Unveiling healthcare insights for patients and practitioners: a pilot study.

BACKGROUND: Doctors in the UK experience significant heterogeneity in training. Whilst core curricula underpin specialty training, diversity in clinical attachments results in a heterogeneous knowledge base and variation in local practice. Some insights or practices, which have the potential to improve patient care, but which only exist anecdotally or in local rather than national guidance, remain undiscovered and underutilised. AIM: To aggregate examples of such clinical insights; To assess the extent of recommendation and evidence for these insights; To raise awareness of underutilised clinical insights, to highlight areas for further study and dissuade the use of inappropriate or un-evidenced practices. METHOD: A qualitative survey seeking free text responses, open to all UK healthcare professionals, was disseminated opportunistically. Responses were recorded and the insights were assessed against the existing evidence base, cost and potential for harm. RESULTS: 29 clinical insights were collated across multiple specialties. Some already formed part of national guidance, but appeared to be underutilised, while others appeared only in local or international guidance. Evidence for some insights was compelling, but often mixed, whilst almost all were rated as low cost and low risk. CONCLUSION: We uncovered a range of lesser-known clinical insights across a range of specialties, as well as some less well-evidenced practices. Many insights have the potential to positively impact patient care, particularly in general practice. There is a clear opportunity to draw attention to those insights which offer low-cost, low-risk and potentially effective treatments, whilst highlighting opportunities to further study less well-evidenced insights and practices.

Sleep disturbance in people living with dementia or mild cognitive impairment: a realist review of general practice.

BACKGROUND: Sleep disturbance is a prevalent condition among people living with dementia (PLwD) or mild cognitive impairment (MCI). Its assessment and management within primary care is complex because of the comorbidities, older age, and cognitive impairment typical of this patient group. AIM: To explore how primary care clinicians assess, understand, and manage sleep disturbance for PLwD or MCI; if and why such initiatives work; and how people and their carers experience sleep disturbance and its treatment. DESIGN AND SETTING: A realist review of existing literature conducted in 2022. METHOD: Six bibliographic databases were searched. Context-mechanism-outcome configurations (CMOCs) were developed and refined. RESULTS: In total, 60 records were included from 1869 retrieved hits and 19 CMOCs were developed. Low awareness of and confidence in the treatment of sleep disturbance among primary care clinicians and patients, combined with time and resource constraints, meant that identifying sleep disturbance was difficult and not prioritised. Medication was perceived by clinicians and patients as the primary management tool, resulting in inappropriate or long-term prescription. Rigid nursing routines in care homes were reportedly not conducive to good-quality sleep. CONCLUSION: In primary care, sleep disturbance among PLwD or MCI is not adequately addressed. Over-reliance on medication, underutilisation of non-pharmacological strategies, and inflexible care home routines were reported as a result of low confidence in sleep management and resource constraints. This does not constitute effective and person-centred care. Future work should consider ways to tailor the assessment and management of sleep disturbance to the needs of individuals and their informal carers without overstretching services.