How can patient partnership help to improve equality as COVID-19 moves from pandemic to endemic?The National Health Service (NHS) aims to provide a 'comprehensive service, available to all' and has a 'wider social duty to promote equality through the services it provides' . 1 However, there is evidence from the last decade that inequality is increasing. For example, Public Health England data show from 2010-2012 to 2016-2018 women in the least deprived six deciles gained 0.5 years of life expectancy, while those in the most deprived decile lost 0.3 years. 2 The COVID-19 pandemic has further exacerbated inequalities in several ways. Higher mortality rates were experienced by individuals from more deprived areas. 3 Further to this, impacts of lockdown restrictions on the wider determinants of health, for example education, are being felt disproportionately by those who were already the most disadvantaged in our society. 4 Healthcare's transition from a pandemic footing is more than a theoretical line in the sand. Tackling COVID-19 loaded additional demands on a system already under pressure. There is now a wide gap between public expectations and what we can provide. 5 Consequently, more than ever, there is a case for a shift in approach. Here, I will set out how putting patient partnership front and centre, levelling the power balance between patients, doctors and executives, has the potential to improve equality and assist the NHS in achieving its founding principles.Medical school teaches us the biomedical underpinnings of a plethora of diseases. In theory, forming a differential diagnosis based on a patient's history and examination enables doctors to offer treatments and relieve suffering. However, an individual's health is a fluid point on a continuum, influenced by much more than the list of symptoms and signs we elicit. Each person is a unique intersection of wider determinants that range from housing to employment. 6 These will impact their vulnerability to illness, access to healthcare and the efficacy of treatments. Failing to account for this in interactions with patients has the potential to exacerbate inequalities. The minority who comfortably fit our disease models and have the resources needed to access care will likely have good outcomes. However, many will not fit these criteria. At best some will derive less benefit from treatment. However, for others, an unconsidered approach may precipitate indirect harm. For example, being unable to access treatment due to a lack of transport may increase feelings of exclusion. The psychological effects of this have the potential for wider negative implications for their life. Hope Citadel, a group of primary care practices in GreaterThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Objectives: Personality disorders (PDs) are often conceptualised as impacting individuals throughout their life. However, there has been limited study of the disorders in those over the age of 65. We have used the psychiatric secondary care medical records of 21,971 individuals over the age of 65 from Cambridgeshire, UK, who received care between 2014 and 2021 to characterise older patients with a PD diagnosis. Methods:The data from all patients >65 with a diagnosis of personality disorder (PD) was extracted (n = 217) along with two comparison groups (n = 2170); patients <65 with a diagnosis of PD and patients >65 with a psychiatric diagnosis other than PD or dementia.Results: Compared to younger patients with PD, older patients were more likely to be male, married, suffering from a mixed PD and live in less deprived areas.Compared to patients >65 with diagnoses other than PD, older patients were more likely to be female, single or divorced and had a higher level of social deprivation.Our most striking finding was that older patients with PDs were more likely to experience polypharmacy. A mean of 18.48 different drugs had been prescribed over their lifetime, compared to 9.51 for patients >65 with other mental health diagnoses. Conclusion:Here we present the largest ever description of this group of patients and provide insights that could inform clinical practice and future research.
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