34 | Nursing in Practice | Summer 2022

RESEARCH UPDATE

Recent research asked if remote consulting increases health inequalities for homeless people , and whether a family ’ s socioeconomic situation influences the likelihood of antibiotic prescribing to children

Remote primary care during the Covid-19 pandemic for people experiencing homelessness : a qualitative study Homelessness is an ongoing and rising problem in England and other countries . 1 Recent evidence shows widening health inequalities for homeless people , who face challenges with acute and ongoing complex mental , social and physical care needs . 2 The NHS Long Term Plan ( 2019 ) aims to close the inequality gap and recommends prioritisation of vulnerable groups in primary care , 3 but the pandemic obliged the sector to adapt . Remote consultations were introduced for most patients , including those experiencing homelessness . This may have exacerbated inequality of access to healthcare . Howells and colleagues 4 set out to explore the experience and impact of Covid-related changes to healthcare access for people experiencing homelessness . They undertook individual semi-structured interviews with 21 homeless people and 22 clinicians and support workers , from September 2020 until the end of January 2021 . The settings were two commissioned primary care services and a community nurse inclusion health service .

The results showed homeless people faced difficulties due to not always having access to a phone or the means to pay for a phone call . Support workers and clinicians in the community had to further increase their workload by providing or facilitating a face-to-face primary care appointment .

The participants also felt there were challenges with maintaining a therapeutic relationship remotely . Some felt phone appointments were easier for repeat prescription , but they missed the ability to ‘ drop in ’ at their GP practice or day centre for a same-day slot .

The main limitation of the study was the lack of quantitative data , which may have provided evidence on the mode of consultation and number of appointments .

Overall , this study demonstrates that while there are benefits to remote consultation , it should not be the default approach for all . A patient ’ s vulnerability and individual needs should be taken into consideration , as a relationship-based approach is important for trust , continuity of care and reducing inequalities .

References 1 Fitzpatrick S et al . The homelessness monitor : England 2019 . bit . ly / 3GkDYBO . 2 Marmot M et al . Health equity in England : the Marmot review 10 years on . bit . ly / 3sZlRMe . 3 NHS England . The NHS long term plan . 2019 . bit . ly / 3lQ0FEo . 4 Howells K et al . Remote primary care during the COVID-19 pandemic for people experiencing homelessness . BJGP . 2021.0596 . bit . ly / 3aBoyNJ

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

Factors predicting amoxicillin prescribing in primary care among children : a cohort study One in three children under five is prescribed at least one antibiotic a year , 1 and three-quarters of antibiotics prescribed to children in primary care are for respiratory tract infections ( RTIs ). 2 , 3 Antibiotic prescribing contributes to antimicrobial resistance , which is a public health emergency . 4 A study by Miller and colleagues 5 aimed to identify factors associated with amoxicillin prescribing and primary care consultations for RTIs in young children . They undertook a cohort study in Bradford , with data collected from 2007-2013 from hospitals and primary care , and air pollution data . They calculated amoxicillin prescribing rates / 1,000 childyears to establish risk factors for amoxicillin prescribing and consultation for RTI during the first two years of life .

The results showed that , among 2,493 children , the amoxicillin prescribing rate was 710 / 1,000 child-years during the first year and 780 / 1,000 during the second year . The odds of receiving at least one prescription during year one were higher for infants who were male , those who were socioeconomically deprived and those with a Pakistani ethnic background . During the second year they were higher for infants with a Pakistani ethnic background and for preterm or early-term infants . Additional risk factors for antibiotic prescribing included caesarean delivery , congenital irregularities , crowded households and attendance at a formal childcare setting . The main limitation of the study was that data were gathered from families living in Bradford , and therefore may not be generalisable throughout the country .

This study highlights that socioeconomic status and ethnic background are strongly associated with amoxicillin prescribing and primary care consultations for RTI in the first two years of life . Active interventions to prevent the spread of RTIs in household and childcare settings may reduce prescribing and support antimicrobial stewardship in primary care .

References 1 Sun X and Gulliford M . Reducing antibiotic prescribing in primary care in England from 2014 to 2017 . BMJ Open 2019 ; 9 ( 7 ): e023989 . 2 Schneider-Lindner V et al . Secular trends of antibacterial prescribing in UK paediatric primary care . J Antimicrob Chemother 2010 ; 66 ( 2 ): 424- 33 . 3 O ’ Brien K et al . Clinical predictors of antibiotic prescribing for acutely ill children in primary care . Br J Gen Pract 2015 ; 65 ( 638 ): e585-92 . 4 World Health Organization . Global Action Plan on Antimicrobial Resistance 2015 . bit . ly / 3lNZgOV 5 Miller F et al . Factors predicting amoxicillin prescribing in primary care among children . BJGP 2021.0639 . bit . ly / 3Q8kvc8

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