Peter Bower

Peter Bower
The University of Manchester · Centre for Primary Care

PhD, BSc

About

607
Publications
141,442
Reads
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27,850
Citations
Additional affiliations
September 1995 - present
The University of Manchester
Position
  • Centre Lead

Publications

Publications (607)
Article
Full-text available
Background: Health services interventions are typically more effective in randomised controlled trials than in routine healthcare. One explanation for this 'voltage drop', i.e. reduction in effectiveness, is a reduction in intervention fidelity, i.e. the extent to which a programme is implemented as intended. This article discusses how to optimise...
Article
Background: People from ethnic minorities in the UK have higher rates of mental health problems and are less likely to take part in mental health research. Previous research indicates that participant information sheets (PIS) are complex, and this complexity may impair comprehension more significantly for ethnic minority participants. Improving the...
Conference Paper
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Background: NHS England have announced plans to enable all adult patients to have full prospective access to their primary care record by default by November 2022. Despite this, we know little about the views and experiences of primary care staff regarding patients accessing their records online (ORA) Aim: To examine the views and experiences of p...
Article
Full-text available
Objective To test the feasibility of undertaking a simultaneous Study Within A Trial (SWAT) to train staff who recruit participants into surgical randomised controlled trials (RCTs), by assessing key uncertainties around recruitment, randomisation, intervention delivery and data collection. Study design and setting Twelve surgical RCTs were eligib...
Article
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Introduction The PROMETHEUS programme (PROMoting THE USE of SWATs) was funded by the UK Medical Research Council (MRC) and Clinical Trials Unit (CTU) infrastructure funding from the National Institute for Health Research (NIHR). The purpose was to develop strategies to increase the recruitment and retention evidence base. This paper aims to present...
Article
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Objective The authors examined associations between stressors and burnout in trainee doctors during the COVID-19 pandemic. Methods An anonymous online questionnaire including 42 questions on general and pandemic-specific stressors, and the Maslach Burnout Inventory-Health Services Survey (MBI-HSS), was sent to 1000 randomly selected trainee doctor...
Article
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Background Population health has stagnated or is declining in many high-income countries. We analysed whether nationally administered austerity cuts in England were associated with prevalence of multimorbidity (individuals with two or more long-term conditions) and health-related quality of life. Methods We conducted an observational, longitudinal...
Article
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Background A failure of clinical trials to retain participants can influence the trial findings and significantly impact the potential of the trial to influence clinical practice. Retention of participants involves people, often the trial participants themselves, performing a behaviour (e.g. returning a questionnaire or attending a follow-up clinic...
Article
Background: Current evidence supports the use of wearable trackers in by people with cardiometabolic conditions. However, as the health benefits are small and conflicted confounded by heterogeneity, there remains uncertainty of as to which patient groups are most helped by wearable trackers are most helpful. Objective: This study examined the eff...
Article
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Objectives To estimate the 'rule of halves' for diabetes care for urban and rural areas in England using several data sources covering the period 2015-2017; and to examine the extent to which any differences in urban and rural settings are explained by population characteristics and the workforce supply of primary care providers (general practice...
Article
Introduction The PROMETHEUS programme (PROMoting THE USE of SWATs) was funded by the UK Medical Research Council (MRC) and Clinical Trials Unit (CTU) infrastructure funding from the National Institute for Health Research (NIHR). The purpose was to develop strategies to increase the recruitment and retention evidence base. This paper aims to present...
Article
Full-text available
Background The NHS Diabetes Prevention Programme for England, “Healthier You”, encourages behaviour change regarding healthy eating and physical exercise among people identified to be at high risk of developing type 2 diabetes. The aim of this research was to examine change, and factors associated with change, in measures of HbA1c and weight in par...
Article
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Background In the UK, postnatal depression is more common in British South Asian women than White Caucasion women. Cognitive–behavioural therapy (CBT) is recommended as a first-line treatment, but there is little evidence for the adaptation of CBT for postnatal depression to ensure its applicability to different ethnic groups. Aims To evaluate the...
Article
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Objectives This study aims to develop a comprehensive list of stressors relevant to junior doctors and will also report findings exploring the associations between burnout and stressors, which include work and non-work–related stressors as well as pandemic-related stressors. Methods An anonymous online questionnaire was sent to 1000 randomly selec...
Preprint
Background The rapid identification and adoption of effective innovations in healthcare is a known challenge. The strongest evidence base for innovations can be provided by evidence synthesis, but this is frequently a lengthy process and even rapid versions of this can be time-consuming and complex. In the UK, the Accelerated Access Review and Acad...
Article
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Introduction: People living with multiple long-term conditions (multimorbidity) (MLTC-M) experience an accumulating combination of different symptoms. It has been suggested that these symptoms can be tracked longitudinally using consumer technology, such as smartphones and wearable devices. Aim: The aim of this study was to investigate longitudinal...
Article
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Background The way we collect and use patient experience data is vital to optimise the quality and safety of health services. Yet, some patients and carers do not give feedback because of the limited ways data is collected, analysed and presented. In this study, we worked together with researchers, staff, patient and carer participants, and patient...
Preprint
BACKGROUND Type 2 diabetes is a common lifelong condition, affecting over 400 million people worldwide. Use of effective medications and active self-management can reduce the risk of serious complications. However, people often have concerns when starting new medications, and face difficulties in taking their medications regularly. Support provided...
Article
Background: Type 2 diabetes is a common lifelong condition that affects over 400 million people worldwide. The use of effective medications and active self-management can reduce the risk of serious complications. However, people often have concerns when starting new medications and face difficulties in taking their medications regularly. Support p...
Article
Full-text available
Background: Patient-reported outcomes measures (PROMs) assess a patient's subjective appraisal of health outcomes from their own perspective. Despite hypothesised benefits that feedback on PROMs can support decision-making in clinical practice and improve outcomes, there is uncertainty surrounding the effectiveness of PROMs feedback. Objectives:...
Article
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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...
Preprint
Full-text available
Background A failure of clinical trials to retain participants can influence the trial findings and significantly impact the potential of the trial to influence clinical practice. Retention of participants involves people, often the trial participants themselves, performing a behaviour (e.g. returning a questionnaire or attending a follow-up clinic...
Article
Full-text available
Background People with frailty may have specific needs for end-of-life care, but there is no consensus on how to identify these people in a timely way, or whether they will benefit from intervention. Aim To synthesise evidence on identification of older people with frailty approaching end-of-life, and whether associated intervention improves outco...
Article
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Objective To quantify general practitioners’ (GPs’) turnover in England between 2007 and 2019, describe trends over time, regional differences and associations with social deprivation or other practice characteristics. Design A retrospective study of annual cross-sectional data. Setting All general practices in England (8085 in 2007, 6598 in 2019...
Article
Full-text available
Importance Wearable physical activity (PA) trackers, such as accelerometers, fitness trackers, and pedometers, are accessible technologies that may encourage increased PA levels in line with current recommendations. However, whether their use is associated with improvements in PA levels in participants who experience 1 or more cardiometabolic condi...
Article
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Objective To assess whether CC is more effective at reducing suicidal ideation in people with depression compared with usual care, and whether study and patient factors moderate treatment effects. Method We searched Medline, Embase, PubMed, PsycINFO, CINAHL, CENTRAL from inception to March 2020 for Randomised Controlled Trials (RCTs) that compared...
Poster
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Importance of the problem The COVID-19 pandemic has changed how people approach their lives and healthcare. To understand meaningful person-based care, the role of patient and public involvement and engagement (PPIE) and co-production methods are essential now more than ever. Managing three or more long-term conditions remains a challenge primary...
Poster
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Background Current policy recommends primary care practitioners improve empowerment by delivering efficient person-based care. Yet, older people (65+ years) with multiple long-term conditions often have complex and unmet needs, and may feel disempowered. However, there is a lack of guidance on how to achieve this. The Empowerment Scale (ES) was pre...
Preprint
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Patients need to be informed about potential risks of taking part in clinical trials. A problem is that there are no standards telling researchers or ethics committees how these risks need to be communicated. Our background research suggests that the way harms are communicated can actually increase the risks of the harms occurring. Over half of our...
Article
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Background Ensuring that a trial is designed so that its participants reflect those who might benefit from the results, or be spared harms, is key to the potential benefits of the trial reaching all they should. This paper describes the process, facilitated by Trial Forge, that was used between July 2019 and October 2020 to develop the INCLUDE Ethn...
Article
Background The UK Government's implementation in 2008 of the Improving Access to Psychological Therapies (IAPT) initiative in England has hugely increased the availability of cognitive behavioural therapy (CBT) for the treatment of depression and anxiety in primary care. Counselling for depression—a form of person-centred experiential therapy (PCET...
Article
Background : During the COVID-19 pandemic ‘social distancing’ has highlighted the need to minimise loneliness and isolation among older adults (aged 50+). We wanted to know what remotely delivered befriending, social support and low intensity psychosocial interventions may help to alleviate social isolation and loneliness and how they work. Methods...
Article
To assess whether CC is more effective at reducing suicidal ideation in people with depression compared with usual care, and whether study and patient factors moderate treatment effects. Method: We searched Medline, Embase, PubMed, PsycINFO, CINAHL, CENTRAL from inception to March 2020 for Randomised Controlled Trials (RCTs) that compared the effe...
Article
Medical sociologists highlight diagnosis as a critical moment in understanding the illness experience and have extended analysis to the growing focus on ‘predisease states’ in relation to policy and medical practice. The biomedicalisation of diabetes risk, labelled as ‘prediabetes’, is one predisease area Public Health England have prioritised via...
Article
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Introduction We revisited the global concept of subjective quality of life (QoL) as assessed by the WHOQOL-BREF to investigate whether it could be elaborated into a conceptually more comprehensive instrument with good psychometric properties. Responding to a growing need for shorter QoL measures with broader social, spiritual and environmental cont...
Article
Common mental health problems of anxiety and depression affect significant proportions of the global population. Within the UK, and increasingly across western countries, a key policy response has been the introduction of high volume, low intensity psychological assessment and treatment services, such as the NHS's Improving Access to Psychological...
Article
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Objectives To use the Theoretical Domains Framework (TDF) to identify barriers and enablers to participant retention in trials requiring questionnaire return and/or attendance at follow-up clinics. Study design and setting We invited participants (n=607) from five pragmatic effectiveness trials, who missed at least one follow-up time point (by not...
Article
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Objectives Frailty is typically assessed in older populations. Identifying frailty in adults aged under 60 years may also have value, if it supports the delivery of timely care. We sought to identify how frailty is measured in younger populations, including evidence of the impact on patient outcomes and care. Design A rapid review of primary studi...
Article
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Background The NHS Diabetes Prevention Programme (NHS-DPP) has been delivered by four commercial organizations across England, to prevent people with impaired glucose tolerance developing Type 2 diabetes. Evidence reviews underpinning the NHS-DPP design specification identified 19 Behavior Change Techniques (BCTs) that are the intervention “active...
Article
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Objective To identify and assess the preferences of people with long‐term health conditions toward generalizable characteristics of self‐management support interventions, with the objective to inform the design of more person‐centered support services. Data Sources Primary qualitative and quantitative data collected on a representative sample of i...
Preprint
Full-text available
Background Ensuring that a trial is designed so that its participants reflect those who might benefit from the results, or be spared harms, is key to the potential benefits of the trial reaching all they should. This paper describes the process used between July 2019 and October 2020 to develop the INCLUDE Ethnicity Framework, part of the wider INC...
Article
Full-text available
Background About one in seven adolescents have a mental health disorder in England, UK. School counselling is one of the most common means of trying to address such a problem. We aimed to determine the effectiveness and cost-effectiveness of school-based humanistic counselling (SBHC) for the treatment of psychological distress in young people in En...
Article
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Background The NHS Diabetes Prevention Programme (NHS-DPP) is a nine-month, group-based behavioural intervention for adults in England at risk of developing Type 2 diabetes. Four independent providers were commissioned to deliver versions of the NHS-DPP, in line with NHS England specifications. This observational study maps NHS-DPP delivery in rout...
Article
Full-text available
Background : During the 2020 COVID-19 pandemic, millions of older adults are advised to avoid contact with those outside their household. ‘Social distancing’ has highlighted the need to minimise loneliness and isolation through the provision of remotely delivered befriending, social support and low intensity psychosocial interventions. We wanted to...
Preprint
Full-text available
BACKGROUND The 2020 COVID-19 pandemic prompted rapid implementation of new and existing digital technologies to facilitate access to health and care services during physical distancing. Older people may be disadvantaged, if they are unable to use smartphones, tablets, computers or other technologies. OBJECTIVE In this study, we synthesise evidence...
Article
Full-text available
Background The 2020 COVID-19 pandemic prompted the rapid implementation of new and existing digital technologies to facilitate access to health and care services during physical distancing. Older people may be disadvantaged in that regard if they are unable to use or have access to smartphones, tablets, computers, or other technologies. Objective...
Article
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Background Mitigating or reducing the risk of medication harm is a global policy priority. But evidence reflecting preventable medication harm in medical care and the factors that derive this harm remain unknown. Therefore, we aimed to quantify the prevalence, severity and type of preventable medication harm across medical care settings. Methods W...
Article
Background Quality of life for children and adolescents living with serious parental mental illness can be impaired, but evidence-based interventions to improve it are scarce. Objective Co-production of a child-centred intervention [called Young Simplifying Mental Illness plus Life Enhancement Skills (SMILES)] to improve the health-related quality...
Article
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This article considers patient choice in mental healthcare services, specifically the ways that choice is enabled or constrained in patient-practitioner spoken interaction. Using the method of conversation analysis (CA), we examine the language used by practitioners when presenting treatment delivery options to patients entering the NHS Improving A...
Article
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Objectives: To study the characteristics of UK individuals identified with non-diabetic hyperglycaemia (NDH) and their conversion rates to type 2 diabetes mellitus (T2DM) from 2000 to 2015, using the Clinical Practice Research Datalink. Design: Cohort study. Settings: UK primary Care Practices. Participants: Electronic health records identif...
Article
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Importance Evidence suggests that physicians experience high levels of burnout and stress and that trainee physicians are a particularly high-risk group. Multiple workplace- and non–workplace-related factors have been identified in trainee physicians, but it is unclear which factors are most important in association with burnout and stress. Better...
Article
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Objective To compare the different self-management models (multidisciplinary case management, regularly supported self-management, and minimally supported self-management) and self-monitoring models against usual care and education to determine which are most effective at reducing healthcare use and improving quality of life in asthma. Design Syst...
Article
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Background: Printed participant information about trials is often technical, long and difficult to navigate. Optimisation and user testing can improve information materials, and may improve participant understanding and rates of recruitment. Methods: A study within a trial (SWAT) was undertaken within the ISDR trial. Potential participants in the I...
Article
Full-text available
Background: Contemporary health policy is shifting towards remotely delivered care. A growing need to provide effective and accessible services, with maximal population reach has stimulated demand for flexible and efficient service models. The implementation of evidence-based practice has been slow, leaving many services ill equipped to respond to...
Presentation
Background: Older people (65+) with multimorbidity are more likely to experience patient safety incidents. In primary care, threats to patient safety often arise as a result of breakdowns in communication between patients and staff. Thus, interventions to improve communication could help reduce risks to patient safety. Research and policy regardi...
Article
Full-text available
Rationale Social prescribing to community assets, like social groups, is a current policy goal. As aging adults lead longer, healthier lives, the effects of participating in community assets raises questions about whether subjective quality of life (QoL) improves during participation and on what dimensions. Objective The study’s goal was to examin...