Elena Lammila-Escalera

Objectives Structured medication reviews (SMRs) in primary care offer a patient-centred approach to optimising medicines for adults with multimorbidity and polypharmacy, but their effect on endpoint outcomes is not yet well-established. This review summarises their impact on these outcomes and on medicines optimisation, while also highlighting common delivery methods (in-person or remote). Design Systematic review using narrative synthesis. Data sources Ovid MEDLINE, Ovid EMBASE, Web of Science and CINAHL via OVID were searched for studies published between January 1997 and August 2025. Eligibility criteria Studies of adults with multimorbidity and polypharmacy receiving an SMR in primary care, compared with usual care. Randomised controlled trials, non-randomised controlled trials, cohort and cross-sectional designs were eligible. Data extraction and synthesis Two reviewers independently screened studies; one reviewer extracted data and a second verified them. Study quality was assessed using the National Heart, Lung, and Blood Institute quality assessment tools. Findings were synthesised narratively. Results Nine studies (8213 participants) assessed SMRs in relation to physical health (n=5), functional status (n=5), safety (n=2), healthcare utilisation (n=7), cost-effectiveness (n=3) and person-centred outcomes (n=3). Most reported no changes in physical health and falls (n=5), with no improvement in functional status (n=5). Safety outcomes showed no differences in survival or mortality (n=2). Healthcare use was largely unchanged (n=7), with only one study reporting fewer medication-related admissions. Person-centred outcomes remained unchanged (n=2). Cost outcomes were favourable, with savings (n=3) and quality-adjusted life year gains (n=2). SMRs were associated with prescription changes (n=4), reduced inappropriate prescribing (n=3) and improved adherence (n=2), although several between-group comparisons showed no significant differences. SMRs were usually delivered by general practitioners, pharmacists or multidisciplinary teams to older adults, although the mode of delivery (in-person or remote) was often unclear. Conclusions SMRs showed little effect on endpoint outcomes, but most studies focused on prescribing rather than clinical effects, limiting this conclusion. Realising their potential requires supportive policy and collaborative practice. Unclear delivery methods hinder evaluation, and as primary care adopts digital solutions, further research on remote SMRs is needed. Trial registration number PROSPERO CRD42023454965.

Background: Type 2 diabetes (T2D) is one of the most common noncommunicable diseases, requiring ongoing lifestyle changes and continuous glucose management through medication, diet, and physical activity. Traditional self-monitoring of blood glucose can be burdensome, especially with frequent finger pricks. As continuous glucose monitoring (CGM) becomes more affordable and accessible, it offers benefits such as increased glucose awareness, behavioral modifications, and reduced anxiety. However, challenges remain, including cost, discomfort, skin reactions, and privacy concerns. In the United Kingdom, perceptions of CGM among people with T2D, including both users and nonusers, are not well understood, limiting insight into factors influencing adoption and sustained use. Objective: This study aims to explore how adults with T2D perceive the benefits and challenges of using CGM, including both current users and nonusers. Methods: This study used a cross-sectional, online survey using YouGov’s nationally representative panel to explore experiences of CGM among adults with T2D in the United Kingdom. A total of 531 participants were recruited from November to December 2024. Thematic analysis of responses to 2 open-ended questions identified key perceived benefits and challenges associated with CGM use. Results: A total of 531 adults with T2D completed the YouGov online survey. Over half were male (297/531, 55.9%) and aged 65 years and older (281/531, 52.9%). Two-thirds (347/531, 65.3%) had lived with T2D for more than 5 years, and 9.6% (51/531) use or had previously used a CGM. Overall, 50.8% (270/531) responded to at least one free-text question, with 49% (260/531) commenting on benefits and 33.1% (176/531) on challenges. Thematic analysis identified five key benefit themes: (1) reduced monitoring burden, described as eliminating frequent finger prick testing and simplifying daily routines; (2) lifestyle feedback, enabling participants to better understand how diet and physical activity influence glucose levels; (3) greater control, by supporting more informed decision-making and increasing confidence in self-management; (4) feeling safer, through alerts for hypo- and hyperglycemia; and (5) sharing data with clinicians, which facilitated communication and more collaborative care. The main challenges were (1) access barriers, including restrictive eligibility criteria and the high cost of self-funding; (2) device issues, such as discomfort, inconvenience, and practical difficulties wearing the sensor; (3) technology reliance, with concerns about depending on devices rather than listening to bodily cues; (4) emotional strain, including anxiety, over-monitoring, and increased preoccupation with glucose levels; and (5) data concerns, particularly regarding accuracy, interpretation, and privacy. Conclusions: Adults with T2D, including both users and nonusers, described CGM as a practical and empowering tool that improves understanding, safety, and collaboration with health care providers. Nevertheless, access barriers, usability issues, and emotional and data-related burdens remain major obstacles to equitable adoption. Addressing these through improved affordability, digital literacy support, and customized clinical guidance may support ongoing and inclusive CGM use in routine care.

Objectives: To evaluate the National Health Service (NHS) Federated Data Platform (FDP) Inpatient (IP) Care Coordination Solution (CCS) digital scheduling tool on elective theatre utilisation. Methods: An interrupted time series assessed changes in theatre utilisation and cancellations following tool adoption (January 2022). Weekly data spanned 90 weeks (April 2021–December 2023). Outcomes included weekly median theatre utilisation (actual, booked and bookings per session) and the percentage of cancelled bookings. Models incorporated a 5-week lag and estimated level (step-change) and trend (slope) effects. Results: Postintervention level and trend increases were observed for booked (β=4.40, p=0.045; β=0.26, p=0.002) and actual (β=3.98, p=0.064; β=0.23, p=0.006) utilisation. Bookings per session showed a significant level increase (β=0.34, p=0.002) with no trend change (β=0.00, p=0.790). Across the postintervention period, compared with counterfactual estimates, booked and actual utilisation were 15.0% (95% CI 13.4% to 16.5%, p<0.0001) and 12.2% (95% CI 10.8% to 13.5%, p<0.0001) higher, while bookings per session were 10.9% (95% CI 9.5% to 12.4%, p<0.0001) higher. Significant positive effects were observed for urology, general surgery, gynaecology, plastic surgery and ophthalmology. A significant upward trend in cancellation rates was associated with the introduction of the tool (β=2.1, p=0.001). Discussion: Findings suggest that centralised digital scheduling tools can improve theatre capacity by enabling more efficient use of existing capacity through improved scheduling visibility. Future research should explore differences in specialty-level usage and long-term sustainability of gains. Conclusion: The introduction of the NHS FDP IP CCS product was associated with improved elective theatre utilisation.

BACKGROUND Type 2 diabetes (T2D) is one of the most common noncommunicable diseases, requiring ongoing lifestyle changes and continuous glucose management through medication, diet, and physical activity. Traditional self-monitoring of blood glucose can be burdensome, especially with frequent finger pricks. As continuous glucose monitoring (CGM) becomes more affordable and accessible, it offers benefits such as increased glucose awareness, behavioral modifications, and reduced anxiety. However, challenges remain, including cost, discomfort, skin reactions, and privacy concerns. In the United Kingdom, perceptions of CGM among people with T2D, including both users and nonusers, are not well understood, limiting insight into factors influencing adoption and sustained use. OBJECTIVE This study aims to explore how adults with T2D perceive the benefits and challenges of using CGM, including both current users and nonusers. METHODS This study used a cross-sectional, online survey using YouGov’s nationally representative panel to explore experiences of CGM among adults with T2D in the United Kingdom. A total of 531 participants were recruited from November to December 2024. Thematic analysis of responses to 2 open-ended questions identified key perceived benefits and challenges associated with CGM use. RESULTS A total of 531 adults with T2D completed the YouGov online survey. Over half were male (297/531, 55.9%) and aged 65 years and older (281/531, 52.9%). Two-thirds (347/531, 65.3%) had lived with T2D for more than 5 years, and 9.6% (51/531) use or had previously used a CGM. Overall, 50.8% (270/531) responded to at least one free-text question, with 49% (260/531) commenting on benefits and 33.1% (176/531) on challenges. Thematic analysis identified five key benefit themes: (1) reduced monitoring burden, described as eliminating frequent finger prick testing and simplifying daily routines; (2) lifestyle feedback, enabling participants to better understand how diet and physical activity influence glucose levels; (3) greater control, by supporting more informed decision-making and increasing confidence in self-management; (4) feeling safer, through alerts for hypo- and hyperglycemia; and (5) sharing data with clinicians, which facilitated communication and more collaborative care. The main challenges were (1) access barriers, including restrictive eligibility criteria and the high cost of self-funding; (2) device issues, such as discomfort, inconvenience, and practical difficulties wearing the sensor; (3) technology reliance, with concerns about depending on devices rather than listening to bodily cues; (4) emotional strain, including anxiety, over-monitoring, and increased preoccupation with glucose levels; and (5) data concerns, particularly regarding accuracy, interpretation, and privacy. CONCLUSIONS Adults with T2D, including both users and nonusers, described CGM as a practical and empowering tool that improves understanding, safety, and collaboration with health care providers. Nevertheless, access barriers, usability issues, and emotional and data-related burdens remain major obstacles to equitable adoption. Addressing these through improved affordability, digital literacy support, and customized clinical guidance may support ongoing and inclusive CGM use in routine care.

Objectives: To evaluate the NHS Federated Data Platform (FDP) Inpatient Care Coordination Solution (CCS) digital scheduling tool on elective theatre utilisation. Methods: An interrupted time series assessed changes in theatre utilisation and cancellations following tool adoption (January 2022). Weekly data spanned 90 weeks (April 2021 to December 2023). Outcomes included weekly median theatre utilisation (actual, booked, and bookings per session) and the percentage of cancelled bookings. Models incorporated a 5-week lag and estimated level (step-change) and trend (slope) effects. Results: Post-intervention level and trend increases were observed for booked (β=4.40 , P =0.045; β=0.26 , P =0.002) and actual (β=3.98 , P =0.064; β=0.23 , P =0.006) utilisation. Bookings per session showed a significant level increase (β=0.34 , P =0.002) with no trend change (β=0.00 , P =0.790). Across the post-intervention period, compared with counterfactual estimates, booked and actual utilisation were 15.0% (95% CI: 13.4 to 16.5%, P P P P= 0.488), but a significant upward trend was associated with the tool (β=2.1, P =0.001). Discussion: Findings suggest that a centralised digital scheduling tool can improve theatre capacity, while a small increase in cancellation trend likely reflects post-pandemic recovery or improved recording. Future research should explore speciality-level use and the sustainability of observed gains. Conclusion: The introduction of the CCS tool was associated with improved theatre utilisation. Summary box: What is already known on the topic: Inefficient surgical scheduling results in delays in care, suboptimal patient outcomes, and increased costs for healthcare providers. Digital theatre scheduling systems have been developed to enhance scheduling efficiency; however, evidence of their effectiveness from real-world implementations remains limited. Most previous studies focus on theoretical optimisation models rather than practical, system-wide impact in routine care settings. What this study adds: Provides real-world evidence that integrated digital scheduling platforms can enhance elective theatre scheduling, indicating a more efficient use of existing capacity despite variation across specialities. How this study might affect research, practice or policy: Enhanced scheduling efficiency benefits patients by minimising wait times and reducing the risks associated with delays, strengthening the argument for adopting such tools to address the current backlog in elective care. Identifies priorities for future research, including long-term evaluation, factors influencing adoption, and the role of digital scheduling in elective recovery.

The growing adoption of digital health applications (apps) presents new opportunities for General Practitioners (GPs) to enhance care and empower patients. However, little is known about how Portuguese GPs incorporate these apps into their practice. To identify the distinguishing characteristics of Portuguese GPs recommending the use of digital health apps to patients, and to investigate the facilitators and barriers influencing this behaviour. A cross-sectional study was conducted using an online questionnaire distributed to Portuguese GPs between July 2023 and January 2024. Univariate logistic regressions identified predictors of app recommendation. Wilcoxon rank-sum tests compared facilitators and barriers between groups. A total of 126 GPs responded (72.2% women; median age 36 years [IQR: 31.8-43.0]); 45.2% recommended digital health apps. The most common were for apps for physical activity (32.4%), nutrition (21.3%), and chronic disease management (21.3%). Among GPs recommending apps, 70.2% did 1-4 times monthly. Most GPs believed that apps could improve chronic disease self-management (97.6%) and reduce face-to-face consultations (74.6%). GPs recommending apps were more likely to personally use health and fitness apps (OR 3.03), clinical decision apps (OR 3.79), and to believe that apps reduce face-to-face consultations (OR 3.46). GPs not recommending apps more often rated scientific validity as 'very important' (84.1% vs 61.4%, p = 0.006). Nearly half of Portuguese GPs surveyed recommended digital apps, highlighting their potential to support self-management and reduce face-to-face consultation. Broader adoption may depend on fostering greater physician confidence in app use by strengthening the scientific evidence of apps.

Introduction Ineffective surgery scheduling fails to align demand with need, resulting in financial waste, resource inefficiencies and delays in care, which ultimately lead to poorer patient outcomes. Digital systems present a promising approach to optimising scheduling. However, research examining their impact remains limited. This planned systematic review aims to evaluate the effects of digital surgery scheduling systems on the quality of preoperative care. Methods and analysis A systematic review will be undertaken using Ovid MEDLINE, Ovid EMBASE, HMIC and PsycINFO (from inception to the present). The outcomes under investigation include the domains of quality of care (eg, patient-centredness, safety, effectiveness, efficiency, timeliness of care and equity). Two independent reviewers will screen and extract data, resolving any disagreements through discussion. Once eligible studies are identified, the extracted data will be summarised in a table. The risk of bias in the articles will be evaluated using the appropriate National Heart, Lung and Blood Institute quality qssessment tool, depending on the study design. A subgroup analysis will be carried out using demographic variables supported by the data. A narrative synthesis and a meta-analysis will be performed, to quantify the impact of digital surgery scheduling tools on reported outcomes. Ethics and dissemination This proposed review aims to collate and summarise peer-reviewed, published evidence, and therefore, does not require ethical approval. This protocol and the subsequent review will be disseminated in peer-reviewed journals, at conferences and through patient-led lay summaries. PROSPERO registration number: CRD42024625469.

Background Access to electronic health records (EHRs) has the potential to improve the quality of care. Clinical notes, free-text entries documenting clinicians’ observations and decisions, are central to EHRs. Sharing these notes may reduce information asymmetry, enhance transparency and empower patients. However, their impact on care quality remains unclear. Aim To assess the impact of sharing clinical notes online with patients on the domains of quality as defined by the Institute of Medicine (ie, patient-centredness, effectiveness, efficiency, safety, timeliness and equity). Methodology A systematic review was conducted with no time limit, using CINAHL, Cochrane, OVID Embase, HMIC, Medline/PubMed and PsycINFO. A narrative synthesis method was employed to extract the study characteristics, and reported outcomes were organised using the six IOM quality domains. The risk of bias of included studies was assessed using the Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I) tool. Results Nineteen studies involving 203 152 participants met inclusion criteria. Outcomes included patient-centredness (n=16), patient safety (n=14), equity (n=6), efficiency (n=4), timeliness (n=0) and effectiveness (n=0). Patient-centredness studies reported high satisfaction (n=6), increased engagement (n=11) and stronger patient–provider trust (n=7). Patient safety studies noted improvements in medication adherence (n=4) and note accuracy (n=5), alongside privacy concerns (n=5). Equity studies found benefits for minority (n=3) and less-educated patients (n=2), with one reporting equitable outcomes (n=1). No significant changes in efficiency were observed (n=4). Discussion Online sharing of clinical notes with patients positively impacted self-reported patient-centredness and patient safety, particularly benefiting underserved populations. However, privacy concerns must be effectively addressed, and robust safeguarding is essential to mitigate confidentiality issues. Further research is needed to evaluate the long-term impact on timeliness, effectiveness and efficiency of care.

Background: Emergency departments (EDs) globally face unprecedented pressures due to aging populations, multimorbidity, and staff shortages. In response, health systems are adopting technological solutions such as digital kiosks to reduce wait times, improve patient flow, and alleviate overcrowding. These tools can automate patient check-in and assist with triage, helping to reduce variability in assessments and identify individuals with urgent needs sooner. However, it remains unclear whether the potential time-saving benefits of these innovations translate into improved patient outcomes and safety. Objective: This systematic review aims to summarize the safety and efficacy impacts of digital check-in and triage kiosks compared with traditional nurse-led triage methods in EDs. Methods: Comprehensive searches were conducted in MEDLINE, EMBASE, and Web of Science. A narrative synthesis was carried out to evaluate the impact on patient safety (eg, agreement rate, accuracy, sensitivity, and specificity) and efficacy (eg, operational efficiency and patient flow). The quality of the studies was assessed using the National Heart, Lung, and Blood Institute quality assessment tools. Results: A total of 5 studies, comprising 47,778 patients and 310,249 ED visits, were included. Out of these 5 studies, 3 focused on self-check-in kiosks, one on self-triage kiosks, and another on technology combining both. Among 5 studies, 2 evaluated safety, reporting high sensitivity for predicting high-acuity outcomes (up to 88.5%) and low under-triage rates (8.0%-10.1%) but poor agreement with nurse-assigned triage scores (27.0%-30.7%). Specificity for low-acuity cases was variable, with one study reporting as low as 27.2% accuracy. Of the 5 studies, 4 examined efficacy, reporting high over-triage rates (59.2%-65.0%) and mixed impacts on waiting times. While 2 studies found significant reductions in time-to-physician and time-to-triage, others reported no significant improvements following adjustments. Kiosks demonstrated high usability, with one study reporting 97% uptake among ED attendees. Conclusions: Evidence on the safety and efficacy of digital check-in and triage kiosks remains sparse. Based on the limited number of studies available, digital kiosks appear effective in accurately identifying high-acuity patients; however, their impact on operational efficiency measures is unclear. High over-triage rates and poor concordance with nurse-assigned triage scores may limit their practical application in busy ED settings. Further research is required to evaluate long-term outcomes, implementation across diverse health care contexts, and integration into ED workflows to better understand how digital kiosks can safely and effectively help address the growing demand for EDs. Trial Registration: PROSPERO CRD42024481506; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024481506 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2024-084506