Family Practice

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BACKGROUND: The Burden of Treatment Questionnaire (TBQ) assesses the impact of a patient's treatment workload on their quality of life. OBJECTIVES: The aim was to translate and validate the TBQ on Chinese primary care patients with multi-morbidity. METHODS: The English TBQ was translated and back-translated using professional translators. Cognitive debriefing interviews were performed on 15 patients. The resulting instrument was tested on 200 primary care patients with multi-morbidity (>1 chronic disease) to examine its psychometric performance including exploratory factor analysis, confirmatory factor analysis, internal consistency and reliability...

BACKGROUND: The incidence of self-harm in young people in primary care is increasing dramatically, and many young people who self-harm visit their GP surgery as a first point of contact for help. OBJECTIVE: To explore with young people, GPs and practice nurses (PNs): (i) why young people present with self-harm to primary care and (ii) whether young people, GPs and PNs can take steps to have more helpful consultations about self-harm in GP surgeries that include self-help materials developed by young people being used to support such consultations to take place...

BACKGROUND: The efficacy of smoking cessation interventions can be quite diverse in day-to-day clinical practice. OBJECTIVE: To analyse the effectiveness in smoking cessation of multicomponent interventions carried out in groups or individually in primary care practices. METHODS: A quasi-experimental, multicentre study of 12-month follow-up of patients treated in multicomponent smoking cessation interventions was carried out in Urban health care centres in Sevilla, Spain...

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Background: Electronic health record (EHR) data on blood pressure (BP) control among patients with hypertension show that practices' rates vary greatly. This suggests providers use different approaches in managing hypertension, and so we aimed to explore challenges small primary care practice providers face and strategies they use to manage patients' BP. We explored differences between providers with high and low BP control rates to help inform future quality improvement work. Methods: In 2015, we recruited practices in New York City with five or fewer providers...

Background: Most of the patients with gastroenteritis seeking health care services are managed in primary care; yet, little is known about these consultations. Syndromic-based surveillance of gastrointestinal infections is used in several countries, including Norway. Aim: To investigate the extent of, and explore characteristics associated with, consultations for gastroenteritis in primary care and to compare consultations in daytime general practice and out-of-hours (OOH) services in Norway...

Background: Studies examine longitudinal continuity of GP contact though few consider 'regularity of GP contact', i.e., the dispersion of contacts over time. Increased regularity may indicate planned ongoing care. Current measures of regularity may be correlated with the number of contacts and may not isolate the phenomenon of interest. Objectives: To compare two published and one newly developed regularity index in terms of their ability to measure regularity of GP contacts independently of the number of contacts and the impact on their association with hospitalization...

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Background: Upper respiratory tract infections (URTIs) are a common presentation in general practice and are linked to high rates of inappropriate antibiotic prescription. There is limited information about the trajectory of patients with this condition who have been prescribed antibiotics. Objective: To document the symptom profile of patients receiving antibiotics for URTIs in Australian general practice using smartphone technology and online surveys. Methods: In total, 8218 patients received antibiotics after attending one of the 32 general practice clinics in Australia from June to October 2017: 4089 were identified as URTI presentations and were the cohort studied...

Background: Identification of patients at the end-of-life is the first step in care planning and many general practices have Palliative Care Registers. There is evidence that these largely comprise patients with cancer diagnoses, but little is known about the identification process. Objective: To explore the barriers that hinder GPs from identifying and registering patients on Palliative Care Registers. Methods: An exploratory qualitative approach was undertaken using semi-structured interviews with GPs in South West England...

Objective: To evaluate the process of clinical medication review for elderly patients with polypharmacy performed by non-dispensing pharmacists embedded in general practice. The aim was to identify the number and type of drug therapy problems and to assess how and to what extent drug therapy problems were actually solved. Method: An observational cross-sectional study, conducted in nine general practices in the Netherlands between June 2014 and June 2015. On three pre-set dates, the non-dispensing pharmacists completed an online data form about the last 10 patients who completed all stages of clinical medication review...

Background: A movement is emerging to encourage health providers and health organizations to take action on the social determinants of health. However, few evidence-based interventions exist. Digital tools have not been examined in depth. Objective: To assess the acceptability and feasibility of integrating, within routine primary care, screening for poverty and an online tool that helps identify financial benefits. Methods: The setting was a Community Health Centre serving a large number of low-income individuals in Toronto, Canada...

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Background: Clinical research is mostly conducted among hospitalized patients, which restricts the generalizability of research results. The involvement of GPs in research has been consistently highlighted as a factor associated with successful study recruitment. Objectives: To assess GPs' motivations and willingness to participate in primary care research as investigators and to identify factors associated with their willingness. Methods: We conducted an observational, cross-sectional study in Normandy, France, with a self-questionnaire sent to 3002 GPs...

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Background: The evidence that large pay-for-performance schemes improve the health of populations is mixed-evidence regarding locally implemented schemes is limited. Objective: This study evaluates the effects in Stoke-on-Trent of a local, multifaceted Quality Improvement Framework including pay for performance in general practice introduced in 2009 in the context of the national Quality and Outcomes Framework that operated from 2004. Methods: We compared age-standardized mortality data from all 326 local authorities in England with the rates in Stoke-on-Trent using Difference-in-Differences, estimating a fixed-effects linear regression model with an interaction effect...

Background: Depression is common among older adults and is typically treated with antidepressants. Objective: To determine the non-adherence rates to antidepressants among older adults in primary care, based on non-initiation, suboptimal implementation or non-persistence. Methods: We selected all patients aged ≥60 years and diagnosed with depression in 2012, from the Netherlands Institute for Health Services Research (NIVEL) Primary Care Database...

Background: Mental health issues are increasingly prevalent within the community. Many people experiencing mental health issues have established relationships with primary care providers, including general practice nurses (GPNs). With the recent growth of general practice nursing, it is timely to explore the evidence for GPNs to provide mental health interventions for adults with mental illness within their scope of practice. Objective: To synthesize the evidence about nurse-delivered interventions in primary care for adults with mental illness...

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