Trisha Greenhalgh

Trisha Greenhalgh
University of Oxford | OX · Department of Primary Care Health Sciences

FMedSci

About

871
Publications
401,678
Reads
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56,130
Citations
Additional affiliations
January 2015 - present
University of Oxford
Position
  • Professor of Primary Care Health Sciences
April 2010 - December 2014
Queen Mary, University of London
Position
  • Professor of Primary Health Care and Dean for Research Impact
April 2010 - present
Barts Health NHS Trust
Position
  • Honorary Consultant

Publications

Publications (871)
Article
Purpose: The questions addressed by this review are: first, what are the guiding principles underlying efforts to stimulate sustained cultural change; second, what are the mechanisms by which these principles operate; and, finally, what are the contextual factors that influence the likelihood of these principles being effective? The paper aims to...
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The idea that policy should be based on best research evidence might appear to be self-evident. But a closer analysis reveals a number of problems and paradoxes inherent in the concept of "evidence-based policymaking." The current conflict over evidence-based policymaking parallels a long-standing "paradigm war" in social research between positivis...
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Seventy six senior academics from 11 countries invite The BMJ’s editors to reconsider their policy of rejecting qualitative research on the grounds of low priority.They challenge the journal to develop a proactive, scholarly, and pluralist approach to research that aligns with its stated mission
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This chapter considers the usefulness and validity of public inquiries as a source of data and preliminary interpretation for case study research. Using two contrasting examples – the Bristol Inquiry into excess deaths in a children’s cardiac surgery unit and the Woolf Inquiry into a breakdown of governance at the London School of Economics (LSE) –...
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Public Health England’s focus on individual behaviour change is unlikely to stem the epidemic of type 2 diabetes A new Public Health England report on the rising prevalence of type 2 diabetes proposes targeting people with non-diabetic hyperglycaemia (defined as an HbA1c concentration of 42-47 mmol/mol) with behavioural interventions (diet and exe...
Preprint
UNSTRUCTURED The COVID-19 pandemic has led to the rapid scale up in the use of video consultations in general practice across the UK, but the impact this has had on digital health disparities concerning certain disadvantaged groups of patients remains largely unknown. We set out to review the research on digital disparities in relation to ethnicity...
Preprint
BACKGROUND Until COVID-19, implementation and uptake of video consultations in healthcare was slow. But the pandemic created a ‘burning platform’ for scaling up such services. As healthcare organizations look to expand and maintain the use of video in the ‘new normal’, it is important to understand infrastructural influences and changes that emerge...
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We studied video consulting in the National Health Service during 2020–2021 through video interviews, an online survey and online discussions with people who had provided and participated in such consultations. Video consulting had previously been used for selected groups in limited settings in the UK. The pandemic created a seismic shift in the co...
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Background: Following a large-scale, pandemic-driven shift to remote consulting in UK general practice in 2020, 2021 saw a partial return to in-person consultations. This occurred in the context of extreme workload pressures due to backlogs, staff shortages and task shifting. Aim: To study media depictions of remote consultations in UK general prac...
Article
Background: Following a pandemic-driven shift to remote service provision, UK general practices offer telephone, video or online consultation options alongside face-to-face. This study explores practices’ varied experiences over time as they seek to establish remote forms of accessing and delivering care. Methods: This protocol is for a mixed-metho...
Article
Background: Accessing and receiving care remotely (by telephone, video or online) became the default option during the coronavirus disease 2019 (COVID-19) pandemic, but in-person care has unique benefits in some circumstances. We are studying UK general practices as they try to balance remote and in-person care, with recurrent waves of COVID-19 and...
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Background Our research was based on the expressed need to evaluate the potential for group clinics to enhance care within the NHS for people with long-term conditions. Objectives We aimed to explore the scope, feasibility, impact and potential scalability of group clinics for young adults with diabetes who have poor experiences of care and clinic...
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Evidence-based medicine (EBM’s) traditional methods, especially randomised controlled trials (RCTs) and meta-analyses, along with risk-of-bias tools and checklists, have contributed significantly to the science of COVID-19. But these methods and tools were designed primarily to answer simple, focused questions in a stable context where yesterday’s...
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Background Accurate assessment of COVID-19 severity in the community is essential for patient care and requires COVID-19-specific risk prediction scores adequately validated in a community setting. Following a qualitative phase to identify signs, symptoms, and risk factors, we aimed to develop and validate two COVID-19-specific risk prediction scor...
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In this conceptual paper, we argue that at times of crisis, what is sometimes called “evidence-based” or “science-driven” policymaking—establishing scientific truths and then implementing them—must be tempered by a more agile, deliberative and inclusive approach which acknowledges and embraces uncertainty. We offer pragmatism as one potential optio...
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Background Group consultations have been gaining ground as a novel approach to service delivery. When in-person care was restricted owing to COVID-19, general practice staff began delivering group consultations remotely over video. Aim To examine how multiple interacting influences underpinned implementation and delivery of video group consultatio...
Article
Background: The Covid-19 pandemic-related rise in remote consulting raises questions about the nature and type of risks in remote general practice AIM: To develop an empirically-based and theory-informed taxonomy of risks associated with remote consultations. Design and setting: Qualitative sub-study of data selected from the wider datasets of t...
Preprint
Introduction Long COVID, a new condition whose origins and natural history are not yet fully established, currently affects 1.5 million people in the UK. Most do not have access to specialist long COVID services. We seek to optimise long COVID care both within and outside specialist clinics, including improving access, reducing inequalities, helpin...
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Background: Long covid (LC) is defined as fatigue, breathlessness, cognitive dysfunction and a variety of other symptoms occurring after coronavirus-2019 disease (COVID-19). (1,2) Over a million people in the UK are estimated to have prolonged symptoms after COVID-19, with 60% of long covid patients reporting extended symptoms lasting months, and 2...
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Background The introduction of remote triage and assessment early in the pandemic raised questions about patient safety. We sought to capture patients and clinicians’ experiences of the management of suspected acute COVID-19 and generate wider lessons to inform safer care. Setting and sample UK primary healthcare. A subset of relevant data was dra...
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Background: Most studies of long covid (symptoms of COVID-19 beyond 4 weeks) have focused on people hospitalised in their initial illness. Long covid is thought to be under-recorded in UK primary care electronic records. Objective: We sought to determine which symptoms people present to primary care following COVID-19, and whether presentation d...
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This article draws on research and clinical experience to discuss how and when to use video consultations in mental health settings. The appropriateness and impact of virtual consultations are influenced by the patient's clinical needs and social context, as well as by service-level socio-technical and logistical factors.
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Background: Fewer than 1% of UK general practice consultations occur by video. Aim: To explain why video consultations are not more widely used in general practice. Design and setting: Analysis of a sub-sample of data from three mixed-method case studies of remote consultation services in various UK settings from 2019-2021. Method: The datas...
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Background: Following COVID-19 up to 40% of people have ongoing health problems, referred to as “post-acute COVID-19” or long covid (LC). LC varies from a single persisting symptom to a complex multi-system disease. Research has flagged that this condition is under recorded in primary care record; and seeks to better define its clinical characteris...
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Background: Following COVID-19, up to 40% of people have ongoing health problems, referred to as "post-acute COVID-19" or 'long covid'. Long covid varies from a single persisting symptom to a complex multi-system disease. Research has flagged that this condition is under recorded in primary care record; and seeks to better define its clinical char...
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Objective To explore the lived experience of ‘brain fog’—the wide variety of neurocognitive symptoms that can follow COVID-19. Design and setting A UK-wide longitudinal qualitative study comprising online focus groups with email follow-up. Method 50 participants were recruited from a previous qualitative study of the lived experience of long COVI...
Preprint
A consensus statement from physicians and scientists with a range of expertise in the areas of respiratory infection and aerosols, to clarify the discussion surrounding a recent preprint (https://www.medrxiv.org/content/10.1101/2022.01.08.22268944v1) describing the aerosol dynamics of SARS-CoV-2 (the virus that causes COVID-19) which generated cont...
Preprint
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Background Accurate assessment of COVID-19 severity in the community is essential for best patient care and efficient use of services and requires a risk prediction score that is COVID-19 specific and adequately validated in a community setting. Following a qualitative phase to identify signs, symptoms and risk factors, we sought to develop and val...
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Full-text available
Requirements for physical distancing as a result of COVID-19 and the need to reduce the risk of infection prompted policy supporting rapid roll out of video consulting across the four nations of the UK—England, Northern Ireland, Scotland and Wales. Drawing on three studies of the accelerated implementation and uptake of video consulting across the...
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Integrated care is an aim and a method for organising health and care services, particularly for older people and those with chronic conditions. Policy expects that integrated care programmes will provide person‐centred coordinated care which will improve patient or client experience, enable population health, prevent hospital admissions and thereb...
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Background There is a growing need for methods that acknowledge and successfully capture the dynamic interaction between context and implementation of complex interventions. Case study research has the potential to provide such understanding, enabling in-depth investigation of the particularities of phenomena. However, there is limited guidance on...
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Introduction Most research on loneliness comes from the health sciences, statistically seeking to measure the health-related effects of feeling alone or isolated. There is a need to expand on this understanding and explore loneliness as a more complex social phenomenon. In this article, we present a qualitative design for studying the intersection...
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Background To evaluate the evidence behind claims that Chinese Herbal Medicine, specifically “three medicines and three formulations” (3M3F, comprising Jinhua Qinggan, Lianhua Qingwen, Xuebijing, Qingfei Paidu, Huashi Baidu, and Xuanfei Baidu), is an effective treatment for COVID-19. Methods We searched PubMed, MEDLINE and CNKI databases, preprint...
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Establishing and running remote consultation services is challenging politically (interest groups may gain or lose), organizationally (remote consulting requires implementation work and new roles and workflows), economically (costs and benefits are unevenly distributed across the system), technically (excellent care needs dependable links and high-...
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Callard and Perego depict long Covid as the first illness to be defined by patients who came together on social media. Responding to their call to address why patients were so effective in making long Covid visible and igniting action to improve its care, we use narrative inquiry – a field of research that investigates the place and power of storie...
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Background Most writing about uncertainty in healthcare has addressed empirical uncertainty – that is, resulting from insufficient or conflicting facts. Objective To consider moral uncertainty by exploring how different theories apply to a single clinical case. Method In this philosophical reflection, I briefly acknowledge empirical uncertainty b...
Preprint
BACKGROUND Scotland—a country of 5.5 million people—has a rugged geography with many outlying islands, creating access challenges for many citizens. The government has long sought to mitigate these through a range of measures including an ambitious technology-enabled care (TEC) program. A strategy to develop a nationwide video consultation service...
Article
Background: Scotland-a country of 5.5 million people-has a rugged geography with many outlying islands, creating access challenges for many citizens. The government has long sought to mitigate these through a range of measures including an ambitious technology-enabled care (TEC) program. A strategy to develop a nationwide video consultation servic...
Preprint
BACKGROUND Since the start of the COVID-19 pandemic, efforts have been made to develop early warning risk scores to help clinicians decide which patient is likely to deteriorate and require hospitalization. The RECAP (Remote COVID-19 Assessment in Primary Care) study investigates the predictive risk of hospitalization, deterioration, and death of p...
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Background: To support shared decision making and improve the management of polypharmacy, it is recommended that GPs take into account quantitative information on the benefits and harms of treatments. Quantitative evidence shows GPs' knowledge of this is low. Aim: To explore GPs' attitudes to and understanding of the quantitative benefits and ha...
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Background Social prescribing (SP) involves linking patients in primary care with services provided by the voluntary and community sector. Despite growing interest within NHS primary care, it remains unclear how and under what circumstances SP might contribute to good practice. Aim To define ‘good’ practice in SP by identifying context-specific en...
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Technology development is gathering pace in epilepsy with seizure detection devices promising to transform self‐care and service provision. However, such accounts often neglect the uncertainties, displacements and responsibilities that technology‐supported care generates. This review brings together a heterogeneous literature, identified through sy...
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Introduction Social prescribing is an innovation being widely adopted within the UK National Health Service policy as a way of improving the management of people with long-term conditions, such as type 2 diabetes (T2D). It generally involves linking patients in primary care with non-medical community-based interventions. Despite widespread national...
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During crises (major events characterised by uncertainty, urgency and threat), society must make sense of rapidly unfolding events. This happens mainly through narrativising—depicting a setting, characters and a meaningful sequence of events and actions unfolding over time. In the early months of the pandemic, UK general practice shifted from face-...
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Background Even when resting pulse oximetry is normal in the patient with acute Covid-19, hypoxia can manifest on exertion. We summarise the literature on the performance of different rapid tests for exertional desaturation and draw on this evidence base to provide guidance in the context of acute Covid-19. Main research questions What exercise te...
Preprint
Full-text available
Background: To evaluate the evidence behind claims that Chinese Herbal Medicine, specifically “three medicines and three formulations” (3M3F, comprising Jinhua Qinggan, Lianhua Qingwen, Xuebijing, Qingfei Paidu, Huashi Baidu and Xuanfei Baidu), is an effective treatment for COVID-19. Methods: We searched PubMed, MEDLINE and CNKI databases, preprin...
Preprint
Full-text available
Background: To evaluate the evidence behind claims that Chinese Herbal Medicine, specifically “three medicines and three formulations” (3M3F, comprising Jinhua Qinggan, Lianhua Qingwen, Xuebijing, Qingfei Paidu, Huashi Baidu and Xuanfei Baidu), is an effective treatment for COVID-19. Methods: We searched PubMed, MEDLINE and CNKI databases, preprint...
Article
Objectives To synthesise evidence concerning the range of filtering respirators suitable for patient care and guide the selection and use of different respirator types. Design Comparative analysis of international standards for respirators and rapid review of their performance and impact in healthcare. Data sources Websites of international sta...
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Full-text available
The COVID-19 pandemic raised considerable challenges to obtain reliable guidance to help occupational health practitioners, workers, and stakeholders building up efficient prevention strategies at the workplace, between the constant increase of publications in the domain, the time required to run high-quality research and systematic reviews, and th...
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Latency in video-mediated interaction can frustrate smooth turn-taking: it may cause participants to perceive silence at points where talk should occur, it may cause them to talk in overlap, and it impedes their ability to return to one-speaker-at-a-time. Whilst potentially frustrating for participants, this makes video-mediated interaction a persp...
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Persistent symptoms lasting longer than 3 weeks are thought to affect 10-20% of patients following SARS-CoV-2 infection. No formal guidelines exist in the UK for treating patients with long COVID and services are sporadic and variable, although additional funding is promised for their development.In this study, narrative interviews and focus groups...
Article
Whether and when to mandate the wearing of facemasks in the community to prevent the spread of coronavirus disease 2019 remains controversial. Published literature across disciplines about the role of masks in mitigating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission is summarized. Growing evidence that SARS-CoV-2 is airb...
Article
Whether and when to mandate the wearing of facemasks in the community to prevent the spread of coronavirus disease 2019 remains controversial. Published literature across disciplines about the role of masks in mitigating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission is summarized. Growing evidence that SARS-CoV-2 is airb...
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Full-text available
Background Approximately 10% of patients with Covid-19 experience symptoms beyond 3–4 weeks. Patients call this “long Covid”. We sought to document such patients’ lived experience, including accessing and receiving healthcare and ideas for improving services. Methods We held 55 individual interviews and 8 focus groups (n = 59) with people recruite...
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Background Remote consulting was introduced quickly into UK general practice in March 2020 as an emergency response to COVID-19. In July 2020, ‘remote-first’ became long-term government policy. Aim To explore how this change was portrayed in national newspapers and how depictions changed over time. Design and setting Thematic analysis of newspape...
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Background The need for better methods for evaluation in health research has been widely recognised. The ‘complexity turn’ has drawn attention to the limitations of relying on causal inference from randomised controlled trials alone for understanding whether, and under which conditions, interventions in complex systems improve health services or th...
Preprint
Full-text available
Persistent symptoms lasting longer than 3 weeks are thought to affect 10-20% of patients following Covid 19 infection. No formal guidelines exist in the United Kingdom for treating ‘long Covid’ patients and services are sporadic and variable, although additional funding is promised for their development. In this study narrative interviews and focus...
Preprint
Full-text available
Background Even when resting pulse oximetry is normal in the patient with acute Covid-19, hypoxia can manifest on exertion. We sought to summarise the literature on the performance of different rapid tests for exertional desaturation. Main research question What tests have been formally evaluated for the rapid assessment of exertional hypoxia in pa...
Preprint
Full-text available
Background Even when resting pulse oximetry is normal in the patient with acute Covid-19, hypoxia can manifest on exertion. We summarise the literature on the performance of different rapid tests for exertional desaturation and draw on this evidence base to provide guidance in the context of acute COVID-19. Main research questions 1. What exercise...
Preprint
Full-text available
Background Even when resting pulse oximetry is normal in the patient with acute Covid-19, hypoxia can manifest on exertion. We sought to summarise the literature on the performance of different rapid tests for exertional desaturation. Research question What tests have been formally evaluated for the rapid assessment of exertional hypoxia? What is...
Article
Full-text available
Background The SUPPORT-HF2 randomised controlled trial compared telehealth technology alone with the same technology combined with centralised remote support, in which a clinician responds promptly to biomarker changes. The intervention was implemented differently in different sites; no overall impact was found on the primary endpoint (proportion o...
Article
Key messages: Gender equity in research can contribute to social progress, scientific workforce sustainability, and the quality of science. Research funders can be critical actors in advancing gender equity through policy interventions and funding incentives. Linking NIHR funding to Athena SWAN gender equality action plans has been associated wi...
Preprint
Whether and when to mandate the wearing of masks or face coverings by the public to prevent the spread of Covid-19 remains controversial. We summarise a large research literature across a range of academic disciplines. There is growing evidence that SARS-CoV-2 is airborne, hence may travel long distances and be inhaled. Infection control policies m...