Reducing health inequalities through general practice in the UK: a realist review (EQUALISE)

Abstract Background In the UK, chronic conditions such as cancer, heart disease, stroke, and chronic obstructive pulmonary disease are driving health inequalities in life expectancy and were responsible for two-thirds of premature mortality in 2017. Voices that stress the importance of primary care in reducing health inequalities have been strengthening during the last decade. However, defining the most effective strategies to reduce health inequalities through general practice remains a challenge. Aims This study examines the evidence on interventions in primary care that are likely to decrease inequalities in NCDs and especially cancer, diabetes, cardiovascular and chronic obstructive pulmonary disease and will provide healthcare organisations with guiding principles on what should be commissioned. Methods The study is a realist review following Pawson's model. Based on a programme theory, we screened systematic reviews of interventions delivered in primary care and through their references, we identified primary studies reporting on inequalities across PROGRESS-Plus criteria. The data were analysed in light of the initial program theory and organised in a model informed by Collins’ Domains of Power framework. Results Out of 251 included reviews we retrieved 6,555 primary studies which resulted in 333 studies for data extraction. We found that there are five guiding principles operating simultaneously across four different domains which can reduce health inequalities in General Practice. The principles include flexibility, continuity, inclusivity, intersectionality, and community and operate simultaneously across the domains of structures and policies; narratives and ideas; rules and practices; and relationships and experience. Conclusions Flexibility, continuity, inclusivity, intersectionality, and community are the five principles which should guide the design and delivery of General Practice for the reduction of health inequalities. Key messages • Flexibility, continuity, inclusivity, intersectionality, and community are the five principles which should guide the design and delivery of General Practice for the reduction of health inequalities. • Action to reduce health inequalities should be taken simultaneously across the domains of structures and policies; narratives and ideas; rules and practices; and relationships and experience.


Background:
Whole-body magnetic resonance imaging (MRI) permits noninvasive, non-ionizing phenotyping of the human body and ideally complements the epidemiological assessment of the NAKO participants. As such, it allows for the detection of morphologic or functional predisposition, early disease stages prior to overt clinical events as well as evident pathological changes. The assessment of progression and regression of imaging phenotypes over time will provide the basis to identify and understand the relevance of imaging-based risk factor profiles for disease development.

Methods:
Integrated in the general NAKO study program and managed by a central Imaging Core, study participants underwent whole-body imaging at five dedicated MR imaging sites. Imaging was performed on five identical 3 Tesla scanners (Magnetom Skyra, Siemens Healthineers, Erlangen, Germany) applying a one hour protocol, including sequences for the brain, the cardiovascular and musculoskeletal system as well as for the thorax and abdomen. Comprehensive measures to assure high image quality and management of incidental findings were established.

Results:
As part of the baseline examination program, a total of 30,861 participants successfully underwent the MR imaging program. All measures of quality assurance and incidental findings management were successfully employed throughout the study period and obtained image quality and completeness of all MR sequences was excellent (>94.2% completeness). While MR imaging as part of the first re-examination is ongoing, baseline MRI data is currently accessible for scientific analyses.

Conclusions:
The MRI-Study of the NAKO will provide a comprehensive imaging phenotypic biobank covering different organ systems with highest morphological and functional detail. MRI data analysis will gain novel insights into the natural history of disease development, the role of subclinical disease burden, and revolutionize our understanding of imaging biomarkers of risk.

Background:
In the UK, chronic conditions such as cancer, heart disease, stroke, and chronic obstructive pulmonary disease are driving health inequalities in life expectancy and were responsible for two-thirds of premature mortality in 2017. Voices that stress the importance of primary care in reducing health inequalities have been strengthening during the last decade. However, defining the most effective strategies to reduce health inequalities through general practice remains a challenge.

Aims:
This study examines the evidence on interventions in primary care that are likely to decrease inequalities in NCDs and especially cancer, diabetes, cardiovascular and chronic obstructive pulmonary disease and will provide healthcare organisations with guiding principles on what should be commissioned.

Methods:
The study is a realist review following Pawson's model. Based on a programme theory, we screened systematic reviews of interventions delivered in primary care and through their references, we identified primary studies reporting on inequalities across PROGRESS-Plus criteria. The data were analysed in light of the initial program theory and organised in a model informed by Collins' Domains of Power framework.

Results:
Out of 251 included reviews we retrieved 6,555 primary studies which resulted in 333 studies for data extraction. We found that there are five guiding principles operating simultaneously across four different domains which can reduce health inequalities in General Practice. The principles include flexibility, continuity, inclusivity, intersectionality, and community and operate simultaneously across the domains of structures and policies; narratives and ideas; rules and practices; and relationships and experience. Conclusions: Flexibility, continuity, inclusivity, intersectionality, and community are the five principles which should guide the design and delivery of General Practice for the reduction of health inequalities. Key messages: Flexibility, continuity, inclusivity, intersectionality, and community are the five principles which should guide the design and delivery of General Practice for the reduction of health inequalities.
Action to reduce health inequalities should be taken simultaneously across the domains of structures and policies; narratives and ideas; rules and practices; and relationships and experience.
iii16 European Journal of Public Health, Volume 32 Supplement 3, 2022