Afghan refugees at risk in the UK: enhancing healthcare access and integration.

BACKGROUND: Following Kabul's fall in August 2021, there was influx of Afghan refugees in the UK. Southampton's Bridging Hotel provided temporary shelter to 22 families, totaling 116 individuals. The Living Well Partnership (LWP); assumed primary care provision for these vulnerable residents facing health inequalities. AIM: Enhancing refugee healthcare access and integration into the NHS system. Improving healthcare education, boosting confidence in appropriate healthcare use, and utilisation of electronic consultations effectively. METHOD: Working with the local authorities, primary care services were brought to the hotel. Regular 3-hour drop-in sessions with a health and wellbeing coach were established and attended by residents. Non-identifiable data was recorded in individual patient care records and summarised quantitatively.  Qualitative data was collected via a pre-established questionnaire during the sessions.   RESULTS: Identified issues included language barriers, mental health problems, infectious diseases, contraception, and healthcare access. Language barriers were addressed with interpreters. Fifty-nine patients accessed support services, with 13 benefiting from e-consultations, and nine requiring on-site medical consultations in a 3-month period. Mental health support and infectious disease referrals were facilitated. Access challenges were mitigated by transitioning to e-consultations or face-to-face appointments. Outcomes included improved patient independence, awareness of healthcare processes, familiarity with LWP services, and confidence in navigating the NHS. CONCLUSION: A multifaceted approach is vital for addressing language and access barriers for refugees. Providing educational resources through facilitated groups empowered refugees and improved healthcare access. This initiative highlights the importance of organised support for vulnerable populations during crises and can be applied more widely.

Learning from the GP-consultant exchange scheme: a qualitative evaluation.

Collaborative working across primary and secondary care is crucial to providing high quality patient care. There is still a lack of communication and understanding between primary and secondary care, which can impede collaborative working. The experience of observing colleagues in a different speciality can prompt insight, improve morale and promote collaborative working. The GP-Consultant Exchange Scheme aimed to improve professional understanding, foster deeper partnerships, and ignite opportunities for innovation and/or quality improvement (QI) with co-owned local solutions. This paper gives an overview of how the scheme works and sets out some of the outcomes reported by some 200 Consultants and GPs participants to date. Overall, the participants found the scheme an enjoyable way to reconnect clinicians and allowed them to learn about the challenges faced in different areas within the NHS. This low-cost intervention needs motivated individuals to drive the project forward and make it sustainable, but it can be replicated within any organisation or profession in the NHS.

A study of diet in older community-dwelling adults in the UK during the COVID-19 pandemic: Findings from the Southampton Longitudinal Study of Ageing (SaLSA).

Introduction: Adequate nutrition is important for health in later life. Older adults are especially vulnerable to adverse outcomes following infection by COVID-19 and have commonly spent a disproportionate time within their own homes to reduce risk of infection. There are concerns that advice to shield may have led to malnutrition as older adults may modify daily routines including usual shopping habits. The aims of this study were to report self-reported pandemic-related changes in diet and examine lifestyle and medical correlates of these changes in older UK community-dwelling adults. Methods: We recruited 491 participants from the city of Southampton, UK. Participants completed a postal questionnaire in summer/autumn 2021, over a year after the first UK national lockdown was announced. The questionnaire ascertained demographic and lifestyle factors, in addition to number of comorbidities, nutrition risk scores, and presence of frailty. Associations between these participant characteristics in relation to self-reported changes in diet quality (lower, similar or higher when compared to before the first lockdown) were examined using ordinal logistic regression. Results: Median (lower quartile, upper quartile) age was 79.8 (77.0, 83.7) years. Overall, 11 (4.9%) men and 25 (9.4%) women had poorer diet quality compared to before the first UK lockdown. The following participant characteristics were associated with increased risk of being in a worse category for change in diet quality after adjustment for sex: lower educational attainment (p = 0.009); higher BMI (p < 0.001); higher DETERMINE (a malnutrition assessment) score (p = 0.004); higher SARC-F score (p = 0.013); and self-reported exhaustion in the previous week on at least 3 days (p = 0.002). Conclusions: Individuals at higher nutritional risk were identified as reporting increased risk of deterioration in diet quality during the pandemic. Further investigation of the factors leading to these changes, and an understanding of whether they are reversible will be important, especially for future pandemic management.

Multi-Morbidity and Polypharmacy in Older People: Challenges and Opportunities for Clinical Practice.

Multi-morbidity and polypharmacy are common in older people and pose a challenge for health and social care systems, especially in the context of global population ageing. They are complex and interrelated concepts in the care of older people that require early detection and patient-centred shared decision making underpinned by multi-disciplinary team-led comprehensive geriatric assessment (CGA) across all health and social care settings. Personalised care plans need to remain responsive and adaptable to the needs and wishes of the patient, enabling the individual to maintain their independence. In this review, we aim to give an up-to-date account of the recognition and management of multi-morbidity and polypharmacy in the older person.