Papers by Rachael Summers
npj Primary Care Respiratory Medicine, 2021
Despite high mortality and morbidity, COPD remains under-diagnosed. Case-finding strategies are p... more Despite high mortality and morbidity, COPD remains under-diagnosed. Case-finding strategies are possible, but patients’ perspectives are unexplored. Using qualitative methods, we explored the patient perspective of a case-finding intervention among at-risk patients in primary care. Semi-structured telephone interviews were transcribed and thematic analysis utilised. Seven patients without (mean age 64.5 years (58–74), n = 4) and 8 with obstructed spirometry (mean age 63.5 (53–75), n = 4) were interviewed. Themes identified were motives, challenges and concerns regarding attending the clinic. These included wanting to be well; to help with research; concern over negative impact to life from COPD diagnosis; perceived utility of the clinic; quality of information given; staff manner, approachability and knowledge; and perceived effects of the clinic on lifestyle, self-management and symptoms. The intervention was generally deemed useful and reassuring, although shared information was t...
Physiotherapists, 2017
Background: MI is a potential method for enhancing adherence to PR. We observed variable skill ac... more Background: MI is a potential method for enhancing adherence to PR. We observed variable skill acquisition amongst PR clinicians following intensive MI training. This study provides insights into their challenges. Aim: To explore PR clinicians’ experiences whilst learning and implementing MI. Method: Nine PR clinicians (7 physiotherapists, 1 physiotherapy technician, 1 nurse) completed a 2-day workshop and on-going supervision. Each undertook a semi-structured follow-up interview that was audio-recorded, transcribed verbatim and analysed with framework analysis. Results: Five themes were identified: 1) Burden: Participants described a high level of psychological effort involved in using MI. Trying novel skills and suppressing behaviours that are antithetical to MI demands much attentional resource and detracted from other key tasks such as maintaining empathy. 2) Destabilising: Recognising the limitations of existing practice, yet feeling underprepared to deliver MI effectively was stressful for some and led to performance anxiety. 3) Committing to uncertainty: Using MI required participants to accept sessions may take longer, cover unanticipated topics and may not result in change. 4) Difficult feelings: concern that MI may reveal emotive issues that are uncomfortable for patients and clinicians. 5) Additional support: Training was viewed positively, but more supervision was perceived necessary. Extending consultations would help integration efforts particularly while skills are novel and inefficient. Conclusion: MI is a complex method that is challenging to do well. These findings have been used to optimise training to promote higher skill levels in a future study.
Rehabilitation and Chronic Care, 2017
1.6 General Practice and Primary Care, 2016
Background: COPD is a major cause of disability and death in the UK. It is estimated that around ... more Background: COPD is a major cause of disability and death in the UK. It is estimated that around 3 million people have COPD, 2 million of whom are undiagnosed. Targeted case-finding run within primary care practices may enhance diagnosis; but currently little is known about views of healthcare professionals (HCPs) working in this area. Aim: To understand the perspectives of HCPs working in primary care on case-finding for COPD. Methods: A convenience sample of 36 HCPs (12 GPs, 14 nurses and 10 practice managers) from 34 UK GP practices participated in semi-structured telephone interviews, which were audio-recorded and transcribed verbatim. Interviews explored the desirability and acceptability of case-finding, and perceived barriers and facilitators. Data were analysed using Framework Approach and multiple coders Results: Most practices approached case-finding opportunistically. Targeted case-finding was reportedly acceptable by most practices if additional resources and support were available. Patient engagement with targeted case-finding, and the cost implications associated with identifying more patients with COPD were perceived as the main barriers. Financial incentives, support from specialist clinicians, and comprehensive guidance for running targeted case-finding were all viewed as facilitators to HCP involvement. Conclusion: Providing cost and resource solutions, training and education opportunities for HCPs on COPD will facilitate targeted case-finding of COPD in primary care practices. Research is needed to explore patient perspectives on COPD and targeted case-finding, and identify ways to optimise public engagement with case-finding initiatives.
NPJ primary care respiratory medicine, Jan 29, 2017
Finding the missing millions' with chronic obstructive pulmonary disease became part of the Depar... more Finding the missing millions' with chronic obstructive pulmonary disease became part of the Department of Health strategy for England in 2010. Targeted case-finding within primary care is one potential pro-active strategy, but currently little is known about the views of healthcare professionals on this approach. In this study, 36 healthcare professionals (12 GPs, 14 nurses, and 10 practice managers) from 34 UK practices participated in semi-structured telephone interviews about targeted case-finding. Interviews followed an interview guide, were audio-recorded, transcribed verbatim, coded and analysed using 'Framework Approach'. Most of those interviewed practiced opportunistic case-finding. The main perceived barriers to wider case-finding programmes were the resource implications associated with running such programmes and identifying more chronic obstructive pulmonary disease patients. Financial incentives, support from specialist clinicians, and comprehensive guidance were viewed as facilitators. While targeted case-finding is conceptually accepted by primary care staff, scepticism surrounding (1) the value of identifying those with mild disease and (2) the availability of effective targeted case-finding methods, may lead some to favour an opportunistic approach. Key concerns were a lack of unequivocal evidence for the relative benefits vs. disadvantages of diagnosing patients earlier, and resource constraints in an already over-burdened system. Barriers to practical implementation of case-finding studies may be addressed with financial, human and educational resources, such as additional staff to undertake searches and perform spirometry tests, and practical and educational support from specialist teams.
Clinical rehabilitation, Jan 20, 2016
To explore respiratory physiotherapists' views and experiences of using goal-setting with peo... more To explore respiratory physiotherapists' views and experiences of using goal-setting with people with chronic obstructive pulmonary disease in rehabilitation settings. A total of 17 respiratory physiotherapists with ⩾12 months current or previous experience of working with patients with chronic obstructive pulmonary disease in a non-acute setting. Participants were diverse in relation to age (25-49 years), sex (13 women), experience (Agenda for Change bands 6-8) and geographic location. Data were collected via face-to-face qualitative in-depth interviews (40-70 minutes) using a semi-structured interview guide. Interview locations were selected by participants (included participants' homes, public places and University). Interviews followed an interview guide, were audio-recorded and transcribed verbatim. Data were analysed using thematic analysis; constant comparison was made within and between accounts, and negative case analysis was used. Three themes emerged through the p...
European Respiratory Journal, 2015
Background: Goal-setting is an integral part of physiotherapy practice and in rehabilitation has ... more Background: Goal-setting is an integral part of physiotherapy practice and in rehabilitation has been described as a 9cornerstone9. However, there is currently a paucity of research into goal-setting in respiratory rehabilitation . Aim: To explore respiratory physiotherapists9 views on goal setting in rehabilitation for people with COPD. Methods: 17 UK respiratory physiotherapists were recruited. They were purposively sampled to reflect diversity in age (25-49 years), gender (13 F), experience (AfC bands 6-8) and geographic location. Data were collected using audio-recorded semi-structured interviews and subjected to thematic analysis. Results: Two competing discourses were identified: 9Patient-focused goal setting9 (enablement, making therapy meaningful, individualising treatment); 9Profession-focused goal setting9 (professional expectations, historic imperative, means of evaluating performance). The former was viewed more positively than the latter. Barriers / facilitators to goal setting arose from environment and person specific factors. Therapeutic environment, physiotherapist experience of goal-setting, the patient9s understanding of their condition and physiotherapy and the degree to which physiotherapists and patients are goal-orientated were all identified as influential. Conclusion: If respiratory physiotherapists are to embrace goal setting, we need wider debate to achieve consensus about the purpose and use of goal setting in respiratory rehabilitation. To cultivate an environment conducive to collaborative goal-setting, provision of adequate time and team support are significant facilitators.
Uzawa (1961) has shown that balanced growth requires technological progress to be strictly Harrod... more Uzawa (1961) has shown that balanced growth requires technological progress to be strictly Harrod neutral (purely labor−augmenting). This paper offers a slightly more general variant of the theorem that does not require assumptions about savings behavior or factor pricing and is much easier to prove.
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Papers by Rachael Summers