Family Practice

BACKGROUND: Perceived patient demand for antibiotics drives unnecessary antibiotic prescribing in outpatient settings, but little is known about how clinicians experience this demand or how this perceived demand shapes their decision-making. OBJECTIVE: To identify how clinicians perceive patient demand for antibiotics and the way these perceptions stimulate unnecessary prescribing. METHODS: Qualitative study using semi-structured interviews with clinicians in outpatient settings who prescribe antibiotics...

BACKGROUND: General Practitioners' (GPs') workload has been suggested to increase in many countries; how does this impact patient follow-up? OBJECTIVE: To investigate trends in GP consultation patterns for adults according to baseline hypertension and anxiety/depression symptoms and attribution of the GP to trend differences. METHODS: Prospective cohort study, linking survey data and clinical measurements from the Norwegian HUNT3 study (2006-08) with national administrative data on GP list assignment and consultations with GP services...

BACKGROUND: Euthanasia and assisted suicide laws in the Netherlands require physicians meet clinical guidelines when performing the practice to ensure death is peaceful and painless. Despite oversight by the regional review committees over each case, little research exists into the frequency of guideline deviation and the reasons for nonadherence. METHODS: Cases reported and reviewed between 2012 and 2017 that did not meet due medical care were analysed for thematic content...

BACKGROUND: Acute uncomplicated cystitis is one of the most common diagnoses for which antibiotic treatment is prescribed in the outpatient setting. Despite the availability of national guidelines, there remains a wide pattern in prescriber choices for therapy. Recent data portray a picture of consistently longer durations than recommended prescribed in outpatient settings. OBJECTIVE: The objective was to evaluate the effect of a system-based intervention on adherence to guideline-recommended durations of therapy for uncomplicated cystitis in the outpatient setting...

BACKGROUND: GPs providing patient-centred care (PCC) is embedded in international health care policies due to its positive impact on patients and potential to lower health care costs. However, what is currently known about GP-delivered PCC is unknown. OBJECTIVE: To synthesize literature investigating GP-delivered PCC and address 'what is currently known about GP-delivered PCC?' METHOD: A systematic literature search was conducted between June and July 2018...

BACKGROUND: Most lung cancer is diagnosed at an advanced stage, resulting in poor survival. This study examined diagnostic pathways for patients with operable lung cancer to identify factors contributing to early diagnosis. METHODS: Surgically treated lung cancer patients (aged ≥40, within 6 months of diagnosis), approached via the population-based Cancer Registry, with their primary care physicians (PCPs) and specialists completed cross-sectional surveys assessing symptoms, diagnostic route (symptomatic or 'investigation' of other problem), tests, key event dates and treatment...

BACKGROUND: Benzodiazepines and Z-drugs (such as zopiclone) are widely prescribed in primary care. Given their association with addiction and dependence, understanding where and for whom these medications are being prescribed is a necessary step in addressing potentially harmful prescribing. OBJECTIVE: To determine whether there is an association between primary care practice benzodiazepine and Z-drug prescribing and practice population socioeconomic status in England...

No abstract text is available yet for this article.

BACKGROUND: Strategic management of primary health care centres is necessary for creating an efficient global health care system that delivers good care. OBJECTIVES: To perform a systematic literature review of the use of data envelopment analysis in estimating the relative technical efficiency of primary health care centres, and to identify the inputs, outputs and models used. METHODS: PubMed, MEDLINE Complete, Embase and Web of Science were searched for papers published before the 25 March 2019...

BACKGROUND: It is unclear whether discharging patients from renal clinic to primary care is safe. AIM: To determine the characteristics, primary care monitoring and renal outcomes of patients discharged from renal clinic. DESIGN AND SETTING: A retrospective study of 2236 adults discharged from a tertiary renal clinic between 2013-2018. METHOD: Patient demographics, primary renal disease, laboratory results and timeline dates were collected from the renal IT system...

BACKGROUND: Non-optimal medication use among older adults is a public health concern. A concrete picture of potentially inappropriate medication (PIM) use is imperative to ensure optimal medication use. OBJECTIVE: To assess the prevalence of PIMs in community-dwelling older adults and identify associated factors. METHODS: A retrospective population-based cohort study was conducted using the Quebec Integrated Chronic Disease Surveillance System (QICDSS)...

BACKGROUND: GP in Japan are encouraged to conduct home visits for older adults. However, most previous studies on home visits were based on secondary analyses of billing data that did not include reasons for the encounter. OBJECTIVES: This study aimed to describe home visit care by GP in Japan, including reasons for encounter, health problems, episodes of care, comprehensiveness and multimorbidity. METHODS: This multicentre descriptive cross-sectional study used the International Classification of Primary Care, second edition, and was conducted in Japan from 1 October 2016 to 31 March 2017...

BACKGROUND: In Scotland, there has been significant investment in pharmacy teams in general medical practices over recent years, aligned to current government policy. OBJECTIVES: To characterize the national pharmacy workforce including activities undertaken, perceived competence and confidence, as well as perception of integration of the intervention. METHODS: A cross-sectional survey of all pharmacists and pharmacy technicians in general practices...

No abstract text is available yet for this article.

BACKGROUND: The hereditary cancer syndromes represent overall <10% of all cancers. These syndromes are not irrelevant for public health because all the cancers typical of these syndromes affected young people and many members of the same family and the cancers are more aggressive than the sporadic ones and need specific surgery and medical therapy. We developed a new family assessment tool: STELO designed for family physicians to identify patients could benefit from Cancer Genetic Counselling...

BACKGROUND: There is limited data on the duration of consults resulting in the prescription of antibiotics for upper respiratory tract infections (URTIs) in general practice. OBJECTIVE: To explore how demographic factors influence consult duration where antibiotics have been prescribed for URTI in Australian general practice. METHODS: 2985 URTI-specific presentations were identified from a national study of patients who were prescribed an antibiotic after presenting to general practice between June and September 2017...

BACKGROUND: Antibiotic resistance is increasing, largely due to the overuse of antibiotics. Patient demographic characteristics can influence rates of antibiotic prescription, but less research has assessed the role of facility-level characteristics. OBJECTIVE: The objective of this study was to examine the prevalence of antibiotic prescriptions for viral-like illness, as well as patient and provider factors that influence antibiotic prescription practices. METHODS: We conducted an observational cohort study using data from the 2012 National Ambulatory Medical Care Survey...

BACKGROUND: People who engage in advance care planning (ACP) are more likely to receive health care that is concordant with their goals at the end of life. Little discussion of ACP occurs in primary care. OBJECTIVE: The objective of this study was to describe primary care clinicians' perspectives on having ACP conversations with their patients. METHODS: We conducted a survey of family physicians and non-physician clinicians in primary care in 2014-2015...

BACKGROUND: In the UK, there is increased pressure on general practitioners' time due to an increase in (elderly) population and a shortage of general practitioners. This means that time has to be used efficiently, whilst optimizing adherence to consistent, appropriate and timely provision of care. OBJECTIVE(S): Create an audit tool that assists general practitioners and family practice staff to evaluate if patients are managed as effectively as possible, and to test the usefulness of this tool in a family practice...

BACKGROUND: To improve earlier presentation with potential symptoms of cancer, accurate data are needed on how people respond to these symptoms. It is currently unclear how self-reported medical help-seeking for symptoms associated with cancer by people from the community correspond to what is recorded in their general practice records, or how well the patient interval (time from symptom onset to first presentation to a health-professional) can be estimated from patient records. METHOD: Data from two studies that reviewed general practice electronic records of residents in Scotland, (i) the 'Useful Study': respondents to a general population survey who reported experiencing symptoms potentially associated with one of four common cancers (breast, colorectal, lung and upper gastro-intestinal) and (ii) the 'Detect Cancer Early' programme: cancer patients with one of the same four cancers...