journal article
Open Access Collection
Home
Aaen Geest, Tina; Wetzels, Raymond; Wensing, Michel; Cohen Castel, Orit; Olesen, Frede; ON BEHALF OF THE IMPROVE RESEARCH GROUP,
doi: 10.1080/13814780600766253pmid: 16945865
Objective: To implement a programme for involvement of older patients aged 70+ in general practice, and to detect quality changes after its implementation. Methods: The study was performed in 11 European countries as an uncontrolled before-and-after study, in which a number of GPs and patients answered a questionnaire before and after receiving an intervention. The intervention was aimed at motivating, instructing and facilitating GPs and older patients to increase patient involvement during consultation by use of a specially designed consultation leaflet. Results: Valid data from seven countries exist. There was a total of 765 patients and 70 GPs in the pre-intervention phase, and 564 patients and 49 GPs in the post-intervention phase. In the post-intervention group, 43% of the patients thought that the consultation leaflet had improved the consultation and 62% of the GPs found it to be useful. There were no significant differences between pre- and post-intervention patient perceptions of the level of involvement, evaluations of consultations and perceptions of feeling enabled to deal with their health situation.Conclusion: Quality of consultations as measured by patient satisfaction and patient enablement did not improve as a result of the intervention, but nearly half of the patients and two thirds of the GPs found the intervention to be useful. Unselected use of this intervention on all patients cannot be advised without further studies on possible effects. Future studies should focus on the applicability and benefits of the methods for special patient groups.
Spijker-Huiges, Antje; Winters, Jan C.; Meyboom-De Jong, Betty
doi: 10.1080/13814780600757120pmid: 16945866
Objectives: To do an inventory on the opinion of long-term acid suppressant drug (ASD) users on their condition and drug treatment, and from that angle to reflect on possibilities to reduce usage and costs of long-term acid suppressant drug therapy. Methods: In the year 2001, in seven general practices, patients who chronically used ASDs without proper indication were identified. A postal questionnaire based on the literature was sent to these patients (n=498). Results: 318 (64%) returned questionnaires were fit for analysis. Patients experienced dyspepsia as unpleasant and restraining, and were extremely positive about ASDs without differences between H2-receptor antagonists (H2RAs) and proton pump inhibitors (PPIs). ASD use was very compliant. Patients smoked and drank less than the normal population. They did not continue unhealthy habits simply because ASDs enable them to. Most patients were not motivated to stop their ASDs.Conclusion: Dyspeptic complaints should not be underestimated. Improving lifestyle is not likely to generate much effect on ASD use. Due to a lack of motivation, discontinuing long-term ASD use may not be an efficient way to reduce the use and costs of ASDs. Patient-centred possibilities are prescribing H2RAs instead of PPIs as a first step, as they are perceived by patients to be equally effective, and encouraging patients to self-regulate drug treatment through on-demand regimes.
O'Dowd, Thomas C.; McNamara, Kevin; Kelly, Alan; O'Kelly, Fergus
doi: 10.1080/13814780600757195pmid: 16945867
Objective. General practice co-operatives have led to significant improvements in quality of life for general practitioners. Little is known about general practitioners’ own experiences with the working arrangements and governance of co-operatives. This study investigates GP satisfaction, the working environment, governance and future developments in co-operatives. Methods. A questionnaire was sent to GPs in two co-operatives in the Republic of Ireland, covering mixed urban and rural areas. Results. Of 221 GPs in the co-operatives, 82% responded and confirmed the co-operatives’ positive effects on their lives. However, 57% still received requests for out-of-hours care while off duty, most commonly from patients who preferred to see their own doctor. Half felt overburdened by out-of-hours work, especially those over 40 y of age. Twenty-five per cent were dissatisfied with the GP complaints mechanism. The majority (63%) would prefer a GP/health board partnership for the organization of out of hours, while 23% wanted sole responsibility. GPs indicated a strong need for better ancillary services such as nursing, mental health, dentistry, pharmacy and social work. Access to records is an important issue in terminal care and mental illness. Conclusion. While GP co-operatives are a success story for general practice, they will work better for general practitioners and their patients if nursing, mental health, dentistry, pharmacy and social services are improved. Support and training is needed in mental health, palliative and emergency care to increase competence and reduce stress. GPs are willing to work with health authorities in further co-operative development. More attention needs to be paid to the complaints and suggestions of GPs in the running and governance of their co-operatives.
De Lusignan, Simon; Hague, Nigel; Van Vlymen, Jeremy; Dhoul, Neil; Chan, Tom; Thana, Lavanya; Kumarapeli, Pushpa
doi: 10.1080/13814780600757260pmid: 16945868
Objectives: To report current levels of obesity and associated cardiac risk using routinely collected primary care computer data. Methods: 67 practices took part in an educational intervention to improve computer data quality and care in cardiovascular disease. Data were extracted from 435 102 general practice computer records. 64.3% (229 108/362 861) of people age 15 y and older had a body mass index (BMI) recording or a valid height and weight record that enabled BMI to be derived. Data about cardiovascular disease and risk factors were also extracted. The prevalence of disease and the control of risk factors in the overweight and obese population were compared with those of normal body weight. Results: 56.8% of men and 69.3% of women aged over 15 y had a BMI record. 22% of men and 32.3% of women aged 15 to 24 y were overweight or obese; rising each decade to a peak of 65.6% of men and 57.5% of women aged 55 to 64 y. Thereafter, the proportion who were overweight or obese declined. The prevalence of ischaemic heart disease, diabetes mellitus and hypertension rose with increasing levels of obesity; their prevalence in those who are moderately obese was between two and three times that of the general population. Systolic and diastolic blood pressure, blood glucose even in non-diabetics, cholesterol and triglycerides were all elevated in the overweight and obese population.Conclusion: Based on the recorded data over half of men and nearly half of women are overweight or obese. They have increased cardiovascular risk, which is not adequately controlled by current practice.
Sauro, Alfonso; Barone, Filippo; Blasio, Giuseppe; Russo, Luigi; Santillo, Luigi
doi: 10.1080/13814780600757153pmid: 16945870
Objective: Respiratory infections are a frequent causes of medical attendance. Influenza viruses increases this phenomena. The aim of this study was to prospectively identify GPs’ increased work in terms of visits and time. Methods: Over a period of five months 5 GPs recorded sex, age, number and place of visits, telephone consultations of the patients visited for acute respiratory disease (ARD)which included acute respiratory infections (ARI), influenza (FLU) and Influenza-like illness (ILI). Upper respiratory tract infections (URTI) were classified as sinusitis, rhinitis, otitis, tonsillitis, pharyngitis, laryngitis, Lower respiratory tract infections (LRTI) were classified as tracheitis, bronchitis, pneumonia, bronchopneumonia, acute episodes of chronic obstructive pulmonary disease (COPD) and asthma. FLU and ILI were considered two different entities on the basis of symptoms. Results: Acute respiratory disease increase of 22 patients attending every GP's office monthly (from 176 to 198 total visits). 6542 patients were observed. The incidence of ARD was 33.5% (2191: 1091 female and 1100 males). URTI affected 944 patients, LRTI 739, FLU 328 and ILI 180. The increase in home visits grew from 10 to 36. Each home visit took from 15 to 45 minutes. In a high number of cases (236), home visits were necessary for sick-leave certificates. FLU (54%) and LRTI (37.5%) required more attention, and they were the primary causes for visits. Telephone consultations took place for all ILI or FLU of minor severity and in young people.Conclusion: During the winter there is an increased work-load for GPs due to the diffusion of influenza virus and respiratory tract diseases. “Burn out syndrome” is increasing among the GPs. Territorial GPs’ action is highly efficacious. Patients self-certification should be evaluated. Vaccine therapy could be more effective if done on a larger population. More research is needed.
Showing 1 to 10 of 11 Articles