30 | Nursing in Practice | Spring 2023

RESEARCH UPDATE

A recent study reminds clinicians of the need for greater awareness of the impact of heavy menstrual bleeding , while another reports on how the growth of remote consulting during the pandemic has affected continuity of care

Women ’ s experiences of heavy menstrual bleeding and medical treatment : qualitative study ¹ Recent surveys report that 27-36 % of women suffer from heavy menstrual bleeding ( HMB ) ^{2 , 3} and it is a common reason for consultation in primary care . ⁴ It is widely recognised that HMB can affect the physical , social , emotional and material quality of life . ^{5 , 6}

Dutton and Kai ( 2022 ) ¹ aimed to explore women ’ s experiences of HMB and their medical treatment up to 10 years after initial management in general practice . Between August 2019 and December 2020 , they undertook semi-structured interviews with 36 women who had participated in medical treatments for HMB . The interviews were all conducted by a female health service researcher either face to face in women ’ s homes or by telephone .

Following thematic analysis , four themes were determined : the impact of HMB and its taboo ; understanding and making sense of HMB ; quality of interaction with healthcare professionals ; and influences on treatment choices and experiences of use .

The women revealed they had frequently normalised their experience despite the wide-ranging and debilitating impacts HMB was having on their lives . They often delayed seeking help for a number of years due to the taboo of menstrual bleeding and because they believed that it was self-treatable .

Their experiences of medical treatments varied , but were influenced by the interactions they had with clinicians . The women seeking treatment were also influenced by health concerns , family and peers , fertility and impending menopause .

The main limitation of the study was that the majority of the participants were ethnically similar ; interviews with women from more diverse communities may have yielded a wider range of responses .

Overall , the research highlighted the need for greater awareness among clinicians of the impact of heavy menstrual bleeding on women . Women have different experiences and influences regarding their treatment , therefore a person-centred approach is vital to ensure their needs can be understood and met .

References 1 Dutton , B and Kai , J . Women ’ s experiences of heavy menstrual bleeding and medical treatment : qualitative study . BJGP 20 December 2022 ; BJGP . 2022.0460 . DOI : 10.3399 / BJGP . 2022.0460 . bit . ly / 41xa1Zr

ONLINE Scan the QR code to access the fully referenced article

Lucille Kelsall-Knight is a lecturer in children ’ s nursing at University of Birmingham School of Nursing

How have remote and digital approaches impacted continuity ? A mixed-studies systematic review ¹ Continuity of care is one of the most valuable aspects of primary care . ² The Covid-19 pandemic led to a rapid expansion of remote and digital care models , ³ and it is important to explore their impact on continuity .

Ladds and colleagues ( 2022 ) ¹ undertook a mixedmethods systematic review to explore this question . A systematic search of electronic databases with snowball sampling – whereby the references in a study help find other papers – was used to identify relevant qualitative and quantitative studies . In total , 17 English-language studies were identified , written between 2000 and 2022 , which explored remote or digital approaches in primary care and their effect on continuity . Relevant data were extracted , analysed and narratively synthesised .

The results show the impact on continuity of using remote care models was rarely overtly addressed . Some patients said they preferred continuity , dependent on the presenting problem ; some chose remote if it meant they could see their own GP rather than another . The clinicians placed a value on continuity and some felt remote consultations were more suited to frequent attenders or those who consulted several times for the same problem . However , both patients and clinicians stated that remote consultations were harder , higher risk and of poorer quality for patients who did not frequently require primary care services .

There was some evidence suggesting implementation of remote care models could worsen inequalities and cause harm by reducing continuity of care . However , if implementation of remote and digital care models ensured that continuity was maintained where it was most important , then it could actually be improved .

The main limitation of this systematic review was that only a small number of studies met its inclusion criteria , highlighting the paucity of research specifically addressing continuity in primary care .

Overall , this study demonstrates the value of continuity within primary care . It concludes that the widespread uptake of remote care during the pandemic makes further research in the area even more important .

References 1 Ladds , E . et al . How have remote and digital approaches impacted continuity ? A mixedstudies systematic review . BJGP 23 January 2023 ; BJGP . 2022.0398 . DOI : 10.3399 / BJGP . 2022.0398 . bit . ly / 3L3GS2v

GETTY IMAGES