
David SeamarkUniversity of Exeter | UoE · Peninsula College of Medicine and Dentistry
David Seamark
PhD FRCGP
About
123
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Introduction
Skills and Expertise
Additional affiliations
January 1995 - present
Publications
Publications (123)
Background:
GPs were a key driving force for the development of a network of community hospitals across England, and have provided medical cover for most of them. However, during the past decade there has been a significant shift, with the dominant trend appearing to be one of declining GP involvement.
Aim:
To explore how and why the role of GPs...
Focus:
This is the first major study on community hospitals in England to explore the role of community hospitals, patient experience and the relationship which community hospitals have with their local community.
Methods:
The study of community hospitals was a multi-methods study, with three phases. Phase one involved national mapping, and constru...
Background
Community hospitals have been part of England’s health-care landscape since the mid-nineteenth century. Evidence on them has not kept pace with their development.
Aim
To provide a comprehensive analysis of the profile, characteristics, patient experience and community value of community hospitals.
Design
A multimethod study with three...
Background
GPs were a key driving force for the development of a network of community hospitals across England and have provided medical cover for most. The past decade, however, has seen a significant shift, with the dominant trend appearing to be one of declining GP involvement.
Aim
To explore how and why the role of GPs within community hospita...
Background
Internationally, evidence on the support needs of family carers who look after a terminally ill adult in home settings is incomplete.
Aim
To illustrate the relevance of ‘relevant background worries’ in family carers’ accounts of caring at home for a dying adult.
Design
A qualitative cross-sectional observational study was conducted in...
Background
A review of the effectiveness of relaxation techniques for chronic obstructive pulmonary disease patients has shown inconsistent results, but studies have varied in terms of technique and outcome measures.
Aim
To determine patient preference for different relaxation techniques.
Methods
Chronic obstructive pulmonary disease patients wer...
Appleby highlights the plight of acute hospital patients with delayed discharge because of waiting for assessments and transfers to other NHS facilities.1 We note an overlooked and neglected NHS resource: community hospitals. The UK has around 500,2 and Simon Stevens, NHS England chief, made a statement supporting improved local access to services...
Background: older people aged 80 and over are increasingly providing end-of-life care to spouses at home and often do so for long periods of time, while also trying to manage their own illnesses and disabilities. Little of the research on older spousal carers has focussed on the oldest carers; hence, the needs of this particular population are not...
Objectives:
To determine the importance of fear and anxiety at the time of an exacerbation of chronic obstructive pulmonary disease. To assess the influence of carers and health professionals on this fear and anxiety.
Design:
A qualitative study to elicit the views of patients and their carers during a hospital admission for exacerbations of chr...
Dying at home is the preference of many patients with life-limiting illness. This is often not achieved and a key factor is the availability of willing and able family carers.
To elicit family carers' views about the community support that made death at home possible.
Qualitative study in East Devon, North Lancashire, and Cumbria.
Participants were...
Objective To explore how bereaved family members recall managing end of life medications when delivering care to a patient dying at home in England.
Design Qualitative study.
Setting Domestic homes in two contrasting areas in England.
Participants 59 bereaved family carers who have delivered care to a patient who spent a minimum of 2 weeks at home...
Background:
Chronic non-cancer pain (CNCP) is common in the UK. GPs manage most patients with such pain. Previous research has suggested that prescribing is influenced by patient and doctor factors, but less is known about the decision- making process involved in prescribing opioid drugs for CNCP.
Aim:
To describe the factors influencing GPs' pr...
Current UK health policy aims to increase the numbers of people dying at home, but it relies on family members being available to take responsibility for caring. The 'Unpacking the home' study elicited the views and experiences of family carers who have cared for a dying family member at home.
This paper examines a key element of carers' responsibi...
Background
Recent end of life care policy prioritises patient choice over place of care and in particular promotes dying at home. This policy is predicated on the assumption that there are family carers able and willing to provide care for the dying person. Through the accounts of bereaved family members, the ‘Unpacking the home’ study aims to gain...
Background:
Being able to identify patients at risk of exacerbations is useful as it enables resources to be targeted at these patients.
Aims:
To test the theoretically-derived prediction that the frequency of non-asthma related visits to the general practitioner (GP) predicts exacerbations.
Methods:
Clinical and demographic data and both self...
Context:
The End of Life Care Strategy for England highlights effective communication between patients and professionals as key to facilitating patient involvement in advance care planning. The strategy emphasizes that, currently, communication in patients with noncancer life-limiting conditions is likely to be inadequate, and research has identif...
Current UK end of life care policy places high priority on patients having choice about their place of care, and promotes dying at home, based on an assumption that there are family carers able and willing to provide care for the dying person.
This paper will discuss how perspectives from a range of social sciences were brought together to investig...
Background:
It is recognised that patients with chronic obstructive pulmonary disease (COPD) should have the chance to discuss end-of-life care and advance care planning (ACP). Admission to hospital with an exacerbation may be a possible opportunity.
Aims:
To examine whether an admission to hospital for an exacerbation of COPD is an opportunity...
Aim:
To work with service users and providers to optimise the design and implementation of handover forms to support the transfer of information between daytime and out-of-hours primary care services for patients with palliative care needs.
Background:
There is a need for improved informational continuity between daytime and out-of-hours primary...
To explore the experiences of people with advanced cancer and/or their caregivers accessing out-of-hours care.
The organisation and delivery of out-of-hours in the United Kingdom has undergone major reforms over the past three decades culminating in the new General Medical Service contract in 2004. There are concerns around continuity of care for p...
The challenges associated with patient-based research in palliative care are well documented. This paper focuses on the ethical challenges and discusses them in the context of a pilot study to explore the palliative-care needs of patients with moderate and severe chronic obstructive pulmonary disease. The main ethical challenge encountered related...
Introduction: Harold Shipman, a general practitioner (GP) working near Manchester in England, is thought to have killed 250 of his patients by diamorphine overdose between 1975 and 1998. Opiates are recommended for relieving dyspnoea in end stage chronic obstructive pulmonary disease (COPD). Little is known about the effect of the Shipman case on c...
Chronic obstructive pulmonary disease (COPD) is a highly prevalent condition worldwide and is associated with significant mortality. This paper gives an overview of the relevant literature regarding care needs in advanced COPD from the perspective of the patient or carer, and aims to explore the appropriateness of a palliative care approach in this...
Prognosis in COPD is poor and many patients perceive shortcomings in the education they receive about aspects of their condition. This study explores the experiences of patients with COPD, particularly fears surrounding death and dying. Semi-structured interviews were conducted with 21 patients with moderate or severe COPD. Findings revealed that p...
We have followed with interest the thread of correspondence initiated by Murdoch1 and culminating with the rather baffling and patronising article by Mathers et al .2 Now we have had time to calm down we would like to put forward the case for practice-based primary care research, drawing on our experiences and those of our colleagues over the last...
The English End of Life Care Strategy promises that all patients with advanced, life limiting illness will have the opportunity to participate in Advance Care Planning (ACP). For patients with Chronic Obstructive Pulmonary Disease (COPD), the barriers to this being achieved in practice are under-explored. Five focus groups were held with a total of...
This paper explores carers' views of dying, death and bereavement for family members who had recently died with heart failure adding to a growing literature on end of life experiences for people with conditions other than cancer.
Twenty interviews were conducted with bereaved carers of older people with heart failure (HF) who had been participating...
This paper explores carers' views of dying, death and bereavement for family members who had recently died with heart failure adding to a growing literature on end of life experiences for people with conditions other than cancer.
METHODS:
Twenty interviews were conducted with bereaved carers of older people with heart failure (HF) who had been pa...
Recent clinical trials suggest that intermittent use of inhaled corticosteroids (ICS) is safe for mild persistent asthma. Intermittent ICS use is inconsistent with current guidelines but is a common form of non-compliance. The aim of this study was to investigate how asthma nurses advise patients to use ICS.
Practice managers of 241 GP surgeries in...
Palliative care in the UK has been developed to meet the needs of predominantly middle aged and younger old people with cancer. Few data are available regarding the extent to which services respond to the specific needs of an older group of people with other illnesses. This paper draws on in-depth interviews conducted with 40 people (median age 77)...
Chronic obstructive pulmonary disease (COPD) is a common chronic disease which causes significant mortality and morbidity. The chronic nature of the disease results in patients and carers generally living with the illness for longer than patients with a cancer diagnosis. In the earlier stages of the disease, management focuses on improving symptoms...
There is widespread concern that the quality of out-of-hours primary care for patients with complex needs may be at risk now that the new general medical services contract (GMS) has been implemented.
To explore changes in the use of out-of-hours services around the time of implementation of the new contract for patients with complex needs, using pa...
To identify factors available to general practitioners (GPs) that are predictive of mortality within a general practice-based population of heart failure patients, and to report the sensitivity and specificity of prognostic information from GPs.
Five hundred and forty-two heart failure patients aged >60 years were recruited from 16 UK GP surgeries....
BACKGROUND: There is widespread concern that the quality of out-of-hours primary care for patients with complex needs may be at risk now that the new general medical services contract (GMS) has been implemented. AIM: To explore changes in the use of out-of-hours services around the time of implementation of the new contract for patients with comple...
Concerns remain that health and social care services often fail people dying of chronic illnesses other than those with cancer. British government policy aims to improve end-of-life care and to enable people to make choices about place of care near the end of life, with the assumption that home is often the preferred option. However, some elderly p...
The objective of the present paper is to explore levels of social service provision, the barriers to receiving these services and the experiences of social service provision amongst older people with heart failure. Five hundred and forty-two people aged over 60 years with heart failure were recruited from UK general practices in four areas of the U...
Objectives: To understand the knowledge, skills and confidence of doctors, nurses and other healthcare workers in delivering end-of-life care in community hospitals.Research design: A cross-sectional questionnaire survey was carried out to evaluate doctors', nurses' and other staff's self-reported knowledge and confidence in delivering general aspe...
Chronic obstructive pulmonary disease (COPD) is a progressive condition characterized by airflow obstruction which ultimately kills many patients. It is common in both men and women and there is a 24-30% 5-year survival rate in the UK for those with severe disease. The annual death rate in the UK from COPD approaches that from lung cancer. Patients...
Objectives: To explore dying trajectories in heart failure.
Design: Prospective, longitudinal study.
Setting: Sixteen GP surgeries in four demographically contrasting areas of the UK.
Participants: A total of 27 heart failure patients, >60 years of age, who completed questionnaires for at least five time-points before death.
Main outcome measures:...
Chronic non-cancer pain is an increasing problem in health care. This study was initiated by a patient wanting to discover more about the experiences of other patients requiring strong opioid analgesia for such pain.
To determine the attitudes and experiences of patients receiving long-term strong opioid medication for chronic non-cancer pain in pr...
What the patient wants from a general practice consultation and what the doctor believes they want are not always the same thing. This mismatch may lead to unwanted and unnecessary prescribing.
To study the effect of a one-page form completed by patients before their consultation and given to the doctor at the start of the consultation, in terms of...
This study explored the prevalence and burden of symptoms in a community-based sample of patients aged >60 with symptomatic heart failure. Five hundred forty-two patients were recruited from UK general practices. Participants completed the Kansas City Cardiomyopathy Questionnaire every 3 months for 2 years. Data are presented at baseline alongside...
The objective of this study was to explore the attitudes of older people and primary care professionals towards communication of diagnosis, prognosis and symptoms in heart failure. Forty-four interviews were conducted with people aged > 60 years with heart failure (New York Heart Association III–IV) recruited from general practices in the UK. Ten f...
to explore the characteristics and views of the family carers of older people with heart failure.
213 family carers of heart failure patients >60 years were recruited from UK general practitioner (GP) practices. Carer strain, quality of life (QOL) and service satisfaction questionnaires were completed every 3 months for 2 years, as well as 16 inter...
Objectives: The perceptions of bereaved family members were obtained to evaluate the nature and quality of end-of-life care in community hospitals. Design: During organizational case studies in six community hospitals in the South East and South West of England, bereaved family members were asked to participate in semi-structured interviews. Partic...
Current understanding of quality of life in heart failure is largely derived from clinical trials. Older people, women and those with co-morbidities are underrepresented in these. Little is known about factors predictive of quality of life amongst older people with heart failure recruited from community settings.
To identify factors predictive of q...
The new General Medical Services contract in England means many GPs have transferred out-of hours work to their primary care organization, with implications for continuity of palliative care in community hospitals.
To examine existing arrangements for out-of-hours medical cover in community hospitals, focusing on palliative care.
Telephone survey o...
This paper highlights some of the challenges encountered when recruiting older people with heart failure into longitudinal, community-based research. It draws on the experience gained in a study to provide insights into the palliative care needs of older people with heart failure and the timing and need for service interventions. Five hundred and f...
To identify specific patterns of corticosteroid use and examine their relationship with asthma outcomes.
An adherence questionnaire was developed and applied in a population-based observational survey; this compared unscheduled care visits and asthma quality of life for adherent and non-adherent patient groups within 176 patients from a semi-rural...
Planned care of patients with chronic diseases in primary care depends on being able to identify them. A recorded label of asthma does not necessarily mean that the patient is currently symptomatic, and failure to record the diagnosis may influence future care.
To determine the degree of under- and over-reporting of the diagnosis of asthma for pati...
Background: A study designed to explore the experiences of patients with severe chronic obstructive pulmonary disease (COPD) and their carers, particularly with regard to ongoing and palliative care needs. Methods: The participants were nine men and one woman with severe COPD and the carers of eight of the men, in East Devon, UK. Semi-structured in...
In the UK there are concerns that, in certain groups of dying patients such as the old, those with non-cancer diagnoses and those in rural areas, the quality of care is unacceptably variable. There has been no systematic survey of the extent to which community hospitals provide general palliative care for such patients. Therefore, by means of a str...
In the UK there are concerns that, in certain groups of dying patients such as the old, those with non-cancer diagnoses and those in rural areas, the quality of care is unacceptably variable. There has been no systematic survey of the extent to which community hospitals provide general palliative care for such patients. Therefore, by means of a str...
As a principle of healthcare planning, continuity of care is losing ground. It is increasingly being superseded by other principles—notably, accessibility and plurality of provision. Baker1 has identified the pressures and Hjortdahl2 writes of continuity ‘going out of style’. National Health Service (NHS) walk-in centres provide open-access primary...
Changes in the organization of primary care in the UK are driven by a need to improve access and availability, but doctor-patient relationships may suffer. To investigate the importance of such relationships in a different setting, we analysed focus-group data obtained in a primary care facility in the USA (Rochester, NY). The findings pointed to t...
Use of point-of-care testing (POCT) in primary care has increased. There is a need for high-quality field evaluation of POCT before deployment can be considered.
A POCT system for C-reactive protein was evaluated in a routine general practice setting. The standard laboratory method was a dry slide method based in a routine hospital laboratory.
Scat...
Changes in the organization of primary care in the UK are driven by a need to improve access and availability, but doctor–patient relationships may suffer. To investigate the importance of such relationships in a different setting, we analysed focus-group data obtained in a primary care facility in the USA (Rochester, NY). The findings pointed to t...
Trial and observational research indicates a high one-year mortality with a significant potential for specialist palliative care for patients with heart failure. A community observational study was undertaken in two general practices, with a total population of 21,000. There were three objectives: to determine the prevalence of symptomatic heart fa...
The importance of psychosocial variables in asthma is increasingly recognised, although attempts to relate these to asthma outcomes often produce only weak relationships. This study aimed to identify whether such relationships might be obscured by the effects of recent asthma experience on psychological status.
An adult community sample of 37 patie...
Aims:
To compare the effectiveness of opportunistic spirometric screening of patients attending a general practice surgery with screening on randomly selected home visits.
Method:
100 patients aged 45+ attending the Honiton Surgery (surgery group) and 100 randomly selected patients visited at their homes (home group) were invited to perform spir...
The issues of referral appropriateness, communication and resources are important when considering new referral routes. The development of patient self-referral within physiotherapy poses difficulties with these issues, while nurse practitioner referral offers a viable new referral route.
There is a lack of basic information regarding the numbers of and facilities offered by community hospitals. This survey identified 471 community hospitals in the United Kingdom containing 18,579 beds with 20% of general practitioners having admitting rights. The majority of hospitals provide a comprehensive range of rehabilitation services and con...
To report the development and psychometric properties of a generic computer-delivered measure of quality of life (QoL) suitable for children aged 6-12 years: the Exqol. The theoretical model adopted is based on an assumption that poorer QoL is the result of discrepancies between an individual's actual ('like me') and ideal self ('how I would like t...
Early detection of mild or moderate COPD in patients who have minimal or no symptoms offers the best hope of modifying disease progression either through pharmacotherapy or smoking cessation. As part of a larger study of COPD in general practice, we compared the effectiveness of screening patients attending a general practice surgery with home visi...