Book of Abstracts Published by Society for Academic Primary Care DOI reference: 10.37361/asm.2020.1.1 DOI LINK: https://sapc.ac.uk/doi/10.37361/asm.2020.1.1 Abstracts on-line: https://sapc.ac.uk/conference/2020/abstracts Copyright belongs to the authors of the individual abstracts under the creative commons licence The abstracts have been published as submitted without further editing 1 Foreword 2020 will forever be remembered as the year of the COVID-19 pandemic. For the first time since 1972, the 49th Annual Scientific Meeting of the SAPC, due to be held in Leeds in July 2020, could not take place. The cancellation occurred after the submission deadline for abstracts, and, as there was no capacity for a ‘virtual’ meeting, these abstracts could not be presented. We thank all of the authors, from around the world, for their submissions, which were, as ever, of high quality, importance, and impact, reflecting the state of our discipline. We have great pleasure in publishing the abstracts in this document. A total of 281 abstracts were submitted, 205 for consideration as ‘long orals’, and 76 as ‘short orals’. A couple of ‘technical’ points to note: . The theme of the meeting was ‘Living and Dying Well’. This has become more poignant as the events of 2020 sadly unfold. They are published ‘as submitted’ with no edits or updates from authors . There has been no selection of abstracts – all are included, except those where authors have declined the option of publication The ASM in Leeds has been rescheduled for 30th June – 2nd July 2021, and we look forward to hosting a successful meeting. We hope that many people who submitted in 2020 will also do so in 2021. Richard Neal & Suzanne Richards On behalf of the Scientific and Organising Committees University of Leeds May 2020 2 Contents Abstract numbers are made up of the letter prefix for the topic followed by a number. The alphabetical presenter index at the back of this document shows the abstract number eg A.1 to aid location of abstracts. Prefix PAGE Distinguished papers – prize winners from NAPCRG, AAAPC A.0 3 Abstracts by topic Access and equity A 6 Ageing, frailty and dementia B 8 Cancer C 24 Cardiovascular D 40 Child health and development E 55 Clinical trials F 59 Comorbidity and multimorbidity G 75 Database research H 79 Diabetes I 85 Education J 97 Experience of illness in health care K 125 Health Services Research L 130 Infectious disease M 136 Information Technology N 138 Living and dying well O 151 Mental health P 160 Migration and migrant health Q 170 Musculoskeletal R 171 Patient-clinician relationship S 188 PPIE T 191 Prescribing U 194 Primary care workforce V 217 Qualitative methods W 225 Respiratory disease X 228 Social determinants of health Y 233 Women's health Z 236 Presenter index 245 3 Distinguished papers and access to rapid referral to LARC insertion clinics. Control GPs had access to neither. Primary outcome: A.0a number of LARCs inserted. Data collected from women at baseline (telephone interview), six months Australasian Association of Academic Primary Care (online survey) and from GPs and gynaecologists Conference (AAAPC) – winning presentation 2019 during contraceptive consultation and at time of contraception uptake. The Australian Contraceptive ChOice pRoject (ACCORd): Results of a cluster randomised controlled Participants trial aimed at increasing Long Acting Reversible GPs: worked 3+ sessions weekly, computerised Contraceptive (LARC) uptake practice and supportive reception staff. Women: Professor Danielle Mazza attended GP, English speaking, sexually active, not pregnant, not planning pregnancy in following year, Professor Danielle Mazza (1). Dr Cathy Watson (1), 16–45 years, interested in contraceptive counselling. Professor Kirsten Black (2). Professor Jayne Lucke (3). Professor Angela Taft (4), Dr Kevin McGeechan (5), Findings Professor Marion Haas (6), Dr Kathleen McNamee (7), Twenty-five intervention GPs and 32 control GPs Professor Jeffrey Peipert (8) recruited 307 and 433 women (N=740). Referral for 1) Department of General Practice Monash LARC insertion within 4 weeks of initial consultation - University Intervention: 37%; Control: 18% (RR 1.98, 95% CI 1.39- 2) Obstetrics, Gynaecology and Neonatology, 2.8; p<0.001). LARC inserted by 4 weeks - University of Sydney Intervention: 19%; Control: 12% (RR 2.03, CI 1.06- 3) Australian Research Centre for Sex, Health 3.89; p=0.033). Using LARC at 6 months - Intervention: and Society (ARCSHS). La Trobe University 45%; Control: 29% (RR1.66, 95%CI 1.28-2.16; 4) Judith Lumley Centre, La Trobe University p<0.001). No difference in age nor parity with LARC 5) School of Public Health, University of Sydney uptake across groups. 6) Centre for Health Economics Research and Implications for practice Evaluation, University of Technology Sydney 7) Family Planning Victoria ACCORd intervention resulted in significantly more 8) Obstetrics and Gynecology, Indiana University LARC uptake at 4 weeks and 6 months and has School of Medicine potential to reduce unintended pregnancies. Context LARCs reduce unintended pregnancy and abortion A.0b rates but Australian uptake is low. General practitioners (GPs) are ideally placed to promote North American Primary Care Group Annual Meeting LARCs. – winning presentation 2019 Objective “Nosotros” Approach: Community health workers as trust builders and community healers The Australian Contraceptive ChOice pRoject (ACCORd), adapted from the US Contraceptive CHOICE study, evaluated whether a complex primary Dr Robert L Ferrer care intervention increased LARC uptake. Authors: Study Design RL Ferrer, CG Schlenker, RS Poursani, I Cruz, P Noel, R Cluster randomised controlled trial in general Palmer, CR Jaén practices in Melbourne, Australia. Intervention GPs Department of Family and Community Medicine, UT received training to deliver structured contraceptive Health San Antonio, Texas, USA counselling with contraceptive effectiveness emphasis 4 Context: Promoting patients’ commitment to engage grew through the 10th measurement occasion (mean in self-care is a core goal of primary care, yet often follow up 1367 days) when it attained an average A1c elusive in the context of social deprivation. of 8.26% vs 9.29% in the engagement group and 9.17% in the stabilization group (p<.003). Objective: To report on an innovative, practice- integrated, community health worker Conclusions: Community health workers can (CHW) intervention designed to promote trusting sustainably engage vulnerable patients, helping them relationships and effective self-care in patients with identify and advance long-term self-management type 2 diabetes. goals in the context of formidable social disadvantage. Study Design: Retrospective cohort study. Setting: Family medicine practice in a safety-net county health care system in San Antonio, Texas, USA. Population studied: Predominantly Hispanic, low- income primary care patients with uncontrolled type 2 diabetes, and significant psychosocial risk factors. Intervention: Clinicians identified eligible patients through a diabetes registry and at point of care. Patients were assigned CHWs, who engaged them in trust-building and relationship-based sense making to understand their social context, collaboratively identify goals, navigate the health care system, and connect them to community resources. Outcome Measures: Primary outcome was patient progress through three prospectively defined stages of self-care: a) Outreach (patient responds to CHW’s invitation to meet face-to-face); b) Stabilization (patient and CHW build trust and create an alliance to address pressing problems within the patient's life circumstances); and c) Self-Care Generativity (patient commits to self-care. Secondary outcome was repeated measures analysis of glycosylated hemoglobin (A1c). Results: From a population of 8,647 patients with diabetes, 986 were referred to the Nosotros Approach over 4 years. Of those, 267 (27.1%) remained in Outreach; 399 (40.5%) progressed to Stabilization; while 320 (32.5%) achieved Self-Care Generativity. Repeated measures ANOVA demonstrates an overall decline in A1c, without group differences, through the 4th A1c measurement occasion (mean follow-up 704 days). Beginning at the 5th A1c measurement occasion (mean 860 days), the self-care generativity group achieved greater declines in A1c (p<.05). The relative advantage of the self-care generatively group 5 A.1 speech pathology) in primary and community health in SWSLHD and South Western Sydney Primary Health Spatial clusters for potentially preventable Network (SWSPHN). The following data is required for hospitalisations (PPHs) for chronic conditions and all services: geographic location (suburb & postcode), access to allied health in South Western Sydney opening hours, out of pocket cost of services (private or community health), and languages spoken by allied Presenter: Sarah Dennis health professionals.The allied health service data for Authors: Janelle Gifford, Soumya Mazumdar, Luke 2019 was obtained from National Health Services Arnold, Matthew Jennings, Bin Jalaluddin, Sarah Directory. The data accuracy and completeness Dennis checked against the directory at SWSPHN and community health services (SWSLHD) publically Institutions available information.The data will be cleaned and University of Sydney, Ingham Institute of Applied coded. Summary statistics will be produced for all Medical Research, South Western Sydney Local Health variables in the data. Inferential or regression models District, South Western