Publications by category
Journal articles
Price S, Wiering B, Mounce LTA, Hamilton W, Abel G (2023). Examining methodology to identify patterns of consulting in primary care for different groups of patients before a diagnosis of cancer: an exemplar applied to oesophagogastric cancer. Cancer Epidemiology, 82, 102310-102310.
Fletcher E, Burns A, Wiering B, Lavu D, Shephard E, Hamilton W, Campbell JL, Abel G (2023). Workload and workflow implications associated with the use of electronic clinical decision support tools used by health professionals in general practice: a scoping review.
BMC Primary Care,
24(1).
Abstract:
Workload and workflow implications associated with the use of electronic clinical decision support tools used by health professionals in general practice: a scoping review
Abstract
. Background
. Electronic clinical decision support tools (eCDS) are increasingly available to assist General Practitioners (GP) with the diagnosis and management of a range of health conditions. It is unclear whether the use of eCDS tools has an impact on GP workload. This scoping review aimed to identify the available evidence on the use of eCDS tools by health professionals in general practice in relation to their impact on workload and workflow.
.
. Methods
. A scoping review was carried out using the Arksey and O’Malley methodological framework. The search strategy was developed iteratively, with three main aspects: general practice/primary care contexts, risk assessment/decision support tools, and workload-related factors. Three databases were searched in 2019, and updated in 2021, covering articles published since 2009: Medline (Ovid), HMIC (Ovid) and Web of Science (TR). Double screening was completed by two reviewers, and data extracted from included articles were analysed.
.
. Results
. The search resulted in 5,594 references, leading to 95 full articles, referring to 87 studies, after screening. of these, 36 studies were based in the USA, 21 in the UK and 11 in Australia. A further 18 originated from Canada or Europe, with the remaining studies conducted in New Zealand, South Africa and Malaysia. Studies examined the use of eCDS tools and reported some findings related to their impact on workload, including on consultation duration. Most studies were qualitative and exploratory in nature, reporting health professionals’ subjective perceptions of consultation duration as opposed to objectively-measured time spent using tools or consultation durations. Other workload-related findings included impacts on cognitive workload, “workflow” and dialogue with patients, and clinicians’ experience of “alert fatigue”.
.
. Conclusions
. The published literature on the impact of eCDS tools in general practice showed that limited efforts have focused on investigating the impact of such tools on workload and workflow. To gain an understanding of this area, further research, including quantitative measurement of consultation durations, would be useful to inform the future design and implementation of eCDS tools.
.
Abstract.
Wiering B, Lyratzopoulos G, Hamilton W, Campbell J, Abel G (2021). Concordance with urgent referral guidelines in patients presenting with any of six ‘alarm’ features of possible cancer: a retrospective cohort study using linked primary care records.
BMJ Quality & Safety,
31(8), 579-589.
Abstract:
Concordance with urgent referral guidelines in patients presenting with any of six ‘alarm’ features of possible cancer: a retrospective cohort study using linked primary care records
BackgroundClinical guidelines advise GPs in England which patients warrant an urgent referral for suspected cancer. This study assessed how often GPs follow the guidelines, whether certain patients are less likely to be referred, and how many patients were diagnosed with cancer within 1 year of non-referral.MethodsWe used linked primary care (Clinical Practice Research Datalink), secondary care (Hospital Episode Statistics) and cancer registration data. Patients presenting with haematuria, breast lump, dysphagia, iron-deficiency anaemia, post-menopausal or rectal bleeding for the first time during 2014–2015 were included (for ages where guidelines recommend urgent referral). Logistic regression was used to investigate whether receiving a referral was associated with feature type and patient characteristics. Cancer incidence (based on recorded diagnoses in cancer registry data within 1 year of presentation) was compared between those receiving and those not receiving referrals.Results48 715 patients were included, of which 40% (n=19 670) received an urgent referral within 14 days of presentation, varying by feature from 17% (dysphagia) to 68% (breast lump). Young patients (18–24 vs 55–64 years; adjusted OR 0.20, 95% CI 0.10 to 0.42, p<0.001) and those with comorbidities (4 vs 0 comorbidities; adjusted OR 0.87, 95% CI 0.80 to 0.94, p<0.001) were less likely to receive a referral. Associations between patient characteristics and referrals differed across features: among patients presenting with anaemia, breast lump or haematuria, those with multi-morbidity, and additionally for breast lump, more deprived patients were less likely to receive a referral. of 29 045 patients not receiving a referral, 3.6% (1047) were diagnosed with cancer within 1 year, ranging from 2.8% for rectal bleeding to 9.5% for anaemia.ConclusionsGuideline recommendations for action are not followed for the majority of patients presenting with common possible cancer features. A significant number of these patients developed cancer within 1 year of their consultation, indicating scope for improvement in the diagnostic process.
Abstract.
Gomez-Cano M, Wiering B, Abel G, Campbell JL, Clark CE (2021). Medication adherence and clinical outcomes in dispensing and non-dispensing practices: a cross-sectional analysis.
Br J Gen Pract,
71(702), e55-e61.
Abstract:
Medication adherence and clinical outcomes in dispensing and non-dispensing practices: a cross-sectional analysis.
BACKGROUND: Most patients obtain medications from pharmacies by prescription, but rural general practices can dispense medications. The clinical implications of this difference in drug delivery are unknown. This study hypothesised that dispensing status may be associated with better medication adherence. This could impact intermediate clinical outcomes dependent on medication adherence in, for example, hypertension or diabetes. AIM: to investigate whether dispensing status is associated with differences in achievement of Quality and Outcomes Framework (QOF) indicators that rely on medication adherence. DESIGN AND SETTING: Cross-sectional analysis of QOF data for 7392 general practices in England. METHOD: QOF data from 1 April 2016 to 31 March 2017 linked to dispensing status for general practices with list sizes ≥1000 in England were analysed. QOF indicators were categorised according to whether their achievement depended on a record of prescribing only, medication adherence, or neither. Differences were estimated between dispensing and non-dispensing practices using mixed-effects logistic regression, adjusting for practice population age, sex, deprivation, list size, single-handed status, and rurality. RESULTS: Data existed for 7392 practices; 1014 (13.7%) could dispense. Achievement was better in dispensing practices than in non-dispensing practices for seven of nine QOF indicators dependent on adherence, including blood pressure targets. Only one of ten indicators dependent on prescribing but not adherence displayed better achievement; indicators unrelated to prescribing showed a trend towards higher achievement by dispensing practices. CONCLUSION: Dispensing practices may achieve better clinical outcomes than prescribing practices. Further work is required to explore underlying mechanisms for these observations and to directly study medication adherence rates.
Abstract.
Author URL.
Gomez-Cano M, Wiering B, Abel G, Campbell J, Clark C (2020). Medication adherence and clinical outcomes in dispensing and non-dispensing practices: a cross-sectional analysis. British Journal of General Practice
Wiering B, de Boer D, Krol M, Wieberneit-Tolman H, Delnoij D (2018). Entertaining accurate treatment expectations while suffering from chronic pain: an exploration of treatment expectations and the relationship with patient- provider communication.
BMC Health Serv Res,
18(1).
Abstract:
Entertaining accurate treatment expectations while suffering from chronic pain: an exploration of treatment expectations and the relationship with patient- provider communication.
BACKGROUND: Accurate patient expectations are important to optimise treatment success, especially for complex conditions such as chronic pain. Communication may be the key to managing patient expectations. This study aimed to explore whether health care provider communication influences patient expectations and which communication aspects are most important. METHODS: We conducted secondary analyses on data that had been collected between September and November 2012. 2603 patients suffering from chronic pain were invited to complete a survey. RESULTS: Although 69.9% of patients achieved or surpassed their treatment goal, 30.2% of patients were unsatisfied. Even though overall health care provider communication and shared decision making were unrelated to patient expectations, several affective communication aspects were related. These aspects were attentive listening, taking enough time, building patient's trust in the physician's competence and giving patients the feeling that the physician is doing all he or she can (p's
Abstract.
Author URL.
Wiering B, de Boer D, Delnoij D (2017). Asking what matters: the relevance and use of patient-reported outcome measures that were developed without patient involvement.
HEALTH EXPECTATIONS,
20(6), 1330-1341.
Author URL.
Wiering B, de Boer D, Delnoij D (2017). Patient involvement in the development of patient-reported outcome measures: the developers' perspective.
BMC HEALTH SERVICES RESEARCH,
17 Author URL.
Wiering B, de Boer D, Delnoij D (2017). Patient involvement in the development of patient-reported outcome measures: a scoping review.
HEALTH EXPECTATIONS,
20(1), 11-23.
Author URL.
Wiering B, de Boer D, Delnoij D (2016). Meeting patient expectations: patient preferences and recovery after hip or knee surgery. European Journal of Public Health, 26(suppl_1).
Wiering BM, Noordman J, Tates K, Zwaanswijk M, Elwyn G, De Bont ESJM, Beishuizen A, Hoogerbrugge PM, Van Dulmen S (2016). Sharing decisions during diagnostic consultations; an observational study in pediatric oncology. Patient Education and Counseling, 99(1), 61-67.
Wiering B, de Boer D, Delnoij D (2015). Patient involvement in patient-reported outcome measure development: the developers’ perspectiveBianca Wiering. European Journal of Public Health, 25(suppl_3).
Wiering BM, Albada A, Bensing JM, Ausems MGEM, van Dulmen AM (2013). The influence of dispositional optimism on post-visit anxiety and risk perception accuracy among breast cancer genetic counselees.
PSYCHO-ONCOLOGY,
22(11), 2419-2427.
Author URL.
Conferences
Wiering BM, de Boer D, Delnoij D (2016). Meeting patient expectations: patient preferences and recovery after hip or knee surgery.
Author URL.
Wiering B, De Boer D, Delnoij D (2014). Patient involvement in the development of Patient-reported Outcome Measures: a literature review.
Author URL.
Publications by year
In Press
Fletcher E, Burns A, Wiering B, Lavu D, Shephard E, Hamilton W, Campbell JL, Abel G (In Press). Workload and Workflow Implications Associated with the Use of Electronic Clinical Decision Support Tools Used By Health Professionals in General Practice: a Scoping Review.
Abstract:
Workload and Workflow Implications Associated with the Use of Electronic Clinical Decision Support Tools Used By Health Professionals in General Practice: a Scoping Review
Abstract
. Background: Electronic clinical decision support tools (eCDS) are increasingly available to assist General Practitioners (GP) with the diagnosis and management of a range of health conditions. It is unclear whether the use of eCDS tools has an impact on GP workload. This scoping review aimed to identify the available evidence on the use of eCDS tools by health professionals in general practice in relation to their impact on workload and workflow.Methods: a scoping review was carried out using the Arksey and O’Malley methodological framework. The search strategy was developed iteratively, with three main aspects: general practice/primary care contexts, risk assessment/decision support tools, and workload-related factors. Three databases were searched in 2019, and updated in 2021, covering articles published since 2009: Medline (Ovid), HMIC (Ovid) and Web of Science (TR). Double screening was completed by two reviewers, and data extracted from included articles were analysed.Results: the search resulted in 5,594 references, leading to 91 full articles after screening. of these, 33 studies were based in the USA, 20 in the UK and 11 in Australia. A further 22 originated from Canada or Europe, with the remaining studies conducted in New Zealand, South Africa and Malaysia. Studies examined the use of eCDS tools and reported some findings related to their impact on workload, including on consultation duration. Most studies were qualitative and exploratory in nature, reporting health professionals’ subjective perceptions of consultation duration as opposed to objectively-measured time spent using tools or consultation durations. Other workload-related findings included impacts on cognitive workload, “workflow” and dialogue with patients, and clinicians’ experience of “alert fatigue”.Conclusions: the published literature on the impact of eCDS tools in general practice showed that limited efforts have focused on investigating the impact of such tools on workload and workflow. To gain an understanding of this area, further research, including quantitative measurement of consultation durations, would be useful to inform the future design and implementation of eCDS tools.
Abstract.
2023
Price S, Wiering B, Mounce LTA, Hamilton W, Abel G (2023). Examining methodology to identify patterns of consulting in primary care for different groups of patients before a diagnosis of cancer: an exemplar applied to oesophagogastric cancer. Cancer Epidemiology, 82, 102310-102310.
Fletcher E, Burns A, Wiering B, Lavu D, Shephard E, Hamilton W, Campbell JL, Abel G (2023). Workload and workflow implications associated with the use of electronic clinical decision support tools used by health professionals in general practice: a scoping review.
BMC Primary Care,
24(1).
Abstract:
Workload and workflow implications associated with the use of electronic clinical decision support tools used by health professionals in general practice: a scoping review
Abstract
. Background
. Electronic clinical decision support tools (eCDS) are increasingly available to assist General Practitioners (GP) with the diagnosis and management of a range of health conditions. It is unclear whether the use of eCDS tools has an impact on GP workload. This scoping review aimed to identify the available evidence on the use of eCDS tools by health professionals in general practice in relation to their impact on workload and workflow.
.
. Methods
. A scoping review was carried out using the Arksey and O’Malley methodological framework. The search strategy was developed iteratively, with three main aspects: general practice/primary care contexts, risk assessment/decision support tools, and workload-related factors. Three databases were searched in 2019, and updated in 2021, covering articles published since 2009: Medline (Ovid), HMIC (Ovid) and Web of Science (TR). Double screening was completed by two reviewers, and data extracted from included articles were analysed.
.
. Results
. The search resulted in 5,594 references, leading to 95 full articles, referring to 87 studies, after screening. of these, 36 studies were based in the USA, 21 in the UK and 11 in Australia. A further 18 originated from Canada or Europe, with the remaining studies conducted in New Zealand, South Africa and Malaysia. Studies examined the use of eCDS tools and reported some findings related to their impact on workload, including on consultation duration. Most studies were qualitative and exploratory in nature, reporting health professionals’ subjective perceptions of consultation duration as opposed to objectively-measured time spent using tools or consultation durations. Other workload-related findings included impacts on cognitive workload, “workflow” and dialogue with patients, and clinicians’ experience of “alert fatigue”.
.
. Conclusions
. The published literature on the impact of eCDS tools in general practice showed that limited efforts have focused on investigating the impact of such tools on workload and workflow. To gain an understanding of this area, further research, including quantitative measurement of consultation durations, would be useful to inform the future design and implementation of eCDS tools.
.
Abstract.
2021
Wiering B, Lyratzopoulos G, Hamilton W, Campbell J, Abel G (2021). Concordance with urgent referral guidelines in patients presenting with any of six ‘alarm’ features of possible cancer: a retrospective cohort study using linked primary care records.
BMJ Quality & Safety,
31(8), 579-589.
Abstract:
Concordance with urgent referral guidelines in patients presenting with any of six ‘alarm’ features of possible cancer: a retrospective cohort study using linked primary care records
BackgroundClinical guidelines advise GPs in England which patients warrant an urgent referral for suspected cancer. This study assessed how often GPs follow the guidelines, whether certain patients are less likely to be referred, and how many patients were diagnosed with cancer within 1 year of non-referral.MethodsWe used linked primary care (Clinical Practice Research Datalink), secondary care (Hospital Episode Statistics) and cancer registration data. Patients presenting with haematuria, breast lump, dysphagia, iron-deficiency anaemia, post-menopausal or rectal bleeding for the first time during 2014–2015 were included (for ages where guidelines recommend urgent referral). Logistic regression was used to investigate whether receiving a referral was associated with feature type and patient characteristics. Cancer incidence (based on recorded diagnoses in cancer registry data within 1 year of presentation) was compared between those receiving and those not receiving referrals.Results48 715 patients were included, of which 40% (n=19 670) received an urgent referral within 14 days of presentation, varying by feature from 17% (dysphagia) to 68% (breast lump). Young patients (18–24 vs 55–64 years; adjusted OR 0.20, 95% CI 0.10 to 0.42, p<0.001) and those with comorbidities (4 vs 0 comorbidities; adjusted OR 0.87, 95% CI 0.80 to 0.94, p<0.001) were less likely to receive a referral. Associations between patient characteristics and referrals differed across features: among patients presenting with anaemia, breast lump or haematuria, those with multi-morbidity, and additionally for breast lump, more deprived patients were less likely to receive a referral. of 29 045 patients not receiving a referral, 3.6% (1047) were diagnosed with cancer within 1 year, ranging from 2.8% for rectal bleeding to 9.5% for anaemia.ConclusionsGuideline recommendations for action are not followed for the majority of patients presenting with common possible cancer features. A significant number of these patients developed cancer within 1 year of their consultation, indicating scope for improvement in the diagnostic process.
Abstract.
Gomez-Cano M, Wiering B, Abel G, Campbell JL, Clark CE (2021). Medication adherence and clinical outcomes in dispensing and non-dispensing practices: a cross-sectional analysis.
Br J Gen Pract,
71(702), e55-e61.
Abstract:
Medication adherence and clinical outcomes in dispensing and non-dispensing practices: a cross-sectional analysis.
BACKGROUND: Most patients obtain medications from pharmacies by prescription, but rural general practices can dispense medications. The clinical implications of this difference in drug delivery are unknown. This study hypothesised that dispensing status may be associated with better medication adherence. This could impact intermediate clinical outcomes dependent on medication adherence in, for example, hypertension or diabetes. AIM: to investigate whether dispensing status is associated with differences in achievement of Quality and Outcomes Framework (QOF) indicators that rely on medication adherence. DESIGN AND SETTING: Cross-sectional analysis of QOF data for 7392 general practices in England. METHOD: QOF data from 1 April 2016 to 31 March 2017 linked to dispensing status for general practices with list sizes ≥1000 in England were analysed. QOF indicators were categorised according to whether their achievement depended on a record of prescribing only, medication adherence, or neither. Differences were estimated between dispensing and non-dispensing practices using mixed-effects logistic regression, adjusting for practice population age, sex, deprivation, list size, single-handed status, and rurality. RESULTS: Data existed for 7392 practices; 1014 (13.7%) could dispense. Achievement was better in dispensing practices than in non-dispensing practices for seven of nine QOF indicators dependent on adherence, including blood pressure targets. Only one of ten indicators dependent on prescribing but not adherence displayed better achievement; indicators unrelated to prescribing showed a trend towards higher achievement by dispensing practices. CONCLUSION: Dispensing practices may achieve better clinical outcomes than prescribing practices. Further work is required to explore underlying mechanisms for these observations and to directly study medication adherence rates.
Abstract.
Author URL.
2020
Gomez-Cano M, Wiering B, Abel G, Campbell J, Clark C (2020). Medication adherence and clinical outcomes in dispensing and non-dispensing practices: a cross-sectional analysis. British Journal of General Practice
2018
Wiering B, de Boer D, Krol M, Wieberneit-Tolman H, Delnoij D (2018). Entertaining accurate treatment expectations while suffering from chronic pain: an exploration of treatment expectations and the relationship with patient- provider communication.
BMC Health Serv Res,
18(1).
Abstract:
Entertaining accurate treatment expectations while suffering from chronic pain: an exploration of treatment expectations and the relationship with patient- provider communication.
BACKGROUND: Accurate patient expectations are important to optimise treatment success, especially for complex conditions such as chronic pain. Communication may be the key to managing patient expectations. This study aimed to explore whether health care provider communication influences patient expectations and which communication aspects are most important. METHODS: We conducted secondary analyses on data that had been collected between September and November 2012. 2603 patients suffering from chronic pain were invited to complete a survey. RESULTS: Although 69.9% of patients achieved or surpassed their treatment goal, 30.2% of patients were unsatisfied. Even though overall health care provider communication and shared decision making were unrelated to patient expectations, several affective communication aspects were related. These aspects were attentive listening, taking enough time, building patient's trust in the physician's competence and giving patients the feeling that the physician is doing all he or she can (p's
Abstract.
Author URL.
2017
Wiering B, de Boer D, Delnoij D (2017). Asking what matters: the relevance and use of patient-reported outcome measures that were developed without patient involvement.
HEALTH EXPECTATIONS,
20(6), 1330-1341.
Author URL.
Wiering B, de Boer D, Delnoij D (2017). Patient involvement in the development of patient-reported outcome measures: the developers' perspective.
BMC HEALTH SERVICES RESEARCH,
17 Author URL.
Wiering B, de Boer D, Delnoij D (2017). Patient involvement in the development of patient-reported outcome measures: a scoping review.
HEALTH EXPECTATIONS,
20(1), 11-23.
Author URL.
2016
Wiering BM, de Boer D, Delnoij D (2016). Meeting patient expectations: patient preferences and recovery after hip or knee surgery.
Author URL.
Wiering B, de Boer D, Delnoij D (2016). Meeting patient expectations: patient preferences and recovery after hip or knee surgery. European Journal of Public Health, 26(suppl_1).
Wiering BM, Noordman J, Tates K, Zwaanswijk M, Elwyn G, De Bont ESJM, Beishuizen A, Hoogerbrugge PM, Van Dulmen S (2016). Sharing decisions during diagnostic consultations; an observational study in pediatric oncology. Patient Education and Counseling, 99(1), 61-67.
2015
Wiering B, de Boer D, Delnoij D (2015). Patient involvement in patient-reported outcome measure development: the developers’ perspectiveBianca Wiering. European Journal of Public Health, 25(suppl_3).
2014
Wiering B, De Boer D, Delnoij D (2014). Patient involvement in the development of Patient-reported Outcome Measures: a literature review.
Author URL.
2013
Wiering BM, Albada A, Bensing JM, Ausems MGEM, van Dulmen AM (2013). The influence of dispositional optimism on post-visit anxiety and risk perception accuracy among breast cancer genetic counselees.
PSYCHO-ONCOLOGY,
22(11), 2419-2427.
Author URL.