Older patients request more information: a survey of use of written patient education materials in general practice

Objectives: To determine GPs' reported use of written education materials with older patients and older patients' reported receipt of these materials. To determine GPs' and older patients' perceptions of written materials. Method: Using self‐report questionnaires, two populations were surveyed; a randomised sample of SO GPs (29 males and 21 females) practising in Brisbane's southern suburbs and a convenience sample of 188 older community‐dwelling people (aged over 64 years). Results: All GPs reported using written materials with patients, although 28% had not given any to the last 10 patients. This increased to 46% when patients were older. Twenty percent of patients wanted more written information from their GP, while some GPs believed that older patients preferred verbal information and gave out written information only when they perceived patient interest. All GPs reported giving written materials at the time of consultation and over two‐thirds discussed the content with patients. Just over 50% of patients reported receiving written information from GPs in the last six months and only half of these again discussed it directly with their GP. Overall, patients were more positive than GPs about the value of written education materials. Conclusions: Older patients' desire for written information may be better met if they are more assertive in requesting this of GPs and GPs may better serve their patients' needs if they make written information more readily available to them. Better access to materials and more financial incentives to give them out might also increase GPs' use of written materials.     

Involvement of general practitioners in managing alcohol problems: a randomized controlled trial of a tailored improvement programme

Aims To assess the effect of a tailored multi‐faceted improvement programme on general practitioners' (GPs') behaviour towards prevention of hazardous and harmful alcohol consumption. The improvement programme consisted of activities aimed at the GP, organization and patient. Educational training sessions and visits by a facilitator were tailored to the GPs' needs and attitudes. Design Cluster randomized controlled trial. Setting General practices in the Netherlands. Participants Seventy‐seven general practices; 119 GPs participated. Data from 6318 patients were available, of whom 765 (12.1%) were at risk. A total of 1502 patients' electronic medical records were reviewed. Measurements The primary outcome was the number of eligible patients who received screening and advice. Findings Difficulties in recruiting GPs and in motivating GPs for participation in the tailored parts of the programme impeded optimal implementation of the programme. Although GPs in both groups became more involved after enrolment, this improvement waned during the trial. The quality improvement programme enhanced the initial improvement in behaviour and it tempered waning (intervention group), compared to our control condition, resulting in average improvement rates of 5% (screening) and 2% (advice‐giving) at 12‐month follow‐up (not significant). Conclusions A tailored, multi‐faceted programme aimed at improving general practitioner management of alcohol consumption in their patients failed to show an effect and proved difficult to implement. There remains little evidence to support the use of such an intensive implementation programme to improve the management of harmful and hazardous alcohol consumption in primary care.     

Colorectal cancer screening practise is influenced by ethnicity of medical practitioner and patient

Background and Aim: Colorectal cancer (CRC) screening improves survival and requires appropriate recommendation by general practitioners (GPs). Screening practises may be influenced by barriers related to ethnicity and training. Methods: A mail survey assessed GPs' practises and the barriers towards CRC screening. The association of screening practises and demography, including GP ethnicity, medical training and practise characteristics, were evaluated. Results: Of 212 GPs (median age 54 years, 73% men, 27% Caucasian, 38% foreign graduates), 87% agreed that fecal occult blood test (FOBT) screening improved survival in the average‐risk patient. Considerable variations existed in the starting age (40–49 years: 31%; 50 years: 65%) and frequency (1–2 years: 77%; 3–5 years: 22%) of screening. FOBT was used for indications other than screening: anemia (59%), altered bowel habits (54%), abdominal pain (24%), and rectal bleeding (23%), and these were significantly more frequent in Asian GPs independent of medical training. GPs were less likely to recommend screening to immigrants, and most reported that immigrants were less likely to participate. More Asian and Middle Eastern GPs reported a major barrier with FOBT inaccuracy compared with Caucasian GPs (22% vs 9%, P = 0.03; and 27% vs 9%, P = 0.03, respectively). Conclusions: Considerable differences existed in GPs' CRC screening practises. Indications for use of FOBT and the subsequent investigation of a positive FOBT also varied according to GPs' ethnicity, independent of medical training. Patient's ethnicity and associated language and cultural barriers may affect screening uptake, which may negatively affect the health of immigrants. Resources and culture‐specific interventions are recommended to improve overall screening participation.     

Would general practitioners support a population-based colorectal cancer screening programme of faecal-occult blood testing?

BACKGROUND: The success of a population-based screening for colorectal cancer (CRC) is determined to a large extent by general practitioner (GP) attitudes, beliefs and support. The extent to which GPs support population-based CRC screening remains unclear. AIMS: To assess the knowledge, attitudes and practices of GPs in relation to CRC screening, and to identify the determinants of GP support for population-based faecal-occult blood testing (FOBT). METHODS: A cross-sectional postal survey was conducted with a random sample of 692 GPs in Queensland, -Australia. We assessed GP knowledge, attitudes and practices concerning CRC screening in relation to their stance on population-based FOBT screening. RESULTS: Although the response rate was low (41%), participants were representative of Queensland GPs in general. Of 284 participating GPs, 143 (50.5%) indicated that they would support a population-based FOBT screening programme, 42 (14.8%) would not and 98 (34.6%) were unsure. Belief in FOBT test efficacy (P <0.001), possession of CRC guidelines (P <0.05) and belief in earlier stage detection (P <0.05) were major determinants of support for population-based FOBT screening. No significant association was observed for doctor's sex, location of practice, age, year completed medical training, membership of a Division of General Practice, number of weekly consultations, number of patients investigated for CRC per month, size of practice, own family history of CRC, interest in further information on CRC screening or treatment, and current use of FOBT with asymptomatic patients aged > or =40 years. CONCLUSIONS: GP support for FOBT population-based screening appears to have increased over recent years. The knowledge and attitudes/beliefs of GPs are key determinants of their support.     

A survey of perceptions and practices of complementary alternative medicine among Canadian gastroenterologists

BACKGROUND:

Despite a high prevalence of complementary alternative medicine (CAM) use among inflammatory bowel disease (IBD) patients, there is a dearth of information about the attitudes and perceptions of CAM among the gastroenterologists who treat these patients.

OBJECTIVE:

To characterize the beliefs, perceptions and practices of gastroenterologists toward CAM use in patients with IBD.

METHODS:

A web-based survey was sent to member gastroenterologists of the Canadian Association of Gastroenterology. The survey included multiple-choice and Likert scale questions that queried physician knowledge and perceptions of CAM and their willingness to discuss CAM with patients.

RESULTS:

Fifty-three per cent of respondents considered themselves to be IBD subspecialists. The majority (86%) of gastroenterologists reported that less than one-half of their patient population had mentioned the use of CAM. Only 8% of physicians reported initiating a conversation about CAM in the majority of their patient encounters. Approximately one-half (51%) of respondents were comfortable with discussing CAM with their patients, with lack of knowledge being cited as the most common reason for discomfort with the topic. Most gastroenterologists (79%) reported no formal education in CAM. While there was uncertainty as to whether CAM interfered with conventional medications, most gastroenterologists believed it could be effective as an adjunct treatment.

CONCLUSION:

Our findings demonstrate that gastroenterologists were hesitant to initiate discussions about CAM with patients. Nearly one-half were uncomfortable or only somewhat comfortable with the topic, and most may benefit from CAM educational programs. Interestingly, most respondents appeared to be receptive to CAM as adjunct therapy alongside conventional IBD treatment.     

What physicians don’t know about patient dietary beliefs and behavior can make a difference

Evaluation of: Zallot C, Quilliot D, Chevaux JB et al. Dietary beliefs and behavior among inflammatory bowel disease patients. Inflamm. Bowel Dis. doi:10.1002/ibd.22965 (2012) (Epub ahead of print).

Patients often ask about dietary management of their inflammatory bowel disease (IBD). No data exist to support any one specific diet in IBD. The reviewed article reports on patients’ beliefs with regards to dietary knowledge and behavior and its impact on social life in IBD. Over a 6-month period, consecutive IBD patients were surveyed using a self-completed questionnaire of 14 items that included information about dietary beliefs and habits. Two hundred and forty four patients were surveyed; 56% believe that food played a role in relapse. Nearly half reported that the disease had changed the pleasure of eating. Sixty seven percent reported purposely avoiding certain foods that they usually liked in order to prevent relapse. The majority of patients avoid eating certain foods and report that food has a strong impact on social life.     

Underdiagnosis of Nocturnal Symptoms in Asthma in General Practice

Objective. To evaluate the prevalence of nocturnal symptoms in a large sample of asthmatic patients, and to assess the agreement between patients' complaints and general practitioners' (GPs') reports in primary care. Design. Cross-sectional survey involved 3,526 GPs and 751 specialists (pulmonologists and allergists) and included 13,493 patients with persistent asthma. Symptoms, treatment, and social and medical data were collected in real time by the patients and their GPs. Setting. France. Results. Prevalence of nocturnal symptoms was 60%. A total of 7,989 patients with nocturnal symptoms had complete data for both patients and GPs; 3,849 (48.1%) had perfect agreement between GP and their complaints for nocturnal symptoms (agreement group; [kappa = 1]); 3,376(42.2%) declared having no symptoms during the night, but these were detected by the GP during the visit (underestimated by patients and detected by GPs); 773(9.6%) declared having nocturnal symptoms, but these were not detected by GPs. Patients with a good agreement with their GP's opinion were significantly more frequently followed-up by a specialist than other patients (p = 0.002). Conclusions. Nocturnal symptoms appear to be underdeclared by patients. GPs should therefore systematically ask their patients about nocturnal symptoms to increase control of asthma and to adequately manage its treatment.     

Driving and dementia: General practitioner attitudes,knowledge and self‐reported clinical practices in South Australia

Objective: To investigate the attitudes, knowledge, and self‐reported clinical practices of general practitioners (GPs) in South Australia (SA) regarding driving and dementia. Method: Information from GPs was gathered via a postal questionnaire. Results: Respondent GPs shared concern about the safety of patients with dementia who drive. Familiarity with the current SA legislation relevant to driving and dementia was modest. A variety of clinical practices are employed by GPs in relation to the assessment and management of the safe driving practices of patients with dementia. Conclusions: Recommendations are made to guide SA GPs in their judgements regarding the driving safety of patients with dementia.     

Diagnostic accuracy of primary care asthma/COPD working hypotheses, a real life study

Misdiagnoses are inevitable when working hypotheses of asthma/COPD of General Practitioners (GPs) are not checked by spirometry. To reduce misdiagnoses, Asthma/COPD-support services (AC-services) offer support by performing spirometry assessed together with written medical history by consulting pulmonologists.Research questionsWhich criteria do GPs use to justify their asthma/COPD working hypotheses? How do diagnostic assessments by an AC-service change GPs' working hypotheses? Do GPs' justifications for their working hypotheses influence the extent to which working hypotheses correspond with diagnoses given by an AC-service?MethodWe investigated the working hypotheses of 17 GPs for 284 patients with respiratory problems and their justifications: “clinical symptoms”, “office spirometry”, or “specialist's correspondence”. Working hypotheses were compared with diagnoses given by an AC-service, and the influence of the different justifications categories on diagnostic accuracy of the working hypotheses was described.Results49% of the working hypothesis were only based on clinical information, 21% were also based on office spirometry. For 30% additional specialist information was available. 50% of the working hypotheses were confirmed by the AC-service. The working hypothesis asthma was confirmed more frequently (62%) than the working hypothesis COPD (40%). The justifications for the working hypotheses given by GPs did not influence these results.ConclusionDiagnostic assessments of the AC-service differed significantly from the working hypotheses of GPs, even when these were based on previous specialists' correspondence or on office spirometry. To optimize the diagnoses in primary care, diagnostic support of an AC-service is recommended for all primary care patients with respiratory problems.     

The role of general practitioners' working style and brief alcohol intervention activity

Aims To examine correlates of general practitioners’ (GP) activity delivery of brief alcohol interventions to patients with particular reference to their ‘working style’. Design A postal questionnaire survey. Setting and participants All 75 GPs in the Community Primary Health Care Centre of the City of Tampere, Finland. Measurements Measures of working style classifying GPs into ‘problem solving’ versus ‘technological’, self‐reported brief advice activity and other demographic details. Findings and conclusions Of the respondents (response rate 85%) 45% (29/64) reported carrying out brief alcohol interventions. Male GPs provided brief interventions more often than female GPs (71% versus 36%, P = 0.017). The respondents had mainly positive attitudes to brief interventions for excessive drinkers. The working style typology did not show any relationship with brief intervention activity.     

Obstacles to cardiovascular prevention in general practice

OBJECTIVE: In spite of a wide diffusion of the European guidelines for prevention of cardiovascular (CV) diseases, failures in both primary and secondary CV prevention are currently acknowledged. We wanted to uncover obstacles to CV prevention related to the general practitioner's (GP) knowledge and attitudes. METHODS AND RESULTS: A postal questionnaire was sent to a random sample of GPs from two Belgian provinces. 282 GPs (32%) answered the questionnaire. The proportion of adequate answers was calculated for each item. The main obstacles related to three domains. Regarding awareness of CV burden, 83% of the GPs underestimated the lethality of myocardial infarction and 41% underestimated the prevalence of high CV risk in the adult population. Regarding CV risk assessment, 80% thought that total cholesterol (TC) adequately reflected the individual CV risk; only 55% systematically registered the patient's CV risk factors in the medical record. A tool for global CV risk assessment was never used by 53% of the GPs. Regarding CV therapeutic attitudes, 66% systematically prescribed a lipid-lowering drug to patients with high TC while 62% did not take into account the evidence-based therapeutic targets in type 2 diabetic patients. CONCLUSIONS: This survey showed that these GPs underestimated the CV burden, lacked a systematic approach to global risk assessment and used to focus on cholesterol treatment rather than on global CV risk management.     

Development and Validation of Quality Indicators for Dementia Diagnosis and Management in a Primary Care Setting

OBJECTIVES: To construct a set of quality indicators (QIs) for dementia diagnosis and management in a primary care setting. DESIGN: RAND modified Delphi method, including a postal survey, a stakeholders consensus meeting, a scientific expert consensus meeting, and a demonstration project. SETTING: Primary care. PARTICIPANTS: General practitioners (GPs), primary care nurses (PCNs), and informal caregivers (ICs) in postal survey and stakeholders consensus meeting. Eight national dementia experts in scientific consensus meeting. Thirteen GPs in the demonstration project. MEASUREMENTS: Mean face validity and feasibility scores. Compliance rates using GPs' electronic medical record data. RESULTS: The initial set consisted of 31 QIs. Most indicators showed moderate or good face validity and feasibility scores. Consensus panels reduced the preliminary set used in the demonstration project to 24 QIs. The overall compliance to the QIs was 45.3%. Discriminative validity of the set was good; significant differences in adherence were found between GPs with high and low levels of patients aged 65 and older in their practice, with and without PCNs, and with positive and negative attitudes toward dementia (all P<.05). Based on the demonstration project, one QI was excluded. The final set consisted of 23 QIs; 15 QIs contained innovative quality criteria on collaboration between GPs and PCNs, referral criteria, and assessment of caregivers' needs. CONCLUSION: This new set of dementia QIs is feasible, reliable, and valid and can be used to improve primary dementia care. Because of the innovative quality criteria, the set is complementary to the existing dementia QIs.     

Open access echocardiography has diagnostic yield similar to outpatient echocardiography and is highly rated by general practitioners and patients

BACKGROUND: Open access echocardiography is widely available to General Practitioners (GP). There is little data comparing the proportion of echocardiographic studies which are abnormal in open access series with that in hospital outpatient practice. This study compares the diagnostic yield from echocardiograms performed for similar indications by open access and hospital out patient requested groups and assesses the attitudes of GPs and patients to open access echocardiography. METHODS: The reports of 151 consecutive patients who had open access echocardiograms were analysed using predefined criteria for an abnormal study. The reports of 100 consecutive patients who had a new outpatient requested echocardiograms for similar indications were used as the control group. The attitudes of GPs and patients to the open access service were also assessed. RESULTS: Fifty seven percent of patients in the open access group and 51% in the hospital requested group had abnormal studies (p>0.05). 92% of GPs who responded to the questionnaire thought the report was easy to understand while 69% thought it led to a change in patient management. 74% said a clinic referral would have been made without this service and 79% preferred a management strategy to be included in the report. 90% of patients had been informed of the result by their GP. CONCLUSIONS: Open access echocardiography has a diagnostic yield similar to echocardiograms requested on new hospital outpatients in a district general hospital setting. GPs and patients report high levels of satisfaction with this service.     

Research in general practice for smokers and excessive drinkers in Australia and the UK. III. Dissemination of interventions

This article reviews the main methods of dissemination of interventions to doctors for the benefit of patients who are smokers and excessive drinkers. Firstly, the modes of delivery of interventions are discussed suck as: postal delivery, face-to-face strategies such as an educational facilitator, courier, training workshops, reinforcement contact after training, and teaching in medical school. Secondly, vie examine GPs' delivery of interventions working in association with others such as with: the health visitor, health facilitator, practice nurse, and specialist clinic. Thirdly, we discuss the debate about the public health impact of GP interventions for smokers, which is about rates of recruitment of patients to programs and about the most effective interventions that will continue to be used by GPs. Fourthly, doctors underutilize their opportunities to identify and intervene with smokers and excessive drinkers and we explore many of the barriers to intervention. Finally, there are several new initiatives in general practice that require research including: matching GPs to specific treatments, comparing the uptake and continued use of different levels of interventions, evaluating the most effective ways of delivering interventions to GPs, and the training of doctors in the intervention methods.     

eHealth for inflammatory bowel disease self-management – the patient perspective

Background: Electronic health (eHealth) solutions may help address the growing pressure on IBD outpatient services as they encompass a component of self-management. However, information regarding patients’ attitudes towards the use of eHealth solutions in IBD is lacking.

Objective: The aim of this study was to evaluate eHealth technology use and explore the perspectives of IBD patients on what constitutes the ideal eHealth solution to facilitate self-management.

Methods: A mixed methods qualitative and quantitative analysis of the outcomes of a discussion forum and an online survey conducted at a tertiary hospital in Melbourne, Australia between November 2015 and January 2016 was undertaken.

Results: Eighteen IBD patients and parents participated in the discussion forum. IBD patients expressed interest in eHealth tools that are convenient and improve access to care, communication, disease monitoring and adherence. Eighty six patients with IBD responded to the online survey. A majority of patients owned a mobile phone (98.8%), had access to the internet (97.7%), and felt confident entering data onto a phone or computer (73.3%). Most patients (98.8%) were willing to use at least one form of information and communication technology to help manage their IBD. Smartphone apps and internet websites were the two most preferred technologies to facilitate IBD self-management.

Conclusions: This study demonstrates the willifngness of patients to engage with eHealth as a potential solution to facilitate IBD self-management. Future development and testing of eHealth solutions should be informed by all major stakeholders including patients to maximise their uptake and efficacy to facilitate IBD self-management.     

French general practitioners' attitudes and reported practices in relation to their participation and effectiveness in a minimal smoking cessation programme for patients

Aims. To examine the participation and effectiveness of GPs in offering a minimal smoking cessation intervention according to attitudinal and reported behaviour variables. Design. General practitioners were surveyed about their practices and attitudes and then matched pairs of smoking and non-smoking doctors were invited to participate in a regional smoking cessation intervention. The relationship of survey responses and the degree of participation and effectiveness in a smoking cessation trial was examined. Setting. Primary care doctors in a large region of southern France, Provence-Alpes-Cote d'Azur (PACA). Participants. Two thousand, eight hundred and sixty GPs from the PACA region in France were interviewed about their attitudes and behaviours. From among 371 smoking GPs and 375 non-smoking GPs invited to take part in a smoking cessation trial with patients, 170 smokers and 202 non-smokers participated. Measurements. The GPs' attitudes and reported professional and personal practices were assessed in a telephone interview. These responses were compared with the GPs' participation in the cessation trial, and with GP "success" (1 or more patients stopping smoking at 1 month, 12 months or both) or "non-success" (no patient cessation at 1 month or at 12 months). Findings. A significantly lower proportion of smokers than non-smokers among the GPs who initially accepted did not participate in the study (45% vs. 54.1%, chi2=5.147 df="1," p 0.05, difference: 8.3% 95% CI: 1.2%; 15.5%), but thereafter, there were no significant associations between GPs' reported smoking practices and attitudes and the extent of their participation or effectiveness. Conclusions. The study results indicate that, when minimal advice has an effect, it is due more to the systematic nature of the provision of the intervention than to the attitudes or reported practices of the practitioner providing the advice.     

Neutrophil chemokines GCP-2 and GRO-alpha in patients with inflammatory bowel disease

OBJECTIVE: To measure the serum levels of neutrophils chemokine granulocyte chemotactic protein‐2 (GCP‐2) and interleukin‐8 (IL‐8) in Crohn's disease (CD) and ulcerative colitis (UC) patients and compare them with serum levels of growth‐related oncogene (GRO‐α). METHODS: Forty‐two patients with inflammatory bowel disease (24 CD and 18 UC) and 38 matched healthy subjects were recruited. Their serum GCP‐2, IL‐8 and GRO‐α were measured by a specific enzyme immunoassay kit. RESULTS: The serum levels of GCP‐2 were significantly higher in the CD than the UC patients but lower than in the healthy subjects. The GCP‐2 in the UC patients were significantly lower than in the healthy subjects. The GRO‐α levels were significantly higher in the IBD patients than in the healthy subjects. The IL‐8 levels were under the detectable limit in both the IBD and the healthy subjects. CONCLUSION: In this group of patients, GCP‐2 did not participate in the inflammatory response in IBD. GRO‐α could be an important factor that enhances the inflammatory state in IBD.     

Diagnosing irritable bowel syndrome: poor agreement between general practitioners and the Rome II criteria

Background: The new guidelines for diagnosing irritable bowel syndrome (IBS) in clinical practice recommend the use of the Rome II criteria. In this study the agreement between general practitioners (GPs) and the Rome II criteria for diagnosing of IBS and functional bowel disorders (FBD) is examined. Methods: Consecutive patients in general practice were asked to report on abdominal complaints, for which they had consulted or wanted to consult a GP. Patients with such complaints completed a questionnaire based on the Rome II criteria for FBD. After consultations, the GPs reported their diagnoses on the abdominal complaints. Results: Of 3097 screened patients, 553 patients were diagnosed by their GP and had complete data in the questionnaire. Of these patients, 107 had IBS according to the GPs and 209 had IBS according to the Rome II criteria (agreement 58%, kappa 0.01 (CI: ?0.06; 0.09)). Agreement on IBS and FBD in patients without organic disease, without reflux or dyspepsia and in patients with a verified diagnosis was 45%–58%, with kappa values from ?0.02 to 0.13. IBS and FBD cases were diagnosed by the Rome II criteria more often than by the GPs in all these groups of patients (P?Conclusions: This study shows poor agreement in the diagnosis of IBS between GPs and the Rome II criteria. Therefore, current knowledge about IBS based on strict criteria is not necessarily transferable to patients with IBS in general practice.