Society for Academic Primary Care conference 3-5 July 2013: well, what happened?

One of SAPC’s Dangerous Ideas Soapboxes, offered to us in the allotted three minutes by Jonathan Shapiro, was that we need “modern, multimedia, dynamic marketing” to better convey our research findings. Given that green light, we won’t blush by starting off this blog by saying that CCHSR opened this year’s SAPC conference with Martin Roland’s keynote challenge to address continuity and personalisation of care; took over the middle of the conference with four parallel session presentations back-to-back; and closed the conference with Rupert Payne’s prize winning “paper of distinction” on the association between some commonly used medications and hospitalisations for acute kidney injury. Of course, the major Departmental achievement was our colleague’s prize for Best Dancer at the Conference Dinner: step forward our new Chair in General Practice (and obviously groovy mover) Simon Griffin.

So, what were the major themes from this year’s meeting? Multimorbidity came through strongly. Stewart Mercer (Glasgow) was awarded the RCGP paper of the year for his and his team’s work on the epidemiology of multimorbidity. Their paper (here) challenges the traditional focus on single diseases, and prompts us to think hard about the implications of multimorbidity for the way we design health care, and educate our doctors. They also highlight an important link between deprivation and onset of multimorbidity – people living in the most deprived areas experience multimorbidity 10-15 years earlier than those in affluent areas. A number of key issues around the care of such patients were presented, such as the complexity and uncertainty of consultations for multimorbidity (Kate Stewart, Nottingham), and the professional isolation of GPs (Carol Sinnott, Cork). Stewart Mercer also presented impressive feasibility work for a primary care based complex intervention for multimorbidity in deprived settings (the CARE Plus Trial). Our own work discussed how the potential adverse impact of polypharmacy varies with varying degrees of multimorbidity (Rupert Payne).

Multimorbidity also spilled into an excellent session on patient experience – another subject close to our hearts in CCHSR. Our own Charlotte Paddison described how patient-centred measures of disease impact (quantified in terms of reduced quality of life), as opposed to number of long-term conditions, explain why individuals with multimorbidity report worse experiences of primary care. Other highlights of this session were the great qualitative work by Katie Gallacher (Glasgow) describing the significant burden of treatment in stroke patients, and in particular drawing attention to inadequate service delivery and organisation, poor information provision and communication, inadequate access to primary care services, fragmented care and overly complex medication regimens.

Another highlight was the presentation of the first results coming out of the ESTEEM trial, run by close collaborators of ours at the University of Exeter. This is a three-arm cluster randomised trial comparing GP-led telephone triage and nurse-led telephone triage with normal care. They found that telephone triage systems increased the number of contacts patients made with primary care, but with no noticeable impact on costs. In the same session, Christopher Burton borrowed the statistics of complex systems and emergent phenomena from physics and applied them to contacts with NHS 24 (something of a flashback to a previous life for one CCHSR member, Gary Abel). He found a continuous inverse power-law distribution from patients with one contact in a year up to those with over 500 contacts in a year, with no obvious scale or break point, making the point that “frequent flyers” were just part of the system.

It was great to come across Bristol’s TARGET NIHR programme, a cohort study and associated qualitative work around treatment of coughs, colds and chest infections in children. Jeremy Horwood’s presentation of how GPs’ use the phrase “it’s a virus” to convey a multitude of meanings was fascinating, and there are many common methodological links with work CCHSR is undertaking videoing GP-patient consultations in the Improve programme grant. We will be in touch with them, they have been warned!

There were certainly many other talks we could have written about. Perhaps, though, it is fitting to finish by mentioning another “theme” that came up again and again – the death earlier this year of Professor Helen Lester. The deep appreciation of Helen’s leadership and her commitment to SAPC was evident from many respected colleagues, and her amazing contributions to primary care research were repeatedly reflected upon. Her work certainly played an important role in helping to achieve the high standard of inspiring research we saw in Nottingham. The bar has been set high for Edinburgh next year.

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  • The Cambridge Centre for Health Services Research (CCHSR) is a thriving collaboration between the University of Cambridge and RAND Europe. We aim to inform health policy and practice by conducting research and evaluation studies of organisation and delivery of healthcare, including safety, effectiveness, efficiency and patient experience.