Greg Irving

• Senior Lecturer at Edge Hill University

Introduction: Type 2 diabetes is associated with excess hospital admissions and increased mortality. Structured diabetes self-management education (DSME) is recommended internationally and is associated with improved self-management skills, well-being and minor improvements in glycated haemoglobin (HBA1c), but does it reduce hospital admissions or...

Background Glycated haemoglobin (HbA1c) targets are commonly used to guide patient management in diabetes to reduce future risk of diabetes complications, but little is known of the psychological impact of HbA1c target-setting. We explored the feasibility of undertaking a conclusive study evaluating the impact of setting explicit HbA1c targets in a...

Introduction Structured diabetes self‐management education (DSME) is internationally recommended for people with type 2 diabetes to support self‐management and to prevent associated long‐term complications. ‘Attendance’ at DSME is currently benchmarked as having completed a registration form and at least one active engagement with programme content...

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...

Background The extent to which digital technologies are employed to promote the delivery of high-quality healthcare is known as Digital Maturity. Individual and systemic digital maturity are both necessary to ensure a successful, scalable and sustainable digital transformation in healthcare. However, digital maturity in primary care has been scarce...

Background The disease burden of diabetes can have wide-ranging implications on patients’ psychological well-being and health-related quality of life. Glycated haemoglobin targets are commonly used to guide patient management in diabetes to reduce the future risk of developing diabetes complications, but little is known of the psychological impact...

Background: The extension to which digital technologies are employed to promote the delivery of high-quality healthcare is known as Digital Maturity. Individuals and systems digital maturity are both necessary to ensure a successful, scalable and sustainable digital transformation in healthcare. Digital maturity in primary care has been scarcely ev...

With the onset of COVID-19, general practitioners (GPs) and patients worldwide swiftly transitioned from face-to-face to digital remote consultations. There is a need to evaluate how this global shift has impacted patient care, healthcare providers, patient and carer experience, and health systems. We explored GPs’ perspectives on the main benefits...

Background: Evidence and guidelines increasingly support an individualised approach to care for people with type 2 diabetes and individualisation of glycaemic targets in response to patient factors. Methods: We undertook a scoping review of the literature for evidence of factors impacting upon glycated haemoglobin target individualisation in adu...

BACKGROUND With the onset of COVID-19, general practitioners (GPs) and patients worldwide swiftly transitioned from face-to-face to digital remote consultations. There is a need to evaluate how this global shift has impacted patient care, healthcare providers, patient and carer experience, and health systems. OBJECTIVE We explored GPs’ perspective...

Dyspnoea is one of the cardinal symptoms of COPD that significantly reduces health‐related quality of life, decreases engagement in physical activity and is linked to physiological and psychological triggers (O'Donnell 2020). Effective management of breathlessness is therefore a key goal of international guidelines for the care of people with COPD...

Background: With the onset of COVID-19, general practitioners (GPs) and patients worldwide swiftly transitioned from face-to-face to digital remote consultations. There is a need to evaluate how this global shift has impacted patient care, healthcare providers, patient and carer experience, and health systems. Objective: We explored GPs' perspectiv...

Many patients are unable to use their inhalers effectively (Sanchis 2016). Research suggests that around 87% of people with COPD or asthma make errors when using a pMDI, and 46% of these errors reduce drug effectiveness (Chrystyn 2017). Furthermore, more than two‐thirds of people with COPD make at least one error when using an inhaler (Cho‐Reyes 20...

BACKGROUND In recent decades, virtual care has emerged as a promising option to support primary care delivery. However, despite the potential, adoption rates remained low. With the outbreak of COVID-19, it has suddenly been pushed to the forefront of care delivery. As we progress into the second year of the COVID-19 pandemic, there is a need and op...

Background: In recent decades, virtual care has emerged as a promising option to support primary care delivery. However, despite the potential, adoption rates remained low. With the outbreak of COVID-19, it has suddenly been pushed to the forefront of care delivery. As we progress into the second year of the COVID-19 pandemic, there is a need and...

Background Expert generalist practice (EGP) is increasingly being viewed as the defining expertise of generalist care. In Japan, several family doctors consider it important and relevant in the Japanese context. However, no study has examined Japanese family doctor educators’ perceptions of EGP. Aim To explore Japanese family doctor educators’ per...

The COVID-19 is an established threat whose clinical features and epidemiology continues to evolve. In an effort to contain the disease, the National Health Service has adopted a digital first approach in UK general practice resulting in a significant shift away from face-to-face consultations. Consequently, more consultations are being completed w...

Aims To present the longer‐term impact of multifactorial treatment of type 2 diabetes on self‐reported health status, diabetes‐specific quality of life, and diabetes treatment satisfaction at 10‐year follow up of the ADDITION‐Europe trial. Methods The ADDITION‐Europe trial enrolled 3057 individuals with screen‐detected type 2 diabetes from four ce...

Background: The multicentre, international ADDITION-Europe study investigated the effect of promoting intensive treatment of multiple risk factors among people with screen-detected type 2 diabetes over 5 years. Here we report the results of a post-hoc 10-year follow-up analysis of ADDITION-Europe to establish whether differences in treatment and c...

This review is withdrawn because it is outdated. A new review is to be published by the end of 2019.

Aim: To quantify the association between behaviour change and weight loss after diagnosis of Type 2 diabetes, and the likelihood of remission of diabetes at 5-year follow-up. Method: We conducted a prospective cohort study in 867 people with newly diagnosed diabetes aged 40-69 years from the ADDITION-Cambridge trial. Participants were identified...

Aims/hypothesis Adults with type 2 diabetes are at high risk of developing cardiovascular disease (CVD). Evidence of the impact of weight loss on incidence of CVD events among adults with diabetes is sparse and conflicting. We assessed weight change in the year following diabetes diagnosis and estimated associations with 10 year incidence of CVD ev...

Japan's health system is well known for achieving one of the world's highest life ex‐pectancy with universal health coverage. However, the country now faces challenges of a rapidly aging population and changes in patterns and burden of disease. Primary care is an important component of a well‐functioning health system. In Japan, pri‐mary care servi...

Japan's health system is well known for achieving one of the world's highest life expectancy with universal health coverage. However, the country now faces challenges of a rapidly aging population and changes in patterns and burden of disease. Primary care is an important component of a well‐functioning health system. In Japan, pri‐mary care servic...

Background The treatment of people with diabetes with metformin can reduce cardiovascular disease (CVD) and may reduce the risk of cancer. However, it is unknown whether or not metformin can reduce the risk of these outcomes in people with elevated blood glucose levels below the threshold for diabetes [i.e. non-diabetic hyperglycaemia (NDH)]. Obje...

BACKGROUND: The treatment of people with diabetes with metformin can reduce cardiovascular disease (CVD) and may reduce the risk of cancer. However, it is unknown whether or not metformin can reduce the risk of these outcomes in people with elevated blood glucose levels below the threshold for diabetes [i.e. non-diabetic hyperglycaemia (NDH)]. OBJE...

Background We aimed to describe the ecology of medical care on an isolated island with limited access to secondary care, and to evaluate the gatekeeping function of the island’s primary care clinic through comparison with a previous nationwide survey. Methods We conducted this retrospective, open cohort study on Iheya, an isolated island in Okinawa...

Background: It has been suggested that interactions between patients and practitioners in primary care have the potential to delay progression of complications in type 2 diabetes. However, as primary care faces greater pressures, patient experiences of patient-practitioner interactions might be changing. Aim: To explore the views of patients wit...

OBJECTIVE: To describe the average primary care physician consultation length in economically developed and low-income/middle-income countries, and to examine the relationship between consultation length and organisational-level economic, and health outcomes. DESIGN AND OUTCOME MEASURES: This is a systematic review of published and grey literature...

Objective To describe the average primary care physician consultation length in economically developed and low-income/middle-income countries, and to examine the relationship between consultation length and organisational-level economic, and health outcomes. Design and outcome measures This is a systematic review of published and grey literature i...

Aims/hypothesis: Metformin is the most-prescribed oral medication to lower blood glucose worldwide. Yet previous systematic reviews have raised doubts about its effectiveness in reducing risk of cardiovascular disease, the most costly complication of type 2 diabetes. We aimed to systematically identify and pool randomised trials reporting cardiova...

The ADDITION trial is supported by the Medical Research Council (grant reference no: G0001164 and Epidemiology Unit programme grant: MC_UU_12015/4), the Wellcome Trust (grant reference no: G061895 ), Diabetes UK and National Health Service R&D support funding. The Primary Care Unit is a member of the National Institute for Health Research (NIHR) Sc...

No country has yet established a national screening programme (NSP) for atrial fibrillation (AF), including the UK. However, there is an increasing body of evidence suggesting screening may be beneficial, prompting recommendations from prominent expert bodies to screen for AF.1 Despite these data, the UK National Screening Committee (NSC) has not r...

Background We aimed to describe the ecology of medical care on an isolated island with limited access to secondary care, and to evaluate the gatekeeping function of the island’s primary care clinic through comparison with a previous nationwide survey. Methods We conducted this retrospective, open cohort study on Iheya, an isolated island in Okinaw...

Objective To determine the diagnostic accuracy of different methods of blood pressure (BP) measurement compared with reference standards for the diagnosis of hypertension in patients with obesity with a large arm circumference. Design Systematic review with meta-analysis with hierarchical summary receiver operating characteristic models. Bland-Alt...

Background: Observational studies have shown differences in process and outcome between the consultations of primary care physicians whose average consultation lengths differ. These differences may be due to self selection. This is the first update of the original review. Objectives: To assess the effects of interventions to alter the length of...

At least two systematic reviews of national and international clinical practice guidelines have used the AGREE tools (I and II).1 2 3 Both found that no guideline was perfect and highlighted the same key problems—a lack of applicability and stakeholder involvement. These domains relate to …

Over the last year, I have been fortunate enough to work at the World Health Organization (WHO) headquarters in Geneva. My work there involved developing strategies to help low- and middle-income countries address health inequalities, defined as the systematic and potentially remediable differences in one or more aspects of health across population...

Academic GPs have made significant contributions to the care of many millions of patients through research in primary care populations. They have also been instrumental in the development of community-based undergraduate medical education. Here, we explore what academic GP training involves and why all associates in training should have an interest...