians often test multiple inflammatory markers, leading to concerns about overuse.
Aim:
To compare the diagnostic accuracies of CRP, ESR, and PV, and to evaluate whether measuring two inflammat...
Background
Primary care workload is high and increasing in the United Kingdom. We sought to examine the association between rates of primary care consultation and outcomes in England.
Methods
Cross sectional observational study of routine electronic health care records in 283 practices from the Clinical Practice Research Datalink from April 2013 t...
Background
UK general practice faces a workforce crisis, with general practitioner (GP) shortages, organisational change, substantial pressures across the whole health-care system and an ageing population with increasingly complex health needs. GPs require lengthy training, so retaining the existing workforce is urgent and important.
Objectives
(1...
Background:
Early identification of cancer in primary care is important and challenging. This study examined the diagnostic utility of inflammatory markers (C-reactive protein, erythrocyte sedimentation rate and plasma viscosity) for cancer diagnosis in primary care.
Methods:
Cohort study of 160,000 patients with inflammatory marker testing in 2...
Background
People with multimorbidity experience impaired quality of life, poor health and a burden from treatment. Their care is often disease-focused rather than patient-centred and tailored to their individual needs.
Objective
To implement and evaluate a patient-centred intervention to improve the management of patients with multimorbidity in g...
Aims
To identify and critically appraise measures that use clinical data to grade the severity of Type 2 diabetes.
Methods
We searched MEDLINE, Embase and PubMed between inception and June 2018. Studies reporting on clinical data‐based diabetes‐specific severity measures in adults with Type 2 diabetes were included. We excluded studies conducted s...
Background
The UK’s National Health Service (NHS) is currently subject to unprecedented financial strain. The identification of unnecessary healthcare resource use has been suggested to reduce spending. However, there is little very research quantifying wasteful test use, despite the £3 billion annual expenditure. Geographical variation has been su...
Objectives
To assess the temporal change in test use in UK primary care and to identify tests with the greatest increase in use.
Design
Retrospective cohort study.
Setting
UK primary care.
Participants
All patients registered to UK General Practices in the Clinical Practice Research Datalink, 2000/1 to 2015/16.
Main outcome measures
Temporal tr...
Background:
Standardised generic patient-reported outcome measures (PROMs) which measure health status are often unresponsive to change in primary care. Alternative formats, which have been used to increase responsiveness, include individualised PROMs (in which respondents specify the outcomes of interest in their own words) and transitional PROMs...