Showing papers in "Family Practice in 1999"
TL;DR: Patients in different cultures and health care systems may have different views on some aspects of care, but most of all that they have many views in common, particularly as far as doctor-patient communication and accessibility of services are concerned.
Abstract: BACKGROUND AND OBJECTIVES Improving the sensitivity of general practice to patients' needs demands a good understanding of patients' expectations and priorities in care provision. Insight into differences in expectations of patients in different cultures and health care systems may support decision-making on desirable models for care provision in general practice. An international study was conducted to determine priorities of patients in general practice care: which views do patients in different countries have in common and which views differ? METHODS Written surveys in general practices in the UK, Norway, Sweden, Denmark, The Netherlands, Germany, Portugal and Israel were performed. Samples of patients from at least 12 practices per country, stratified according to area and type of practice, were included. Patients rated the importance of 38 different aspects of general practice care, selected on the basis of literature analysis, qualitative studies and consensus discussions. Rankings between countries were compared. RESULTS A total number of 3540 patients (response rate on average 55%) completed the questionnaire. Patients in different countries had many opinions in common. Aspects that got the highest ranking were: getting enough time during the consultation; quick services in case of emergencies; confidentiality of information on patients; telling patients all they want to know about their illness; making patients feel free to talk about their problems; GPs going to courses regularly; and offering preventive services. However, differences between opinions of patients in different countries were also found for some of the selected aspects. A confounding effect of patients' characteristics may have played a role in these differences. DISCUSSION The study provides information on what patients expect of and value in general practice care. It shows that patients in different cultures and health care systems may have different views on some aspects of care, but most of all that they have many views in common, particularly as far as doctor-patient communication and accessibility of services are concerned.
288 citations
TL;DR: Evidence from pilot studies of cystic fibrosis screening provides the strongest evidence for the feasibility of providing genetic services in primary care, and potential methods of supporting primary care in the provision of genetics services are defined.
Abstract: Background In response to growing demands on genetics departments and advances in genetic medicine, it has been proposed that primary care should provide a frontline service in clinical genetics. However, there are concerns that primary care may be unwilling or ill prepared to take on this new role. Objectives This study aimed to review systematically the literature exploring the role of primary care in delivering genetic services, and define potential methods of supporting primary care in the provision of genetics services. Methods Seven electronic databases were searched. This was complemented by contacting experts in the field and handsearching reference lists. In total, 230 papers were identified, including traditional reviews, of which 96 were examined in detail. Fifty-one papers are included in this review. On account of the heterogeneity of papers identified, we conducted a qualitative synthesis of the results, focusing on five key questions. Results GPs accept that they have an increasing role to play in genetics, but lack confidence in their ability to do so because of limited knowledge of clinical genetics. Evidence from pilot studies of cystic fibrosis screening provides the strongest evidence for the feasibility of providing genetic services in primary care. Conclusions Although genetic issues currently constitute a relatively small part of the overall workload in primary care, this will almost certainly change in the light of new genetic discoveries. Educational programmes and referral guidelines, computer decision support and genetic nurse specialist outreach clinics may provide useful methods of supporting GPs in the new field of primary care genetics.
183 citations
TL;DR: If primary care is to become more involved in the delivery of genetic services in the future, then a major educational effort is required to raise awareness of the potential scope and limitations of new developments.
Abstract: BACKGROUND Given the limited specialist resources available to cope with the rising demand for genetic services, it has been proposed that at least some of these services are provided by primary care in the future. OBJECTIVE We aimed to explore GPs' attitudes towards new developments in genetics, to establish the role they envisage for primary care and to clearly define the education, information and training needed to support them in this role. METHODS We carried out a qualitative study with GPs using four focus groups (26 GPs) and 15 individual semi-structured interviews. RESULTS GPs perceive genetics as an important and increasingly relevant topic for primary care. Views on the appropriate level of involvement for primary care are mixed. GPs currently lack the relevant knowledge and skills to manage patients concerned about their family history. Other potential barriers to increasing primary care involvement included the time and costs involved, and ethical and legal concerns. CONCLUSION If primary care is to become more involved in the delivery of genetic services in the future, then a major educational effort is required to raise awareness of the potential scope and limitations of new developments.
176 citations
TL;DR: GPs readily identify a role for themselves in cancer genetics services, but admit to a lack of confidence in this area, calling for clear referral guidelines and specialist community support.
Abstract: Results. GPs identified their role to be: taking a family history; making appropriate referrals to specialist services; providing emotional support; teaching breast self-examination; and discussing need for screening. Lack of confidence within this role was reflected in low levels of understanding of cancer genetics and in inappropriate referral practices. Concerns were expressed about the increasingly specialist role demanded of primary care. A desire for referral guidelines and community genetics clinics was identified. Conclusions. GPs readily identify a role for themselves in cancer genetics services, but admit to a lack of confidence in this area, calling for clear referral guidelines and specialist community support. Current inappropriate referral to specialist services results from a lack of confidence in estimating cancer risk, highlighting the need for the development of clear referral criteria. Given the rapidly increasing demand for cancer genetics services and the vital role of primary care, it is important to identify a model of these services that facilitates effective involvement of GPs without further increasing their workload.
144 citations
TL;DR: LBP in general practice has a good prognosis with regard to sick leave, but a high proportion of patients continue to complain of LBP, and the overall assessment by the GPs seems to be the most important predictor associated with the long-term outcome.
Abstract: OBJECTIVES We aimed to examine the prognosis of acute low back pain (LBP) in patients in general practice and to identify prognostic factors associated with the long-term prognosis based on information immediately available to the GP. METHOD We conducted a prospective cohort study in general practice in Denmark. The patients were those aged 18-60 years consulting their GP due to an episode of LBP lasting less than 2 weeks. The GPs collected data regarding 34 exposure variables, including their global assessment of the likelihood of chronic LBP. Outcome variables were collected from the patients after 1, 6 and 12 months. The outcome measures were days on sick leave, and functional or complete recovery from LBP. RESULTS In total, 503 (96%) patients were followed during the whole study period. Fifty per cent of the patients on sick leave returned to work within 8 days; after 1 year, only 2% remained on sick leave. At the 1-year follow-up, 45% of the patients continued to complain of LBP. Logistic regression analyses showed that the factors most significantly associated with poor long-term LBP outcome were (i) severity of LBP at inclusion, (ii) assessments by the GP of susceptibility to develop chronic LBP and (iii) a history of LBP having caused previous sick leave. CONCLUSIONS LBP in general practice has a good prognosis with regard to sick leave, but a high proportion of patients continue to complain of LBP. We were not able to identify objective measures that strongly predict the prognosis of the individual LBP patient. The overall assessment by the GPs seems to be the most important predictor associated with the long-term outcome.
141 citations
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137 citations
TL;DR: The Australian GPs in this study had mixed views about the increasing profile of evidence-based medicine, and the use of this paradigm in practice.
Abstract: Background. Over the last 6 years there has been an exponential increase in the publication of medical literature on evidence-based medicine. In Australia, as in many other parts of the world, there have been calls for an increase in the practice of evidence-based medicine. In general practice, two major themes of criticism have been the lack of relevant research evidence in primary care and the failure of evidence-based medicine to take into account the complexity of the consultation. Objective. We aimed to explore the attitudes of Australian GPs to evidence-based medicine. Methods. We conducted a qualitative study using evidence-based guidelines as a model to explore attitudes within focus group interviews. Focus group data were analysed using grounded theory methodology. The study was set in the Australian cities Melbourne, Adelaide and Darwin. The subjects were 27 GPs in five focus groups. Results. Data were used to generate a model illustrating factors affecting the consideration and use of evidence within consultations. Prior beliefs and experience had a strong influence on decision-making. Overall, the GPs had a positive attitude to evidence-based medicine and stated that this could be a helpful strategy for meeting their information needs. These needs arose during the consultation and were frequently generated by patients. The evidence-based approach was regarded as particularly useful when patients required validation of their management or had specific queries. However, the GPs also expressed some concerns, such as the application of evidence from clinical trials to individuals, and the appropriateness of using research evidence with certain patients. They also feared a move away from the ‘art of medicine’. None of the GPs expressed a need for critical appraisal skills. Conclusions. The Australian GPs in this study had mixed views about the increasing profile of evidence-based medicine, and the use of this paradigm in practice. Acceptability was more likely to be influenced by relevance to general practice and local contextual and patient factors than by the strength, or critical quality of the evidence.
126 citations
TL;DR: As a large proportion of chronic pain presents only in the community, there may be a role for greater primary care input to management, and full assessment of the patient will improve his or her outlook.
Abstract: Chronic pain is a very common cause of suffering, disability and economic adversity in the community. It is a complex problem that needs to be understood in a multi-dimensional way for effective management. Most research to date has been based in specialist clinics rather than in primary care, with consequently limited findings. Chronic pain differs from acute pain in that management follows a rehabilitative rather than a treatment model, though these are not mutually exclusive. Full assessment of the patient, preferably multi-disciplinary, will improve his or her outlook. Management should be holistic, rigorous in the application of conventional therapies (including analgesics and physical therapy) and ready to admit an improved understanding of psychological and social techniques. There may be a role for complementary therapies. As a large proportion of chronic pain presents only in the community, there may be a role for greater primary care input to management.
116 citations
TL;DR: Drug prescribing in general practice for elderly patients is described, using patients' age and sex, encounters, indications for prescribing and the occurrence of some predefined inappropriate drug prescriptions to identify prescribing problems.
Abstract: BACKGROUND Elderly patients are particularly vulnerable and most at risk of suffering adverse drug reactions, which are often caused by inappropriate prescribing practice. Gaining insight into physicians' drug prescribing patterns in order to identify prescribing problems is the fundamental first step in trying to improve the quality of prescribing. OBJECTIVES We aimed to describe drug prescribing in general practice for elderly patients, using patients' age and sex, encounters, indications for prescribing and the occurrence of some predefined inappropriate drug prescriptions. METHODS A cross-sectional, descriptive study was conducted in the Norwegian county of More & Romsdal. All patient contacts (n = 16 874) and prescriptions (n = 16 774) issued during two months in general practice were recorded. In defining inappropriate prescriptions, explicit criteria were used. RESULTS Prescriptions (of which 72% were repeat) were issued during two-thirds of all contacts, and 63% were for females. Seventy per cent of all prescriptions were made up by the ten most commonly prescribed therapeutic groups, for which the three most frequent diagnostic indications for prescribing comprised between 47 and 89% of all diagnoses for prescribing each of them. About one in six patients who received a benzodiazepine tranquillizer was concurrently prescribed another benzodiazepine for sleeping problems. In total, 13.5% of all prescriptions met at least one of the criteria listed for pharmacological inappropriateness. CONCLUSION Inappropriate drug prescriptions for elderly patients are common in general practice. Since the majority of the prescribing practice is made up by rather few diagnoses and drugs, improved practice for only a few may nevertheless have a large impact on the total profile.
111 citations
TL;DR: It is recognized that health promotion involves more than the provision of simple information and advice, but GPs and practice nurses lack confidence in lifestyle counselling skills, and beliefs in the effectiveness of lifestyle counselling were associated with positive attitudes towards health promotion and greater confidence in training.
Abstract: Background. Cardiovascular health promotion is an important element of national health strategy, but doubts have been raised about current methods, and attitudes among general practice staff are ambivalent. Objectives. We aimed to assess attitudes to cardiovascular health promotion, opinions about efficacy and perceptions of skills in lifestyle counselling in GPs and nurses from the same practices. Method. A questionnaire survey of 107 GPs and 58 practice nurses from 19 group practices (100% response rate). Results. Practice nurses were seen to have the main responsibility for cardiovascular health promotion. Although attitudes to health promotion were generally positive, lack of training in lifestyle counselling was perceived to be a problem. Few responders believed that they were very influential in helping people change their lifestyles. Beliefs about the effectiveness of lifestyle counselling were mixed, with cigarette smoking, physical inactivity a nd obesity bei ng seen as difficult to change. Beliefs in the effectiveness of lifestyle counselling were associated with positive attitudes towards health promotion and greater confidence in training. No association between personal health behaviour and attitudes towards health promotion were observed. Conclusions. It is recognized that health promotion involves more than the provision of simple information and advice, but GPs and practice nurses lack confidence in lifestyle counselling skills. The attitudes of health professionals are crucial to the implementation of prevention strategies and require regular review.
109 citations
TL;DR: It is argued that the incommensurability of these models lies at the root of the CLBP consultation as a problem, while doctors operate using a model that stresses psychosocial factors.
Abstract: Background: Chronic low back pain (CLBP) is a symptom commonly presented to GPs, accounting for a significant proportion of their workload. It is also a common reason for sickness absence, and thus of national economic importance. Objectives: This qualitative study aimed to provide an understanding of how GPs understood CLBP, how they approached the consultation with CLBP patients and how they conceptualized the management of this problem. Method: Qualitative research techniques were employed. Twenty GPs working in North-West England were interviewed. Interviews were semi-structured and recorded on audio-tape. Transcripts of these interviews were then subjected to constant comparative qualitative analysis. Results: Subjects described their difficulties in responding to and managing CLBP. They acknowledged the link between CLBP and psychological distress, and that it legitimizes long-standing illness behaviour. They were pessimistic about the chances for successful cure or palliation of CLBP. Conclusion: Subjects seemed to be cognisant of collusion between doctor and patient, in cases where the patient's explanatory model of back pain is not challenged. We argue that this can be accounted for by the patient operating within a physical model of pain causation, while doctors operate using a model that stresses psychosocial factors. The incommensurability of these models lies at the root of the CLBP consultation as a problem.
TL;DR: The results suggest that GPs have a good level of knowledge of the health benefits of regular physical activity and the levels required to achieve these, but do not promote activity in a way that will have an impact on the population level.
Abstract: Background GPs have the potential to increase population levels of activity and thus produce important health gains. Objectives and methods The aim of this questionnaire survey was to determine the knowledge, attitudes and self-reported practice of GPs towards promoting regular physical activity and to assess the likely impact of GPs on population levels of physical activity. Results and conclusions A high response rate to the questionnaire was obtained and the results suggest that GPs have a good level of knowledge of the health benefits of regular physical activity and the levels required to achieve these, but do not promote activity in a way that will have an impact on the population level.
TL;DR: Whether 'brown bag' medication review could be used successfully in the UK, and particularly whether it represents an efficient and potentially cost-effective means of identifying medication problems, is investigated.
Abstract: Background 'Brown bag' medication reviews carried out by community pharmacists collaborating with GPs have become established, in the USA and elsewhere, as an effective means of helping primary care patients to derive maximum benefit from their medicines, of identifying medication-related problems and of reducing wastage of medicines. Objective We aimed to determine whether 'brown bag' medication review could be used successfully in the UK, and particularly whether it represents an efficient and potentially cost-effective means of identifying medication problems. Method 'Brown bag' medication reviews were carried out on 205 volunteer patients in 23 pharmacies in south-east London. Pharmacists' interventions to improve patients' knowledge and usage of their medicines were analysed. Potential clinical problems identified by pharmacists were analysed in order to identify the drug groups most likely to cause problems. Results Interventions were made in 87% of reviews; interventions to improve patients' knowledge of the purpose and correct usage of their drugs were made in 65% of reviews. In 12% of reviews, problems were identified that could potentially result in a hospital admission, and the potential for an improved outcome for the patient if drug therapy was changed was identified in a further 34% of cases. Beta-blockers, NSAIDs and verapamil were identified as being associated with potential problems of the highest clinical significance. Patients taking psychoactive medication were at greatest risk of a medication-related problem from any cause. Conclusion Pharmacists could contribute to patients' welfare and reduce health care costs by carrying out 'brown bag' medication reviews on behalf of GPs.
TL;DR: In this setting, the DRE appears to be a test with a high specificity and negative predictive value, but a low sensitivity and positive predictive value.
Abstract: Objective This systematic review examines the diagnostic value of the digital rectal examination (DRE) for the diagnosis of prostate cancer. Method Only studies relating to unselected populations and using either biopsy or surgery as the reference standard were included. The methodological quality of the studies was used in an attempt to explain differences between studies. Results Fourteen studies were eligible for selection, of which five complied with the predetermined list of 'good-quality' requirements. Between study heterogeneity was high, even within the group of high-quality studies, and could not be explained by the registered indicators of methodological quality. Conclusions In this setting, the DRE appears to be a test with a high specificity and negative predictive value, but a low sensitivity and positive predictive value. Neither a positive nor a negative test result is sufficient to enable conclusions without further confirmation.
TL;DR: It is indicated that more accuracy is needed when diagnosing bronchial asthma, and the number of patients given the wrong diagnosis of asthma is estimated.
Abstract: BACKGROUND There are studies indicating that bronchial asthma is often underdiagnosed, while only a little research has been conducted as concerns overdiagnosing asthma. OBJECTIVE We aimed to estimate the number of patients who have been given the wrong diagnosis of asthma. METHODS All patients aged above 18 years who had visited two GPs during 1994 or 1995, with the diagnosis of bronchial asthma confirmed in the medical register, were examined by a specialist in allergies. RESULTS One hundred and twenty-three patients fulfilled the criteria for being included in the study. Eighty-six patients (70%) attended the examination. Of these, 51 (59%) had bronchial asthma, six (7%) asthma in combination with chronic obstructive pulmonary disease (COPD) and 29 (34%) no asthmatic disease. CONCLUSION The study indicates that more accuracy is needed when diagnosing bronchial asthma.
TL;DR: The impact of type 2 diabetes mellitus on functional status, particularly in relation to cardiovascular morbidity, is demonstrated in Dutch general practice.
Abstract: Background Traditionally, health and the outcomes of medical treatment have been measured in terms of morbidity, incidence or prevalence of disease, or even mortality. This disease model provides an adequate framework for acute illnesses, but for chronic diseases, severity and their effect on everyday functioning are paramount. For chronic diseases, functional health status, as a vital part of quality of life, is now recognized as an important outcome measure of the GP's care. Objective We aimed to assess the impact of type 2 diabetes mellitus on functional health status in Dutch general practice. Method We conducted a cross-sectional study of the functional health status of all patients with type 2 diabetes mellitus under 85 in two general practices, using the Sickness Impact Profile (SIP) and the COOP/WONCA charts. A control group of non-diabetic patients was selected, matched for practice, sex and age. Results In total, 127 type 2 diabetes mellitus patients and 127 controls participated in the study, the responses being 78 and 70%, respectively. Between these groups the following were significantly different: the SIP subscore Physical, the SIP sum score and the COOP/WONCA scores for physical fitness and overall health. Type 2 diabetes mellitus patients were 2.46 (95% CI 1.5-4.1) times more likely to experience functional impairment. Cardiovascular morbidity (odds ratio 2.5, 95% CI 1.3-4.7), locomotory morbidity (odds ratio 2.6, 95% CI 1.4-5.1) and diabetes itself (odds ratio 1.4, 95% CI 1.1-1.9) were significantly associated with the presence of functional impairment. Conclusion This study demonstrates the impact of type 2 diabetes mellitus on functional status, particularly in relation to cardiovascular morbidity.
TL;DR: It is suggested that patient demand for prescriptions may not only be overestimated but also perpetuated by GPs' belief in its existence and a wish to maintain a good doctor-patient relationship.
Abstract: Background Controlling prescribing costs is an issue of concern to many GPs. Objective and methods This paper is based on interviews with 21 GPs in which they were asked about influences on prescribing budgets. Results The results presented relate specifically to GPs' perceptions of the influence of patients on prescribing. Perceptions of patient demand were described both in terms of a general demand and demand by patients with specific health beliefs or particular social characteristics. Generally, GPs reported that decisions to prescribe were informed by a concern to maintain a good relationship with their patients, and not to risk the relationship by not prescribing when they believed a prescription was expected. Conclusions Although information was available about whether practices had a 'high' or 'low' budget, and whether they were under- or overspent, there did not appear to be any relationship between GPs' beliefs that patient expectations affected their prescribing and whether they were under or over budget. This paper suggests that patient demand for prescriptions may not only be overestimated but also perpetuated by GPs' belief in its existence and a wish to maintain a good doctor-patient relationship.
TL;DR: It is concluded that patients tend to overestimate the amount of physical activity undertaken and that ambulatory heart-rate monitoring may be more useful for verifying actual behaviour.
Abstract: BACKGROUND The assessment of levels of physical activity relies upon suitable measurement tools. OBJECTIVE We aimed to investigate whether a practice nurse, using a motivational interview technique, could encourage older patients to increase their physical activity. METHODS Health and well-being were monitored at baseline and 8 weeks following intervention. Physical activity levels were ascertained using both a self-report measure and ambulatory heart-rate monitoring. RESULTS Whilst patients reported higher levels of physical activity at follow-up, this finding was not confirmed by the heart-rate data. CONCLUSION The study concludes that patients tend to overestimate the amount of physical activity undertaken and that ambulatory heart-rate monitoring may be more useful for verifying actual behaviour.
TL;DR: The prevalence of intimate partner violence in primary care populations is described and the known physical, mental health and pregnancy consequences of abuse are reviewed as well as the implications of intimacy partner violence on primary care practice are discussed.
Abstract: Background. The organization of health care system to emphasize managed care has placed the primary care provider in an ideal position to assess the impact of intimate partner violence (IPV) on the health of women. Primary care practice provides a setting in which women can develop an ongoing relationship with their health care provider in which they feel safe to discuss IPV and possible options to improve their lives. Women's health and safety could be dramatically improved if primary care providers were prepared to assess, intervene and appropriately refer women who are in violent relationships. Objectives. The purpose of this article is to describe the prevalence of intimate partner violence in primary care populations and review the known physical, mental health and pregnancy consequences of abuse as well as discuss the implications of intimate partner violence on primary care practice. Language: en
TL;DR: Prescriber feedback and management guidelines were shown to influence antibiotic prescribing for URTI and choice of antibiotic for tonsillitis/streptococcal pharyngitis, a model for targeting educational input to those prescribers who most need to change their behaviour.
Abstract: Objectives. We aimed to examine the effectiveness of prescriber feedback and management guidelines in reducing antibiotics prescribing by GP trainees for undifferentiated upper respiratory tract infection, and in improving the choice of antibiotic for tonsillitis/streptococcal pharyngitis. The research tested a stepwise approach to targeting educational input to high prescribers. Method. General Practice trainees in New South Wales (n = 157) were randomly allocated to a treatment group (n = 78) which received an education intervention on antibiotic use, or to a control group (n = 79) which received an intervention on an unrelated topic. Trainees completed three practice activity surveys, each of 110 consecutive patient encounters, with 6-month intervals between surveys. Prescriber feedback and management guidelines on use of antibiotics for URTI and choice of antibiotic for tonsillitis/streptococcal pharyngitis were delivered in a written form between surveys 1 and 2. An educational outreach visit to high prescribers occurred between surveys 2 and 3. Outcome measures were the rate of antibiotic prescribing for all indications, for URTI and prescribing of select antibiotics for tonsillitis/streptococcal pharyngitis. Results. Antibiotic prescribing by the intervention group declined over three occasions from 25.0 to 23.3 to 19.7 per 100 URTI problems, while the control group increased from 22.0 to 25.0 to 31.7 per 100 URTI problems (P = 0.002). Prescribing in agreement with accepted guidelines for tonsillitis/streptococcal pharyngitis increased over time in the intervention group from 55.6 to 69.8 to 73.0 per 100 problems, but decreased in the control group from 59.6 to 57.5 to 58.5 (P = 0.05). Conclusion. Prescriber feedback and management guidelines were shown to influence antibiotic prescribing for URTI and choice of antibiotic for tonsillitis/streptococcal pharyngitis. This study provides a model for targeting educational input to those prescribers who most need to change their behaviour.
TL;DR: Most spouses witnessed months of global dysfunction preceding the symptom leading to physician consultation, and the importance of acknowledging the power of the spouse as a provider of substantial information from everyday life facilitating differential diagnosis is stressed.
Abstract: BACKGROUND The time between experiencing symptoms and treatment in cancer diseases is a time of insecurity and despair. Brain tumour disease is a severe disease with dramatic manifestations and it is important that this time be kept as short as possible. METHODS A consecutive sample of 28 patients with malignant gliomas and their spouses were interviewed about symptom development, help-seeking and experiences of medical care. The cumulative development of their symptoms was described and factors acting as obstacles to medical care were identified. RESULTS Most spouses witnessed months of global dysfunction preceding the symptom leading to physician consultation. The patient factors 'less alien symptoms', 'personality change' and 'avoidance'; the spouse factors 'spouse's passivity' and 'spouse's successive adaptation'; and the physician factors 'reasonable alternative diagnosis', 'physician's inflexibility' and 'physician's personal values' were identified as obstacles on the pathway to appropriate medical care. The importance of acknowledging the power of the spouse as a provider of substantial information from everyday life facilitating differential diagnosis is stressed.
TL;DR: The literature indicates that teenagers rarely receive health promotion advice from their physicians, and the impact on behaviour change, of screening and health promotion for teenagers in general practice requires further evaluation.
Abstract: BACKGROUND AND METHODS Teenagers are acknowledged to be at high risk of health-damaging behaviours including smoking, teenage pregnancy, and drug and alcohol use. Additionally, the recognition of high levels of psychological distress is cause for serious concern about teenage health. This paper reviews health promotion interventions for teenagers in general practice. Medline, BIDS, Psyclit and SIGLE databases for January 1990-February 1997 were systematically searched for English language studies on adolescent/teenage health and health promotion interventions in primary health care/general practice; reference sections of articles were checked for earlier work. CONCLUSIONS The literature indicates that teenagers rarely receive health promotion advice from their physicians. The impact on behaviour change, of screening and health promotion for teenagers in general practice requires further evaluation to asssess the potential effectiveness in preventing the onset or continuation of health-damaging behaviours.
TL;DR: The reliability of the charts is good, and nine out of ten of the patients gave clinically meaningful answers after 2-3 days, and the use of COOP/WONCA Functional Assessment Charts is commented on.
Abstract: Method. A test‐retest study comprising 40 randomly selected patients attending GPs’ surgeries was conducted. Eight GPs took part in this study. The response rate for the questionnaire was 100%. In a second study, 245 asthma patents who consulted 53 different GPs were consecutively included; 171 of these repeated completion of the charts after 6 months. Mean scores from a random sample of 2864 persons in the total population of the municipality of Ullensaker in Norway are given as reference values. There was a postal return rate of 64%. Results and conclusions. The reliability of the charts is good, and nine out of ten of the patients gave clinically meaningful answers after 2‐3 days. The scores of the 171 asthma patients were nearly identical after 6 months. The reference values are presented. A standardized method for reliability testing is discussed, and the use of COOP/WONCA Functional Assessment Charts is commented on.
TL;DR: A high prevalence of UI is found in younger women with a UTI, not taking oestrogen, nulliparous or having given birth to one or two children, and in older women in the age group 51-70 years with UI.
Abstract: Background. The International Continence Society has defined urinary incontinence as a condition in which involuntary loss of urine is objectively demonstrable and is a social or hygiene problem. Urinary incontinence is presumably a common health problem among women even in younger ages. Objectives.The primary aim was to investigate the prevalence of urinary incontinence (UI) in a female population with a special focus on younger women (18–30 years old). The secondary aim was to investigate the association between UI and number of deliveries, use of contraceptives or oestrogen substitutions, and urinary tract infections (UTIs). Methods.A population-based study with a self-administered questionnaire was set in the community of Surahammar, Sweden. Subjects were all women (3493) aged 18–70 years living in Surahammar during 1995. The main outcome measures were the prevalence of UI and variables such as number of deliveries, use of contraceptives or oestrogen substitutions, and UTIs. Results. Twenty-six per cent of the women reported problems of UI. The prevalence of UI in younger women was 12%. The number of reported complaints of UTIs was significantly higher in the women with UI compared with women without urinary incontinence (wUI). In the younger women UTI, nulliparous or having given birth to one or two children were most frequent in those with UI. The use of contraceptives was more common in younger women without UI (P < 0.05). However, the use of oestrogen was more common in older women in the age group 51–70 years with UI (P < 0.01). Conclusion.Our findings have shown that 26% of the women who took part in the survey reported problems of UI. Among women below 30 years of age, 12% reported complaints of UI. We found a high prevalence of UI in younger women with a UTI, not taking oestrogen, nulliparous or having given birth to one or two children. There are needs for further investigations with a special focus on younger women
TL;DR: The presence of vertigo, fainting and avoidance in a person with dizziness is predictive of chronic handicapping dizziness, and the outcome of symptoms of dizziness in a sample of patients identified from London general practices is assessed.
Abstract: Background. Dizziness is commonly experienced in the community, but little is known about the long-term progression of the condition.Objective. We aimed to assess over 18 months the outcome of symptoms of dizziness in a sample of patients identified from London general practices.Method. We followed up at 18 months a cohort of patients who reported symptoms of dizziness with or without anxiety, panic reactions or avoidance of situations that provoked the symptoms. The subjects completed a structured questionnaire both at baseline and at 18 months.Results. At 18 months, 24% (95% CI = 23.5-34.8%) were more handicapped and 20% (95% CI = 15.2-25.2%) had recurrent dizziness, while 20% (95% CI = 14.9-24.8%) had improved. Patients with significant dizziness were more likely to consult their GP (OR = 14.4, 95% Cl = 7.0-29.1) and were more likely to receive treatment (OR = 7.8, 95% CI = 3.2-22.4) or be referred to hospital (OR = 8.4, 95% CI = 3.2-22.4). The independent predictors of handicapping dizziness at 18 months were a history of fainting (OR = 2.4, 95% CI = 1.2-4.7), vertigo (OR = 2.6, 95% CI = 1.3-5.0) and avoidance of a situation that provoke dizziness (OR = 4.8, 95% CI = 2.5-9.0).Conclusion. Four per cent of all patients registered with a GP suffer persistent symptoms of dizziness and at least 3% are severely incapacitated by their symptoms. The presence of vertigo, fainting and avoidance in a person with dizziness is predictive of chronic handicapping dizziness. Further research is required on the progressions of symptoms of dizziness in a sample of GP attenders and those in the community.
TL;DR: This study indicates the prominence and importance of physical symptoms in the presentation of depression in Japanese primary care patients and must be alerted to the possibility of depression, especially when patient complaints include abdominal, neck or head pain.
Abstract: Waza K, Graham AV, Zyzanski SJ and Inoue K. Comparison of symptoms in Japanese and American depressed primary care patients. Family Practice 1999; 16: 528‐533. Background. Depression is a highly prevalent, worldwide problem with multiple social and health consequences. It often presents in primary care with physical symptoms. Little research has been done on cross-cultural expression of depression in primary care. This paper examines the hypothesis that depressed Japanese patients present with more and with more distinct somatic complaints than depressed American patients. Methods. Data were collected by chart audit for patients with a diagnosis of depression at two sites: Minamikawachi Tochigi, Japan and Cleveland, Ohio, USA. Patient demographics and type and number of presenting symptoms in the two populations were compared. Logistic regression was used to determine whether there were differences between countries in physical symptoms and to adjust for relevant demographic characteristics. Results. Japanese family physicians charted more somatic complaints from patients diagnosed as depressed than did American family physicians. Specific physical symptoms differed by country: Japanese patients had more abdominal distress, headaches, and neck pain. These symptoms have strong cultural significance for Japanese patients. Conclusions. This study clearly indicates the prominence and importance of physical symptoms in the presentation of depression in Japanese primary care patients. Their physicians must be alerted to the possibility of depression, especially when patient complaints include abdominal, neck or head pain.
TL;DR: The slope and shape of the diffusion curve are both dependent on physician and drug characteristics, but late prescribers share some common characteristics.
Abstract: Results. The distributions of the diffusion time of the drugs by 95 solo practitioners were asymmetrical, with a long upper tail representing the late prescribers. The shape and slope of the diffusion curve were highly drug dependent. There was poor agreement of the three adopter categories (early, intermediate and late prescribers) between the five drugs (kappa , 0.35), but being a late prescriber was the most consistent condition. Late prescribing of tramadol, compared with intermediate prescribing, was associated with female physicians (odds ratio (OR) 5.7; 95% CI 1.5‐21.3), smaller list size (OR 0.1; 95% CI 0.0‐0.8), a strong general restrictive attitude to pharmacotherapy (OR 0.07; 95% CI 0.01‐0.68) and a tendency to lower diagnostic activity per patient (OR 0.4; 95% CI 0.1‐1.9). Conclusions. The slope and shape of the diffusion curve are both dependent on physician and drug characteristics, but late prescribers share some common characteristics.
TL;DR: It is possible to take detailed family histories and provide genetic counselling advice in primary care with minimal training of clinical primary care staff and the service is acceptable to patients, does not induce anxiety and has little effect on numbers of patients referred.
Abstract: Rose P, Humm E, Hey K, Jones L and Huson SM. Family history taking and genetic counselling in primary care. Family Practice 1999; 16: 78‐83. Objectives. We aimed to evaluate the feasibility and acceptability of taking routine family histories and subsequent counselling. Methods. The study was set in primary care in the UK. The subjects were patients between the ages of 20 and 34 years registered at one general practice. Patients were invited by letter to attend a clinic in their GP surgery, run by a GP and health visitor. A family history was constructed and counselling undertaken for any identified problems. A telephone survey of a sample of nonattenders was also performed. The outcome measures were attendance rate, patient views, patient anxiety as measured by the short form of the Spielberger State‐Trait Anxiety Inventory and referrals to secondary care. Results. In total, 16.1% patients attended the clinic; 40.3 % had a family history of at least one disease with a possible genetic component. Anxiety levels fell immediately after the consultation and rose to pre-clinic levels at 12 weeks. The clinic generated three referrals to secondary care and a further seven patients who were counselled by the investigators following advice from a consultant geneticist. Conclusions. It is possible to take detailed family histories and provide genetic counselling advice in primary care with minimal training of clinical primary care staff. The service is acceptable to patients, does not induce anxiety and has little effect on numbers of patients referred.