Geva Greenfield

Imperial College London | Imperial · Department of Primary Care and Public Health

Objectives To explore the characteristics of the General Practice Patient Survey (GPPS) respondents using the different functionalities of the online services in the context of England’s National Health Service General Practices. We hypothesised that respondents who are older, with lower socioeconomic status and non-white ethnicity would be less li...

Introduction With the growing use of remote appointments within the National Health Service, there is a need to understand potential barriers of access to care for some patients. In this observational study we examined missed appointments rates, comparing remote and face-to-face appointments among different patient groups. Methods We analysed adul...

Background: The adoption of virtual consultations, catalyzed by the COVID-19 pandemic, has transformed the delivery of primary care services. Owing to their rapid global proliferation, there is a need to comprehensively evaluate the impact of virtual consultations on all aspects of care quality. Objective: This study aims to evaluate the impact...

Objectives: To summarise the impact of community-based interventions for multimorbid patients on unplanned healthcare use. The prevalence of multimorbidity (co-existence of multiple chronic conditions) is rapidly increasing and affects one-third of the global population. Patients with multimorbidity have complex healthcare needs and greater unplan...

BACKGROUND Expanding access to self-management via Digital Health Technologies may supplement traditional care, mitigating pressures on primary care through self-management. Primary Care Physicians can play a critical role in the integration of digital health technologies into patient care, but it is unclear what factors influence Primary Care Phys...

Multidisciplinary team (MDT) working is essential to optimise and integrate services for people who are frail. MDTs require collaboration. Many health and social care professionals have not received formal training in collaborative working. This study investigated MDT training designed to help participants deliver integrated care for frail individu...

BACKGROUND The adoption of virtual consultations, catalyzed by the COVID-19 pandemic, has transformed the delivery of primary care services. Owing to their rapid global proliferation, there is a need to comprehensively evaluate the impact of virtual consultations on all aspects of care quality. OBJECTIVE This study aims to evaluate the impact of v...

Background: The adoption of remote consultations, catalysed by the COVID-19 pandemic, has transformed the delivery of primary care services. We evaluated the impact of remote consultations on the quality of primary care. Methods: Six databases were searched. Studies evaluating the impact of remote consultations, for any disease, were included. Titl...

ABSTRACT Introduction: Multidisciplinary team (MDT) meetings could facilitate coordination of care for individuals living with multimorbidity, yet there is limited evidence on their effectiveness. We hence explored the common characteristics of MDT meetings in primary care and assessed the effectiveness of interventions that include such meetings,...

Background We examine differences in posthospitalisation outcomes, and health system resource use, for patients hospitalised with COVID-19 during the UK’s first pandemic wave in 2020, and influenza during 2018 and 2019. Methods This retrospective cohort study used routinely collected primary and secondary care data. Outcomes, measured for 90 days...

National Health Service (NHS) 111 helpline was set up to improve access to urgent care in England, efficiency and cost-effectiveness of first-contact health services. Following trusted, authoritative advice is crucial for improved clinical outcomes. We examine patient and call-related characteristics associated with compliance with advice given in...

Background Growing numbers of people with multimorbidity have a co-occurring mental health condition such as depression. Co-occurring depression is associated with poor patient outcomes and increased healthcare costs including unplanned use of secondary healthcare which may be avoidable. Aim To summarise the current evidence on the association bet...

Objective To summarise the literature on frequent attendances to hospital emergency departments (EDs) and describe sociodemographic and clinical characteristics of children who attend EDs frequently. Setting Hospital EDs. Participants Children <21 years, attending hospital EDs frequently. Primary outcome measures Outcomes measures were defined s...

Objectives To review the characteristics and motivations of patients seeking second opinions, and the impact of such opinions on patient management, satisfaction and cost effectiveness. Data sources Embase, Medline, PsycINFO and Health Management Information Consortium (HMIC) databases. Study design A systematic literature search was performed fo...

Objectives Mental health disorders contribute significantly to the global burden of disease and lead to extensive strain on health systems. The integration of mental health workers into primary care has been proposed as one possible solution, but evidence of clinical and cost effectiveness of this approach is unclear. We reviewed the clinical and c...

Background Frequent attendances of the same users in emergency departments (ED) can intensify workload pressures and are common among children, yet little is known about the characteristics of paediatric frequent users in EDs. Aim To describe the volume of frequent paediatric attendance in England and the demographics of frequent paediatric ED use...

Background There has been growing international interest in performing remote consultations in primary care, particularly amidst the current COVID-19 pandemic. Despite this, the evidence surrounding the safety of remote consultations is inconclusive. The appropriateness of antibiotic prescribing in remote consultations is an important aspect of pat...

Background Frequent paediatric attendances make up a large proportion of a GP's workload. Currently, there is no systematic review on frequent paediatric attendances in primary care. Aim To identify the sociodemographic and clinical characteristics of children who attend primary care frequently. Design & setting A systematic review. Method The e...

BACKGROUND There is growing interest internationally in using remote consultations in primary care, particularly amidst the current COVID-19 pandemic. Despite this, the evidence surrounding safety of remote consultations is inconclusive. Appropriateness of antibiotic prescribing in remote consultations is an important aspect of patient safety that...

Objective To describe changing use of primary care in relation to use of urgent care and planned hospital services by children aged less than 15 years in England in the decade following major primary care reforms from 2007 to 2017 Design Population-based retrospective cohort study. Methods We used linked data from the Clinical Practice Research D...

Background A small proportion of patients referred to as ‘frequent attenders’ account for a large proportion of hospital activity such as ED attendances and admissions. There is a lack of recent, national estimates of the volume of frequent ED attenders. We aimed to estimate the volume and age distribution of frequent ED attenders in English hospit...

Background: Evidence suggests that pharmacists integrated into primary care can improve patient outcomes and satisfaction, but their impact on healthcare systems is unclear. Aim: To identify the key impacts of pharmacists' integration into primary care on health system indicators, such as healthcare utilisation and costs. Design and setting: A...

Objectives To evaluate the utilisation (overall and by specialty) and the characteristics of second-opinion seekers by insurance type (either health fund or supplementary insurance) in a mixed private-public healthcare. Design An observational study. Setting Secondary care visits provided by a large public health fund and a large supplementary he...

Background In most countries, patients can get a second opinion (SO) through public or private healthcare systems. There is lack of data on SO utilization in private vs. public settings. We aim to evaluate the characteristics of people seeking SOs in private vs. public settings, to evaluate their reasons for seeking a SO from a private physician an...

This article provides an analysis of the skills that health professionals and patients employ in reaching diagnosis and decision-making in telemedicine consultations. As governmental priorities continue to emphasize patient involvement in the management of their disease, there is an increasing need to accurately capture the provider–patient interac...

Background: There is a growing body of evidence that supports the uses of telehealth to monitor and manage people with diabetes at a distance. Despite this, the uptake of telehealth has been low. The objective of this study is to explore patients' perceptions of using telehealth for type 2 diabetes management. Methods: Semi-structured interviews...

Background: There is a growing body of evidence to support the use of telehealth in monitoring HbA1c levels in people living with type 2 diabetes. However, the overall magnitude of effect is yet unclear due to variable results reported in existing systematic reviews. The objective of this study is to conduct a systematic review and meta-analysis o...

Background Seeking a second-opinion (SO) is a common clinical practice that can optimize treatment and reduce unnecessary procedures and risks. We aim to characterize the composition of the population of SO seekers, their reasons for seeking a SO and choosing a specific physician, and their perceived outcomes following the SO. Methods A cross-sect...

Background Professional truck drivers, as other shift workers, have been identified as a high-risk group for various health conditions including cardiovascular disease, obesity, diabetes, sleep apnoea and stress. Mobile health technologies can potentially improve the health and wellbeing of people with a sedentary lifestyle such as truck drivers. Y...

Objective Urgent care centres (UCCs) co-located within an emergency department were developed to reduce the numbers of inappropriate emergency department admissions. Since then various UCC models have developed, including a novel general practitioner (GP)-led UCC that incorporates both GPs and emergency nurse practitioners (ENPs). Traditionally the...

Objectives General practitioner (GP)-led urgent care centres were established to meet the growing demand for urgent care. Staff members working in such centres are central in influencing patients’ choices about which services they use, but little is known about staff perceptions of patients’ motives for attending urgent care. We hence aimed to expl...

Background Some patients attend emergency departments more frequently than others and account for a disproportionate number of attendances. However, little is known about repeat attenders at National Health Service urgent care centres. We aimed to describe the volume and characteristics of repeat attenders at such centres. Methods In an observatio...

Introduction: Multidisciplinary group meetings are one of the key drivers of facilitating integrated care. Health care professionals attending such groups have a key role in the success of these discussions and hence, in the forming of multi-professional integrated care. The study aimed to explore the professionals’ experiences and views of partici...

Background Person-centered care emphasizes a holistic, humanistic approach that puts patients first, at the center of medical care. Person-centeredness is also considered a core element of integrated care. Yet typologies of integrated care mainly describe how patients fit within integrated services, rather than how services fit into the patient¿s w...

The NHS’s Quality and Outcomes Framework no longer offers points for patient experience. But these are a good incentive to encourage general practitioners to offer person centred care, says Geva Greenfield Person centred medicine is seen as crucial to high quality healthcare in the NHS and abroad.1 The UK government envisions that patients should...

Background: Person-centred care emphasises the benefits of a holistic, humanistic approach that puts patients first and at the centre of clinical care. Person-centeredness is also considered a core element of integrated care. Yet typologies of integrated care mainly describe how patients fit within services, rather than how services fit into the pa...

The literature on integrated care is limited with respect to practical learning and experience. Although some attention has been paid to organizational processes and structures, not enough is paid to people, relationships, and the importance of these in bringing about integration. Little is known, for example, about provider engagement in the organ...

Asthma is one of the most common long-term conditions worldwide, which places considerable pressure on patients, communities and health systems. The major international clinical guidelines now recommend the inclusion of self management programmes in the routine management of patients with asthma. These programmes have been associated with improved...

In the context of integrated care, Multidisciplinary Group meetings involve participants from diverse professional groups and organisations and are potential vehicles to advance efficiency improvements within the local health economy. We advance a novel method to characterise the communication within Multidisciplinary Group meetings measuring the e...

This paper provides the results of a year-long evaluation of a large-scale integrated care pilot in north-west London. The pilot aimed to integrate care across primary, acute, community, mental health and social care for people with diabetes and/or those aged 75+ through care planning, multidisciplinary case reviews, information sharing and project...

Multidisciplinary Group meetings (MDGs) are seen as key facilitators of integration, moving from individual to multi-disciplinary decision-making, and from a focus on individual patients to a focus on patient groups. We have developed a method for coding MDG transcripts to identify whether they are or are not vehicles for delivering the anticipated...

In the context of integrated care, multidisciplinary group (MDG) meetings involve participants who are not only from different professional groups but also from different organisational backgrounds within a complex local health economy. Such meetings therefore provide opportunities for participants to discuss complex care of individual patients, as...

Second opinion is a treatment ratification tool that may critically influence diagnosis, treatment, and prognosis. Second opinions constitute one of the largest expenditures of the supplementary health insurance programs provided by the Israeli health funds. The scarcity of data on physicians' attitudes toward second opinion motivated this study to...

Theories on the patient-physician relationship have evolved within the last decades to portray a nuanced picture of the traditional patient-physician "dyad". Shifts in social, economic, and technological contexts in which the physician-patient encounters are taking place raised the need for more complex frameworks to study patient-physician encount...

Second medical opinions have become commonplace and even mandatory in some health-care systems, as variations in diagnosis, treatment or prognosis may emerge among physicians. To evaluate whether physicians' judgment is affected by another medical opinion given to a patient. Orthopedic surgeons and neurologists filled out questionnaires presenting...

There is a wide treatment gap between evidence-based guidelines and their implementation in primary care. To evaluate the extent to which physicians "literally" follow guidelines for secondary prevention of dyslipidemia and the extent to which they practice "substitute" therapeutic measures. We performed a post hoc analysis of data collected in a p...

Patients are most at risk during transitions in care across settings and providers. The communication and reconciliation of an accurate medication list throughout the care continuum are essential in the reduction in transition-related adverse drug events. Most current research focuses on the outcomes of reconciliation interventions, yet not on the...

A wide therapeutic gap exists between evidence-based guidelines and their practice in the primary care, which is primarily attributed to physician and patient adherence. This study aims to differentiate physician and patient adherence to dyslipidemia secondary prevention guidelines and various factors affecting it. A post hoc analysis of data colle...

Medication omissions and dosing failures are frequent during transitions in patient care. Medication reconciliation (MR) requires bridging discrepancies in a patient’s medical history as a setting for care changes. MR has been identified as vulnerable to failure, and a clinician’s cognition during MR remains poorly described in the literature. We s...

Second opinion is a decision-support tool for ratification or modification of a suggested treatment, by another physician. Second opinion may have a critical influence on the diagnosis, treatment and prognosis. The patient can benefit from treatment optimization and avoid unnecessary risks. The physician can benefit from less exposure to legal clai...

Clinical reminders can promote adherence with evidence-based clinical guidelines, but they may also have unintended consequences such as alert fatigue, false alarms and increased workload, which cause clinicians to ignore them. The described clinical reminder system identifies patients eligible for primary prevention of cardiovascular diseases and...

While clinical reminders can promote adherence with evidence-based clinical guidelines, they may have unintended consequences such as alert fatigue, false alarms and increased workload, which cause clinicians to ignore them. We evaluated clinicians' response rates to suggestions to enroll patients in a nationwide clinical reminders intervention, ai...

Decision-support systems, and specifically rule-based clinical reminders, are becoming common in medical practice. Despite their potential to improve clinical outcomes, physicians do not always use information from these systems. Concepts from the cognitive engineering literature on users' responses to warning systems may help to define physicians'...

IntroductionIn-vehicle information systems can improve safety, improve driver’s situational awareness and reduce anxiety, but they may also increase mental workload and distraction. This issue is particularly important in road tunnels because they create extremely dangerous driving conditions.GoalsTo evaluate the effect of in-vehicle displays on dr...

A variety of computer-based applications, including computerized clinical reminders, are intended to increase adherence to evidence-based clinical guidelines. The value of these systems in clinical practice is still unclear. One reason for the limited success of clinical reminders may be physicians' low tendency to adhere to their advice. We studie...

When driving in a tunnel the driver is confined to a dark closed environment for a long period of time, with very little clearance on both sides of the lane. This environment may impair performance and lead to severe accidents. Accidents in tunnels often involve rapidly spreading fires that engulf many drivers. Giving drivers early warnings and cle...