Imperial College London

DrRichardMa

Faculty of MedicineSchool of Public Health

NIHR Doctoral Research Fellow
 
 
 
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Contact

 

r.ma

 
 
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Location

 

319Reynolds BuildingCharing Cross Campus

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Summary

 

Publications

Publication Type
Year
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113 results found

Cecil E, Dewa L, Ma R, Majeed F, Aylin Pet al., 2021, General practitioner and nurse practitioner attitudes towards electronic reminders in primary care: A qualitative analysis, BMJ Open, Vol: 11, ISSN: 2044-6055

Objectives Reminders in primary care administrative systems aim to help clinicians provide evidence-based care, prescribe safely and save money. However, increased use of reminders can lead to alert fatigue. Our study aimed to assess general practitioners’ (GPs) and nurse practitioners’ (NPs) views on electronic reminders in primary care.Design A qualitative analysis using semistructured interviews.Setting and participants Fifteen GPs and NP based in general practices located in North-West London and Yorkshire, England.Methods We collected data on participants’ views on: (1) perceptions of the value of information provided; (2) reminder-related behaviours and (3) how to improve reminders. We carried out a thematic analysis.Results Participants were familiar with reminders in their clinical systems and felt many were important to support their clinical work. However, participants reported, on average, 70% of reminders were ignored. Four major themes emerged: (1) reaction to a reminder, which was mixed and varied by situation. (2) Factors influencing the decision to act on reminders, often related to experience, consultation styles and interests of participants. Time constraints, alert design, inappropriate presentation and litigation were also factors. (3) Negative consequences of using reminders were increased workload or costs and compromising GP and NPs behaviour. (4) Factors relating to improving users’ engagement with reminders were prevention of unnecessary reminders through data linkage across healthcare administrative systems or the development of more intelligent algorithms. Participants felt training was vital to effectively manage reminders.Conclusions GPs and NPs believe reminders are useful in supporting the provision of good quality patient care. Improving GPs and NPs’ engagement with reminders centres on further developing their relevance to their clinical practice, which is personalised, considers cognitive workflow and s

Journal article

Gillespie D, Knapper C, Hughes D, Couzens Z, Wood F, de Bruin M, Ma R, Jones AT, Williams A, Hood Ket al., 2021, Early impact of COVID-19 social distancing measures on reported sexual behaviour of HIV pre-exposure prophylaxis users in Wales, SEXUALLY TRANSMITTED INFECTIONS, Vol: 97, Pages: 85-87, ISSN: 1368-4973

Journal article

Ma R, Cecil E, Bottle A, French R, Saxena Set al., 2020, Impact of a pay-for-performance scheme for long-acting reversible contraceptive (LARC) advice on contraceptive uptake and abortion in British primary care: An interrupted time series study, PLoS Medicine, Vol: 17, Pages: e1003333-e1003333, ISSN: 1549-1277

BackgroundLong-acting reversible contraception (LARC) is among the most effective contraceptive methods, but uptake remains low even in high-income settings. In 2009/2010, a target-based pay-for-performance (P4P) scheme in Britain was introduced for primary care physicians (PCPs) to offer advice about LARC methods to a specified proportion of women attending for contraceptive care to improve contraceptive choice. We examined the impact and equity of this scheme on LARC uptake and abortions.Methods and findingsWe examined records of 3,281,667 women aged 13 to 54 years registered with a primary care clinic in Britain (England, Wales, and Scotland) using Clinical Practice Research Datalink (CPRD) from 2004/2005 to 2013/2014. We used interrupted time series (ITS) analysis to examine trends in annual LARC and non-LARC hormonal contraception (NLHC) uptake and abortion rates, stratified by age and deprivation groups, before and after the P4P was introduced in 2009/2010. Between 2004/2005 and 2013/2014, crude LARC uptake rates increased by 32.0% from 29.6 per 1,000 women to 39.0 per 1,000 women, compared with 18.0% decrease in NLHC uptake. LARC uptake among women of all ages increased immediately after the P4P with step change of 5.36 per 1,000 women (all values are per 1,000 women unless stated, 95% CI 5.26–5.45, p < 0.001). Women aged 20 to 24 years had the largest step change (8.40, 8.34–8.47, p < 0.001) and sustained trend increase (3.14, 3.08–3.19, p < 0.001) compared with other age groups. NLHC uptake fell in all women with a step change of −22.8 (−24.5 to −21.2, p < 0.001), largely due to fall in combined hormonal contraception (CHC; −15.0, −15.5 to −14.5, p < 0.001). Abortion rates in all women fell immediately after the P4P with a step change of −2.28 (−2.98 to −1.57, p = 0.002) and sustained decrease in trend of −0.88 (−1.12 to −0.63, p < 0.001). The largest

Journal article

Ma R, Cecil E, French R, Bottle A, Saxena Set al., 2020, Impact of financial incentives for primary care to give long acting reversible contraceptive advice, Publisher: OXFORD UNIV PRESS, ISSN: 1101-1262

Conference paper

Rai T, Bruton P, Kall M, Ma R, Pufall E, Day S, Delpech V, Ward Het al., 2019, Experience of primary care for people with HIV: a mixed-method analysis, British Journal of General Practice, Vol: 3, ISSN: 0960-1643

BackgroundAdvances in treatment have transformed HIV into a long-term condition (LTC), presenting freshchallenges for health services, HIV specialists and general practitioners (GPs).AimTo explore the experience of people living with HIV (PLHIV) regarding using their GPs.Design and settingA mixed-method analysis using data from two sources: a nationally-representative survey of PLHIVand a qualitative study with London-based PLHIV.MethodsUnivariate logistic regression for quantitative data and Framework analysis for qualitative data.ResultsThe survey had 4,422 participants; the qualitative study included 52 participants. In both studies, GPregistration and HIV status disclosure were high. Similar to general population trends, recent GP usewas associated with poor self-rated health status, co-morbidities, older age and lower socioeconomic status. Two-thirds reported a good experience with GPs; a lower proportion feltcomfortable asking HIV-related questions. Actual or perceived HIV stigma were consistentlyassociated with poor satisfaction. In the interviews, participants with additional LTCs valuedsensitive and consistent support from GPs. Some anticipated, and sometimes experienced, problems relating to HIV status, GPs’ limited experience and time to manage their complex needs. Sometimesthey took their own initiatives to facilitate coordination and communication. For PLHIV, a ‘good’ GPoffered continuity and took time to know and accept them without judgement.ConclusionWe suggest clarification of roles and provision of relevant support to build confidence in GPs andprimary care staff to care for PLHIV. As PLHIV population ages, there is a strong need to developtrusting patient/GP relationships and HIV-friendly GP practices.

Journal article

Cecil E, Bottle RA, Ma R, Hargreaves D, Wolfe I, Mainous III AG, Saxena Set al., 2018, Impact of preventive primary care on children’s unplanned hospital admissions; population-based birth cohort study of UK children 2000-2013, BMC Medicine, Vol: 16, ISSN: 1741-7015

BackgroundUniversal health coverage (UHC) aims to improve child health through preventive primary care and vaccine coverage. Yet, in many developed countries with UHC, unplanned and ambulatory care sensitive (ACS) hospital admissions in childhood continue to rise. We investigated the relation between preventive primary care and risk of unplanned and ACS admission in children in a high-income country with UHC.MethodsWe followed 319,780 children registered from birth with 363 English practices in Clinical Practice Research Datalink linked to Hospital Episodes Statistics, born between January 2000 and March 2013. We used Cox regression estimating adjusted hazard ratios (HR) to examine subsequent risk of unplanned and ACS hospital admissions in children who received preventive primary care (development checks and vaccinations), compared with those who did not.ResultsOverall, 98% of children had complete vaccinations and 87% had development checks. Unplanned admission rates were 259, 105 and 42 per 1000 child-years in infants (aged < 1 year), preschool (1–4 years) and primary school (5–9 years) children, respectively.Lack of preventive care was associated with more unplanned admissions. Infants with incomplete vaccination had increased risk for all unplanned admissions (HR 1.89, 1.79–2.00) and vaccine-preventable admissions (HR 4.41, 2.59–7.49). Infants lacking development checks had higher risk for unplanned admission (HR 4.63, 4.55–4.71). These associations persisted across childhood. Children who had higher consulting rates with primary care providers also had higher risk of unplanned admission (preschool children: HR 1.17, 1.17–1.17). One third of all unplanned admissions (62,154/183,530) were for ACS infectious illness. Children with chronic ACS conditions, asthma, diabetes or epilepsy had increased risk of unplanned admission (HR 1.90, 1.77–2.04, HR 11.43, 8.48–15.39, and HR 4.82, 3.93–5.91, respective

Journal article

Ma R, 2018, Patients at risk of STIs not attending sexual health services, Practitioner, Vol: 262, Pages: 10-10, ISSN: 0032-6518

Journal article

Ma R, 2018, Exploring the barriers to fitting IUCDs in primary care, Practitioner, Vol: 262, Pages: 9-9, ISSN: 0032-6518

Journal article

Ma RMMN, Dixon M, 2018, Should all patients be asked about their sexual orientation?, BMJ, Vol: 360, ISSN: 0959-8138

Journal article

Chirwa M, Ma R, Guallar C, Tariq Set al., 2017, Managing menopause in women living with HIV: A survey of primary care practitioners., Post Reproductive Health, Vol: 23, Pages: 111-115, ISSN: 2053-3705

Objective One in three women living with HIV (WLHIV) in the UK is aged 45-56, and therefore of potentially menopausal age. Little is known about the management of menopause in WLHIV in primary care. We aim to describe current knowledge and practice in the management of menopause in WLWH among primary care practitioners (PCPs). Methods A questionnaire-based study of 88 PCPs attending two sexual and reproductive health conferences. Results Almost all respondents (n = 87, 99%) routinely managed women with menopause-related symptoms; however, only 18 (20%) reported having managed menopause in WLHIV. Over 95% (n = 85) reported being confident in managing menopause in general, whereas less than half (n = 40) reported confidence in managing menopause in WLHIV ( p < 0.001). The majority of respondents (n = 84) felt that menopause should be routinely managed in primary care, whereas just over half thought that menopause in WLHIV should be managed in primary care (n = 50, p < 0.001). Almost all respondents (n = 85) reported concerns about managing menopause in WLHIV. Conclusion PCPs reported limited experience of and low levels of confidence in managing menopause-related symptoms in WLHIV. Nearly all PCPs had concerns about managing menopause-related symptoms in WLHIV, many stating that this should be managed outside primary care. Development of national guidance and specialised training, coupled with good liaison between HIV services and PCPs, may improve confidence in this area.

Journal article

Ma R, 2017, Chlamydia and HIV testing for young people in primary care, Practitioner, Vol: 261, Pages: 9-10, ISSN: 0032-6518

Journal article

Ma RMMN, Saxena S, Cecil E, 2017, Can Clinical Practice Research Datalink (CPRD) be used to study trends in recorded abortions in UK general practice?, Faculty of Sexual and Reproductive Healthcare Annual Scientific Conference

Conference paper

Ma R, 2017, Sexually transmitted infections managed in primary care, Women's Health in Primary Care, Editors: Connolly, Britton, Publisher: Cambridge University Press, Pages: 37-44, ISBN: 9781316537398

Book chapter

Ma R, 2016, Saliva may be a vehicle for gonorrhoea transmission, Practitioner, Vol: 260, Pages: 11-12, ISSN: 0032-6518

Journal article

Ma R, 2016, Does the choice of forceps during IUD insertion affect pain scores?, Practitioner, Vol: 260, Pages: 9-9, ISSN: 0032-6518

Journal article

Ma R, 2016, England's teenage pregnancy strategy has been a success: now let's work on the rest, LANCET, Vol: 388, Pages: 1981-1981, ISSN: 0140-6736

Journal article

Ma R, Shah R, 2016, Are medical educators in general practice untapped potential to increase training capacity in sexual and reproductive healthcare? Results of a survey in London, UK, London Journal of Primary Care, Vol: 8, Pages: 85-90, ISSN: 1757-1472

BackgroundLong waiting times for training in sexual and reproductive healthcare (SRH) including long acting reversible contraception (LARC) might lead to attrition from training programmes, leading to reduced capacity for sexual health services, and reduced access to such contraception for women.SettingGeneral practice in London, UK.QuestionCan medical educators in general practice be used as untapped potential to train other health care professionals in sexual and reproductive healthcare?MethodWe conducted an online survey to find out the qualifications, skills and willingness of established educators in primary care in London to train other clinicians in sexual and reproductive healthcare, including LARC.ResultsWe received 124 responses from medical educators (10.1% response rate from general practitioner (GP) trainers and 59.0% of clinical supervisors for Foundation Year doctors). 86 (69.9%) had diploma of the Faculty of Sexual and Reproductive Healthcare (DFSRH) qualification and further 18 (14.6%) were interested in obtaining this qualification. Eleven respondents were trained to fit intrauterine contraception only, three for contraceptive implants only and 37 were trained to fit both. 50 (40.3%) of 124 respondents were willing get involved in DFSRH training; 74% of these were willing to teach on any component of DFSRH including LARC.DiscussionThere is a shortage of training places and long waiting list for clinicians who wish to train in SRH. This survey suggests there is a pool of GP educators with skills and experience in SRH and are willing to train others. This can potentially increase the training capacity and improve overall access to good contraception and LARC for women.Keywords: Contraception, professional education, general practice, reproductive health, sexually transmitted diseasesImpact statementStrategies to reduce unplanned pregnancies and abortions must include timely access to information and wide range of contraception including LARC for wome

Journal article

Ma R, 2016, Chlamydia infection raises long-term risk of reproductive complications., Practitioner, Vol: 260, Pages: 5-5, ISSN: 0032-6518

Journal article

Ma R, 2016, Lidocaine spray reduces pain during IUD insertion, Practitioner, Vol: 260, Pages: 9-9, ISSN: 0032-6518

Journal article

Ma R, 2016, Does vasectomy affect sexual function?, Practitioner, Vol: 260, Pages: 8-8, ISSN: 0032-6518

Journal article

Ma R, 2016, Recreational use of drugs to enhance sexual performance, Practitioner, Vol: 260, ISSN: 0032-6518

Journal article

Ma R, 2016, Pill use before or during pregnancy does not raise risk of birth defects., Practitioner, Vol: 260, ISSN: 0032-6518

Journal article

Ma R, Perera S, 2016, Safer 'chemsex': GPs' role in harm reduction for emerging forms of recreational drug use, British Journal of General Practice, Vol: 66, Pages: 4-5, ISSN: 1478-5242

Journal article

Ma R, 2016, The alien sex club, British Journal of General Practice, Vol: 66, Pages: 42-42, ISSN: 0960-1643

Journal article

Ma R, 2015, Is mine a normal size doctor?, Practitioner, Vol: 259, ISSN: 0032-6518

Journal article

Ma R, 2015, Shortfalls in primary care management of HIV, Practitioner, Vol: 259, ISSN: 0032-6518

Journal article

Ma RMMN, 2015, Light and shade behindthe opt-out system forthe HIV screening, The lancet HIV, ISSN: 2352-3018

Journal article

Ma R, 2015, Identifying factors associated with unplanned pregnancy, Practitioner, Vol: 259, ISSN: 0032-6518

Journal article

Ma R, 2015, How do patients with STIs inform their partners?, Practitioner, Vol: 259, ISSN: 0032-6518

Journal article

Ma R, 2015, Hormonal contraception use and acquisition of HIV, Practitioner, Vol: 259, ISSN: 0032-6518

Journal article

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