Hajira Dambha-Miller

University of Southampton · Primary Care Research Centre

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...

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...

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...

Objective To examine the effect on cardiovascular (CVD) risk factors of interventions to alter consultations between practitioners and patients with type 2 diabetes. Search Strategy Electronic and manual citation searching to identify relevant randomised controlled trials (RCTs). Inclusion Criteria RCTs that compared usual care to interventions to...

Purpose: To examine the association between primary care practitioner (physician and nurse) empathy and incidence of cardiovascular disease (CVD) events and all-cause mortality among patients with type 2 diabetes. Methods: This was a population-based prospective cohort study of 49 general practices in East Anglia (United Kingdom). The study popu...

Aim: In the United Kingdom people with diabetes who do not attend annual review appointments often have higher Haemoglobin A1c (HbA1c) levels.1-3 We aim to determine the acceptability of self-collected posted capillary blood samples, and if they produce accurate and reliable HbA1c results. Methods: We include adult studies comparing capillary bl...

Diversity is on the rise globally. To mention just a few of diversity’s dimensions in the UK, 10 million (14.5%) of the country’s citizens were born outside the UK, 9 million (14%) of the population is non-white, and there are 6 religions with at least 250,000 adherents.1 A similar picture presents itself in many other parts of the world. In the US...

Abstract Objective To estimate the risk of Long COVID by socioeconomic deprivation and to further examine the socioeconomic inequalities in Long COVID by sex and occupational groups. Design We analysed data from the COVID-19 Infection Survey conducted by the Office for National Statistics between 26/04/2020 and 31/01/2022. This is the largest and...

Background Weight loss, hyperglycaemia and diabetes are known features of pancreatic cancer. We quantified the timing and the amount of changes in body mass index (BMI) and glycated haemoglobin (HbA1c), and their association with pancreatic cancer from five years before diagnosis. Methods A matched case-control study was undertaken within 590 prim...

p>Background: Multiple Long Term conditions (MLTC) are a major health care challenge associated with high service utilisation and expenditure. Once established, the trajectory to an increased number and severity of conditions, hospital admission, increased social care need and mortality is multifactorial. The role of wider environmental determinant...

Background Concerns have been raised that angiotensin-converting enzyme-inhibitors (ACE-I) and angiotensin receptor blockers (ARBs) might facilitate transmission of severe acute respiratory syndrome coronavirus 2 leading to more severe coronavirus disease (COVID-19) disease and an increased risk of mortality. We aimed to investigate the association...

Background A more comprehensive understanding and measurement of adult social care need could contribute to efforts to develop more effective, holistic personalised care, particularly for those with Multiple Long Term Conditions. Progress in this area faces the challenge of a lack of clarity in the literature relating to how social care need is ass...

Background: Worldwide there are an estimated 463 million people with diabetes. In the UK people with diabetes are offered annual review which includes monitoring of Haemoglobin A1c (HbA1c). This can identify people with diabetes who are not meeting their glycaemic targets, enabling early intervention. Those who do not attend these reviews often ha...

Background: Limited recent observational data have suggested that there may be a protective effect of oestrogen on the severity of COVID-19 disease. Our aim was to investigate the association between hormone replacement therapy (HRT) or combined oral contraceptive pill (COCP) use and the likelihood of death in women with COVID-19. Methods: We un...

Background Treatment burden is the effort required of patients to look after their health and the impact this has on their functioning and wellbeing. Little is known about change in treatment burden over time for people with multimorbidity. Aim To quantify change in treatment burden, determine factors associated with this change, and evaluate a re...

Background Practitioner expressions of optimism and empathy may improve treatment engagement, adherence and patient satisfaction but are not delivered consistently amidst the challenges of everyday clinical practice. Aims To explore primary care practitioner (PCP) views about optimistic and empathic communication in consultations; and to identify...

Objectives: To describe primary care utilisation patterns among adults with type 2 diabetes and to quantify the association between utilisation and long-term health outcomes. Design: Retrospective cohort study. Setting: 168 primary care practices in Southern England within the Electronic Care and Health Information Analytics database between 2...

Objective To explore primary care practitioners’ (PCPs) and patients’ priorities and concerns for healthcare interactions for osteoarthritis (OA) in primary care. Methods We searched Embase, CINAHL, Medline, PsychInfo (1990 to present) for primary qualitative and mixed methods studies with findings concerning healthcare interactions for OA symptom...

Introduction Worldwide there are an estimated 463 million people with diabetes. [1] In the UK people with diabetes are offered an annual review including monitoring of Haemoglobin A1c (HbA1c). [2] [3] This can identify people with diabetes who are not meeting their glycaemic targets, enabling early intervention. Those who do not attend these review...

Background As the prevalence of older adults with multimorbidity increases, greater integration of services is necessary to manage the physical and psycho-social needs of this cohort. This study describes and summarises current evidence, clinical provision and progress towards integrated primary care and social services for older adults with multim...

Background Treatment burden is the effort required of patients to look after their health and the impact this has on their functioning and wellbeing. It is likely treatment burden changes over time as circumstances change for patients and health services. However, there are a lack of population-level studies of treatment burden change and factors a...

BACKGROUND Multiple long-term health conditions (Multimorbidity) (MLTC-M) are increasingly prevalent and associated with high rates of morbidity, mortality and health-care expenditure. Strategies to tackle this have primarily focused on addressing biological aspects of disease, but MLTC-M are also the result of and associated with additional psycho...

Background: Multiple long-term health conditions (multimorbidity) (MLTC-M) are increasingly prevalent and associated with high rates of morbidity, mortality, and health care expenditure. Strategies to address this have primarily focused on the biological aspects of disease, but MLTC-M also result from and are associated with additional psychosocia...

Background: Primary care consultations for respiratory tract symptoms including identifying and managing COVID-19 during the pandemic have not been characterized. Methods: A retrospective cohort analysis using routinely collected records from 70,431 adults aged 18+ in South England within the Electronic Care and Health Information Analytics (CHI...

BACKGROUND: Growing demand from an increasingly ageing population with multimorbidity has resulted in complex health and social care needs requiring more integrated services. Integrating primary care with social services could utilise resources more efficiently, and improve experiences for patients, their families, and carers. There is limited evid...

Aims There is increasing interest in using stratification in type 2 diabetes to target resources, individualize care, and improve outcomes. We aim to systematically review and collate literature that has utilised population stratification methods in the study of adults with type 2 diabetes; and to describe and compare stratification methodologies,...

Background: Empathic communication and positive messages are important components of “placebo” effects and can improve patient outcomes, including pain. Communicating empathy and optimism to patients within consultations may also enhance the effects of verum, i.e., non-placebo, treatments. This is particularly relevant for osteoarthritis, which is...

Acknowledgment: The authors thank the EMIS (Egton Medical Information Systems) practices that contribute to the database as well as the University of Nottingham and University of Oxford for expertise in establishing, developing, and supporting the QResearch database. QResearch acknowledges funding from the Nottingham Biomedical Research Centre fund...

Background The current GP workforce is insufficient to manage rising demand in patient care within the out-of-hours (OOH) primary care services. To meet this challenge, non-medical practitioners (NMPs) are employed to fulfil tasks traditionally carried out by GPs. It is important to learn from experiences of task-shifting in this setting to inform...

Importance Although children mainly experience mild COVID-19 disease, hospitalization rates are increasing, with limited understanding of underlying factors. There is an established association between race and severe COVID-19 outcomes in adults in England; however, whether a similar association exists in children is unclear. Objective To investig...

p>Over the next 20 years, the proportion of over-65s in the UK will rise by a quarter, ¹ around two-thirds of whom will live with multimorbidity (multiple long-term conditions). ² This change in demographic is likely to lead to a significant growth in care needs, ³ further increasing demand on primary care and socia...

The impact of COVID-19 has underlined the need for reliable information to guide clinical practice and policy. This urgency has to be balanced against disruption to journal handling capacity and the continued need to ensure scientific rigour. We examined the reporting quality of highly disseminated COVID-19 research papers using a bibliometric anal...

Pancreatic cancer is the 10th most common cancer diagnosed; despite recent advances in many areas of oncology, survival remains poor, in part owing to late diagnosis. Whilst primary care data are used widely for epidemiology and pharmacovigilance, they are less used for observing survival. In this study we extracted a pancreatic cancer cohort from...

Background: Growing demand from an ageing population, chronic preventable disease and multimorbidity has resulted in complex health and social care needs requiring more integrated services. Integrating primary care with social services could more efficiently utilise resources, and improve experiences for patients, their families and carers. There...

Aim To quantify the association between type 2 diabetes remission and 5-year incidence of cardiovascular disease outcomes, overall and in pre-defined subgroups. Methods Retrospective cohort analysis of 60,287 adults with type 2 diabetes from the Care and Health Information Analytics (CHIA) database. Multivariable Cox models were used to assess the...

Purpose: to quantify the association between weight change and the likelihood of remission of type 2 diabetes in a population-based cohort without intensive interventions. Methods: a retrospective analysis of adults with type 2 diabetes registered across 150 primary care practices in Southern England, United Kingdom, within the Electronic Care and...

Introduction Recent evidence suggests that ethnic minority groups are disproportionately at increased risk of hospitalisation and death from SARS-CoV-2 infection. Population-based evidence on potential explanatory factors across minority groups and within subgroups is lacking. This study aims to quantify the association between ethnicity and the ri...

Background Osteoarthritis (OA) causes pain and disability. An empathic optimistic consultation approach can improve patient quality of life, satisfaction with care, and reduce pain. However, expressing empathic optimism may be overlooked in busy primary care consultations and there is limited understanding of patients’ views about this approach. A...

Introduction Recent evidence suggests that influenza vaccination may offer protection against COVID-19 severity. Our aim was to quantify the association between influenza vaccination status and risk of hospitalisation or all-cause mortality in people diagnosed with COVID-19. Methods A retrospective cohort study using routinely collected health rec...

The use of big data containing millions of primary care medical records provides an opportunity for rapid research to help inform patient care and policy decisions during the first and subsequent waves of the coronavirus disease 2019 (COVID-19) pandemic. Routinely collected primary care data have previously been used for national pandemic surveilla...

Background The successful management of hypertension requires sustained engagement in self-care behaviour such as adhering to medication regimens and diet. Bandura’s Social Cognitive Theory suggests that self-efficacy is a major determinant of engagement in self-care behaviour. Self-efficacy refers to an individual’s belief in their capacity to exe...

Objective: To investigate the association between Hormone Replacement Therapy (HRT) or Combined Oral Contraception (COCP) use, and the likelihood of death in women with COVID-19. Design: A cohort study Setting: 465 general practices in England within the Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) pri...

Background: Growing demand from an ageing population, chronic preventable disease and multimorbidity has resulted in complex health and social care needs requiring more integrated services. Integrating primary care with social services could more efficiently utilise resources, and improve experiences for patients, their families and carers. There i...

Background: Given the effect of chronic diseases on risk of severe COVID-19 infection, the present pandemic may have a particularly profound impact on socially disadvantaged counties. Methods: Counties in the USA were categorised into five groups by level of social vulnerability, using the Social Vulnerability Index (a widely-used measure of socia...

Background: As the prevalence of older adults with multimorbidity increases, greater integration of services is necessary to manage the range of physical and social needs of the population. The aim of this study is to describe and summarise current evidence, clinical provision and progress towards integrated primary care and social services for old...

Background: given the effect of chronic diseases on risk of severe COVID-19 infection, the present pandemic may have a particularly profound impact on socially disadvantaged counties. Methods: counties in the USA were categorised into five groups by level of social vulnerability, using the Social Vulnerability Index (a widely used measure of socia...

Several studies have reported a higher rate of COVID-19 mortality in men.[1–3] A higher rate of COVID-19 mortality has also been reported in Black, Asian and minority ethnic (BAME) groups,[3–5] especially among healthcare providers.[6]

Background: Remission of Type 2 diabetes is achievable through dietary change and weight loss. In the UK, lifestyle advice and referrals to weight loss programmes predominantly occur in primary care where most Type 2 diabetes is managed. Objective: To quantify the association between primary care experience and remission of Type 2 diabetes over...

Background Tobacco smoking is a major cause of chronic disease and premature mortality. Its effects are socially patterned. Observational studies show that low socioeconomic status [SES] is associated with higher smoking prevalence and lower cessation rates. Interventions in primary care may improve or exacerbate health inequalities depending on so...

Objective: To review evidence on routinely prescribed drugs in the UK that could up or downregulate Angiotensin Converting Enzyme 2 (ACE2) and potentially affect COVID-19 disease Design: Systematic review Data source: MEDLINE, EMBASE, CINAHL, the Cochrane Library and Web of Science Study selection: Any design with animal or human models examini...

Several studies have reported a higher rate of COVID-19 mortality in men compared with women. A higher rate of COVID-19 mortality has also been reported in Black, Asian and minority ethnic (BAME) groups, compared with White ethnicity, especially among healthcare providers. While some studies attempted to examine if existing disparities could be exp...

Background The SARS-CoV-2 virus causing COVID-19 binds human angiotensin-converting enzyme 2 (ACE2) receptors in human tissues. ACE2 expression may be associated with COVID-19 infection and mortality rates. Routinely prescribed drugs that up- or down-regulate ACE2 expression are, therefore, of critical research interest as agents that might promote...

A recent systematic review of randomized trials suggested that empathic communication improves patient health outcomes. However, the methods for training healthcare practitioners (medical professionals; HCPs) in empathy and the empathic behaviours demonstrated within the trials were heterogeneous, making the evidence difficult to implement in routi...

Background Empathy is a key health care concept and refers to care that incorporates understanding of patient perspective’s, shared decision making, and consideration of the broader context in which illness is experience. Evidence suggests experiences of doctor empathy correlate with improved health outcomes and patient satisfaction. It has also be...

Objective: To review evidence on routinely prescribed drugs in the UK that could up or downregulate Angiotensin Converting Enzyme 2 (ACE2) and potentially affect COVID-19 disease Design: Systematic review Data source: MEDLINE, EMBASE, CINAHL, the Cochrane Library and Web of Science Study selection: Any design with animal or human models examining a...

Background: The SARS-CoV-2 virus causing COVID-19 binds human angiotensin-converting enzyme 2 (ACE2) receptors in human tissues. ACE2 expression may be associated with COVID-19 infection and mortality rates. Routinely prescribed drugs which up- or down-regulate ACE2 expression are therefore of critical research interest as agents which might promot...

To conduct a systematic review and develop a conceptual framework on the mechanisms linking loneliness, social isolation, health outcomes and mortality. Electronic databases were systematically searched (PubMed, MEDLINE, Scopus and EMBASE) from inception to October 2018 followed by manual searching to identify research on loneliness, social isolati...

Clinical scoring systems are algorithms designed to predict outcomes, aid decision making, support treatment options, manage clinical risk or improve efficiency. The term clinical scoring system is known interchangeably as clinical decision rule, prediction algorithm, clinical prediction tool, risk score or scoring tool.[1] Medicine is not short of...

Background Tobacco smoking is a major cause of chronic disease and premature mortality. Its effects are socially patterned. Observational studies show that low socioeconomic status [SES] is associated with higher smoking prevalence and lower cessation rates. Interventions in primary care may improve or exacerbate health inequalities depending on so...

Background: Patients desire both honesty and hope from their healthcare practitioners. A recent systematic review of 22 randomised trials found that healthcare practitioners who deliver positive messages improve patient outcomes, most notably by reducing pain. However, the verbal and non-verbal components of positive messages within these trials va...

Background: there is little evidence on the impact of national pressures on primary care provision for type 2 diabetes from the perspectives of patients and their GPs and nurses. Aim: to explore experiences of primary care provision for people with type 2 diabetes and their respective GPs and nurses. Design and setting: a qualitative interview s...

The use of big data containing millions of primary care medical records provides an opportunity for rapid research to help inform patient care and policy decisions during the first and subsequent waves of the COVID-19 pandemic. Routinely collected UK primary care data have previously been used for national pandemic surveillance, quantifying associa...

In this paper, as part of our empathy series, we will introduce the notion of empathy and attempt to define “therapeutic empathy”. While the concept of “empathy” is an umbrella term that involves many different (and sometimes opposing) components, clinical or therapeutic empathy implies more specific characteristics. From a methodological point of...

Type 2 diabetes is a common condition that is associated with high rates of morbidity, mortality and healthcare costs. Multifactorial management has been shown to be effective in preventing complications and inducing remission or cure of the disease. Despite this, the rate of new cases and the overall burden of the disease remains high. There is a...

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...

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...

The opportunity for authors to appeal against rejected manuscripts provides an important step in ensuring that high-quality and credible science is not incorrectly rejected from publication in the highest impact factor journals. However, little is known about editorial processes related to appeals and their outcomes. Our research investigated the n...

Knut Schroeder Wiley-Blackwell, 2016, PB, 832pp, £49.99, 978-1119106340 Ten-minute consultations are often rushed affairs with most of us running late. So how do we keep to time while being clinically effective, safe, and patient centred? The 10-Minute Clinical Assessment by Knut Schroeder has the answers. The book provides a helpful guide for GP...

Objective To examine the effect on cardiovascular (CVD) risk factors of interventions to alter consultations between practitioners and patients with type 2 diabetes. Search Strategy Electronic and manual citation searching to identify relevant randomized controlled trials (RCTs). Inclusion Criteria RCTs that compared usual care to interventions t...

Objective: To examine the association between the experience of patient-centred care (PCC), health behaviours and cardiovascular disease (CVD) risk factor levels among people with type 2 diabetes. Design: Population-based prospective cohort study Setting: 34 general practices in East Anglia UK, delivering organised diabetes care. Participants:...

The evidence base supporting the potential benefits of patient-centred care is growing and GPs should be encouraged to integrate this into their practice. Attempting to understand the patients in front of you, their ideas, concerns and expectations, and how their current illness is affecting their day-to-day life, may allow a more effective diagnos...

Patient-centred care is a core value in general practice and is increasingly recognised as a hallmark of good quality healthcare. It describes healthcare that considers the needs, expectations and preferences of the individual patient, and places the patient at the centre of the GP consultation. It encourages GPs to take into account a patient’s su...

Quality improvement describes the process of improving patients’ safety, experiences and health outcomes by systematically addressing individual and organisational processes. This is aimed at creating a ‘self-improving NHS’, in which individual clinicians are empowered to make changes toward a more efficient, safe and cost-effective healthcare syst...

The current GP recruitment crisis has prompted speculation about why students are avoiding primary care,1 2 but there has been little mention of the students’ perspective. Some have pointed to bias in recruitment websites, a lack of exposure, and disproportional representation from the Medical Schools Council,2 but from our perspective the attracti...

The contribution of GP trainees to individual practices and to national data on patient experience is often not emphasised, or perhaps undervalued. I would be interested in clarifying what proportion of consultations within these training practices in the …

In this interesting editorial, Helen Atherton discusses the use of emails for consulting with patients.1 The consultation is at the core of general practice. With the patient in front of us in the consulting room, we are able to interact and engage with them, develop a rapport, and nurture the doctor–patient relationship. We have the opportunity to...