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1.
Franoise Riou Christine Piette Grard Durand Jacques Chaperon 《The British journal of general practice》2007,57(540):574-576
BACKGROUND: The impact of a quality-circle GP prescribing improvement programme, implemented in France in 2001-2002, was assessed by a controlled study. The study involved all 27 GPs of three semi-rural areas of Brittany, France. Practice data (overall prescribing cost and markers of prescribing efficiency) were collated in an intention-to-treat analysis, using the Mann-Whitney U test. Twenty-four GPs attended the meetings regularly. The reduction in drug expenditure exceeded the cost of the programme, although variations in size effects were observed among the settings. 相似文献
2.
Jodie T Allen Simon R Cohn Amy L Ahern 《The British journal of general practice》2015,65(633):e248-e255
BackgroundReferral to a commercial weight-loss programme is a cost-effective intervention that is already used within the NHS. Qualitative research suggests this community-based, non-medical intervention accords with participants’ view of weight management as a lifestyle issue.AimTo examine the ways in which participants’ attitudes and beliefs about accessing a commercial weight management programme via their doctor relate to their weight-loss experience, and to understand how these contextual factors influence motivation and adherence to the intervention.MethodTwenty-nine participants (body mass index [BMI] ≥28 kg/m2; age ≥18 years), who took part in the WRAP (Weight Loss Referrals for Adults in Primary Care) trial, were recruited at their 3-month assessment appointment to participate in a semi-structured interview about their experience of the intervention and weight management more generally. Interviews were audiorecorded, transcribed verbatim, and analysed inductively using a narrative approach.ResultsAlthough participants view the lifestyle-based, non-medical commercial programme as an appropriate intervention for weight management, the referral from the GP and subsequent clinical assessments frame their experience of the intervention as medically pertinent with clear health benefits.ConclusionReferral by the GP and follow-up assessment appointments were integral to participant experiences of the intervention, and could be adapted for use in general practice potentially to augment treatment effects. 相似文献
3.
Damian RJ Martínez-St John Antonio Palazón-Bru Vicente F Gil-Guillén Armina Sepehri Felipe Navarro-Cremades Dolores Ramírez-Prado Domingo Orozco-Beltrán Concepción Carratalá-Munuera Ernesto Cortés María M Rizo-Baeza 《The British journal of general practice》2015,65(636):e454-e459
BackgroundPrevalence of diagnostic inertia (DI), defined as a failure to diagnose disease, has not been analysed in patients with obesity.AimTo quantify DI for cardiovascular risk factors (CVRF) in patients with obesity, and determine its association with the cardiovascular risk score.MethodAll patients with obesity attending during the first 6 months of the preventive programme were analysed. Participants had to be free of CVD (myocardial ischaemia or stroke) and aged 40–65 years; the criteria used to measure SCORE (Systematic COronary Risk Evaluation). Three subgroups of patients with obesity with no personal history of CVRF but with poor control of risk factors were established. Outcome variable was DI, defined as poor control of risk factors and no action taken by the physician. Secondary variables were diabetes, fasting blood glucose (FBG), body mass index (BMI), and SCORE. Adjusted odds ratios (OR) was determined using multivariate logistic regression models.ResultsOf 8687 patients with obesity in the programme, 6230 fulfilled SCORE criteria. Prevalence of DI in the three subgroups was: hypertension, 1275/1816 (70.2%) patients affected (95% CI = 68.1 to 72.3%); diabetes, 335/359 (93.3%) patients affected (95% CI = 90.7 to 95.9%); dyslipidaemia subgroup, 1796/3341 (53.8%) patients affected (95% CI = 52.1 to 55.4%. Factors associated with DI for each subgroup were: for hypertension, absence of diabetes, higher BMI, and greater cardiovascular risk; for dyslipidaemia, diabetes, higher BMI, and greater cardiovascular risk (SCORE); and for diabetes, lower FBG levels, lower BMI, and greater cardiovascular risk.ConclusionThis study quantified DI in patients with obesity and determined that it was associated with a greater cardiovascular risk. 相似文献
4.
Dispensing good sleep health behaviours not pills – a cluster‐randomized controlled trial to test the feasibility and efficacy of pharmacist‐provided brief behavioural treatment for insomnia
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Joanne M. Fuller Keith K. Wong Camilla Hoyos Ines Krass Bandana Saini 《Journal of sleep research》2016,25(1):104-115
5.
Feeding response to melanocortin agonist predicts preference for and obesity from a high-fat diet 总被引:4,自引:0,他引:4
Overconsumption and increased selection of high fat (HF) foods contribute to the development of common obesity. Because the hypothalamic melanocortin (MC) system plays an integral role in the regulation of food intake and dietary choice, we tested the hypothesis that proneness (-P) or resistance (-R) to dietary-induced obesity (DIO) may be due to differences in MC function. We found that prior to developing obesity and while still maintained on chow, acute, central administration of MTII, an MC agonist, produced a greater anorectic response in DIO-P rats than in DIO-R rats. However, after only 5 days of exclusive HF feeding, the DIO-R rats had significantly greater suppression of intake after MTII treatment than they did when maintained on chow. In addition, the DIO-P rats were much less responsive to MTII treatment than the DIO-R rats after only 5 days of the HF diet. In fact, MTII-induced anorexia during HF feeding correlated negatively with body weight gained on the HF diet. These results suggest that the voluntary decrease of HF feeding in DIO-R rats may be mediated by increased endogenous MC signaling, a signal likely compromised in DIO-P rats. Differences in MC regulation may also explain the observed preference for HF over a lower fat food choice in DIO-P rats. Finally, the results indicate that responses to exogenous MC challenge can be used to predict proneness or resistance to DIO. 相似文献
6.
Chris Salisbury Leigh Johnson Sarah Purdy Jose M Valderas Alan A Montgomery 《The British journal of general practice》2011,61(582):e12-e21
Background
In developed countries, primary health care increasingly involves the care of patients with multiple chronic conditions, referred to as multimorbidity.Aim
To describe the epidemiology of multimorbidity and relationships between multimorbidity and primary care consultation rates and continuity of care.Design of study
Retrospective cohort study.Setting
Random sample of 99 997 people aged 18 years or over registered with 182 general practices in England contributing data to the General Practice Research Database.Method
Multimorbidity was defined using two approaches: people with multiple chronic conditions included in the Quality and Outcomes Framework, and people identified using the Johns Hopkins University Adjusted Clinical Groups (ACG®) Case-Mix System. The determinants of multimorbidity (age, sex, area deprivation) and relationships with consultation rate and continuity of care were examined using regression models.Results
Sixteen per cent of patients had more than one chronic condition included in the Quality and Outcomes Framework, but these people accounted for 32% of all consultations. Using the wider ACG list of conditions, 58% of people had multimorbidity and they accounted for 78% of consultations. Multimorbidity was strongly related to age and deprivation. People with multimorbidity had higher consultation rates and less continuity of care compared with people without multimorbidity.Conclusion
Multimorbidity is common in the population and most consultations in primary care involve people with multimorbidity. These people are less likely to receive continuity of care, although they may be more likely to gain from it. 相似文献7.
Gemma Mansell Mark Shapley Danielle van der Windt Tom Sanders Paul Little 《The British journal of general practice》2014,64(625):e509-e515
Background
Patients with lung or colorectal cancer often present late and have a poor prognosis. Identifying diagnostic indicators to optimally assess the risk of these cancers in primary care would support early identification and timely referral for patients at increased risk.Aim
To obtain consensus regarding potential diagnostic indicators that are important for assessing the risk of lung or colorectal cancer in primary care consulters presenting with lung or abdominal symptoms.Design and setting
A Delphi study was conducted with 28 participants from primary and secondary care and academic settings in the UK and Europe.Method
Indicators were obtained from systematic reviews, recent primary studies and consultation with experts prior to the Delphi study being conducted. Over three rounds, participants rated each diagnostic indicator in terms of its importance, ranked them in order of importance, and rated each item as crucial or not crucial to assess during a GP consultation.Results
The final round resulted in 25 items remaining for each type of cancer, including established cancer symptoms such as rectal bleeding for colorectal cancer and haemoptysis for lung cancer, but also less frequently used indicators such as patients’ concerns about cancer.Conclusion
This study highlights the items clinicians feel would be most crucial to include in the clinical assessment of primary care patients, a number of which have rarely been noted in the previous literature. Their importance in assessing the risk of lung or colorectal cancer will be tested as part of a large prospective cohort study (CANDID). 相似文献8.
9.
Brandon A. Gaudiano Carter H. Davis Ivan W. Miller Lisa Uebelacker 《Clinical psychology & psychotherapy》2020,27(3):396-407
A common setting where depression is identified and treated is in primary care, where there is a need for low‐intensity and cost‐effective interventions to be used as part of a stepped‐care model. The current study involved a pilot, parallel‐group, randomized controlled trial of a video self‐help intervention for primary care patients based on acceptance and commitment therapy (ACT). The intervention, called LifeStories, consisted of storytelling vignettes of patients describing their use of ACT‐consistent coping skills for depression. Primary care patients were recruited to determine feasibility, acceptability, and potential clinical effects of the intervention. Twenty‐one participants were assigned to use LifeStories over a period of 4 weeks, and 19 participants were assigned to an attention‐matched comparison group. Qualitative feedback indicated that participants using LifeStories found the intervention to be engaging and useful in transmitting key ACT principles. Furthermore, those receiving LifeStories rated their level of “transportation” or immersion in the videos higher than the control group. Both conditions showed large improvements in levels of depression at a 12‐week follow‐up. There were no significant differences in symptom outcomes between groups; however, because this was a pilot study, it was not powered to detect differences between interventions. Both conditions additionally showed smaller effect size changes in psychological flexibility, a key ACT mechanism. The results suggest LifeStories to be a feasible and acceptable psychological intervention that may improve depression, and further research is warranted to determine its effectiveness as part of a stepped‐care approach to treating depression in primary care. 相似文献
10.
Jo Middlemass Zowie Davy Kate Cavanagh Conor Linehan Kevin Morgan Shaun Lawson A Niroshan Siriwardena 《The British journal of general practice》2012,62(605):e840-e850
BackgroundInsomnia is a common psychological complaint. Cognitive behavioural therapy for insomnia (CBT-I), although effective, is little used because of lack of trained providers. Computerised CBT-I (CCBT-I) may be a solution to this shortfall in access.AimTo explore patient and health professional perspectives and the role of social networking, to develop a novel CCBT-I programme to increase access to this form of intervention.MethodSemi-structured interviews and focus groups with a purposive sample of health professionals and adults with insomnia.ResultsA total of 23 health professionals and 28 patients were interviewed. Features designed to engender trust and improve functionality were perceived to improve uptake and adherence to CCBT-I. Trust lay in programme accreditation; for professionals, trust derived from evidence of effectiveness; for patients, trust depended on the doctor–patient relationship, professional support, the quality of online peer support, and perceptions of risk. Patients wanted mobile applications; access in short periods; self-assessment; interactive, personalised information on sleep; and moderated contact with other users. Patients and practitioners differed over whether useful information could be distinguished from less useful or potentially incorrect information.ConclusionImproving uptake and adherence to online programmes for insomnia requires design features focusing on trust and functionality. Enabling greater patient control and interaction with other users and professionals may stimulate positive experiences of online therapy. CCBT-I would enable greater access to treatment but is limited by lack of online access or poor computer literacy. 相似文献
11.
J?rg Haasenritter Norbert Donner-Banzhoff Stefan B?sner 《The British journal of general practice》2015,65(640):e748-e753