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1.
Helen Lester Tatum Matharu Mohammed A Mohammed David Lester Rachel Foskett-Tharby 《The British journal of general practice》2013,63(611):e408-e415
Background
Pay for performance is now a widely adopted quality improvement initiative in health care. One of the largest schemes in primary care internationally is the English Quality and Outcomes Framework (QOF).Aim
To obtain a longer term perspective on the implementation of the QOF.Design and setting
Qualitative study with 47 health professionals in 23 practices across England.Method
Semi-structured interviews.Results
Pay for performance is accepted as a routine part of primary care in England, with previous more individualistic and less structured ways of working seen as poor practice. The size of the QOF and the evidence-based nature of the indicators are regarded as key to its success. However, pay for performance may have had a negative impact on some aspects of medical professionalism, such as clinical autonomy, and led a significant minority of GPs to prioritise their own pay rather than patients’ best interests. A small minority of GPs tried to increase their clinical autonomy with further unintended consequences.Conclusion
Pay for performance indicators are now welcomed by primary healthcare teams and GPs across generations. Almost all interviewees wanted to see a greater emphasis on involving front line practice teams in developing indicators. However, almost all GPs and practice managers described a sense of decreased clinical autonomy and loss of professionalism. Calibrating the appropriate level of clinical autonomy is critical if pay for performance schemes are to have maximal impact on patient care. 相似文献2.
Helene R Voogdt-Pruis George HMI Beusmans Anton PM Gorgels Arnold DM Kester Jan W Van Ree 《The British journal of general practice》2010,60(570):40-46
Background
A substantial part of cardiovascular disease prevention is delivered in primary care. Special attention should be paid to the assessment of cardiovascular risk factors. According to the Dutch guideline for cardiovascular risk management, the heavy workload of cardiovascular risk management for GPs could be shared with advanced practice nurses.Aim
To investigate the clinical effectiveness of practice nurses acting as substitutes for GPs in cardiovascular risk management after 1 year of follow-up.Design of study
Prospective pragmatic randomised trial.Setting
Primary care in the south of the Netherlands. Six centres (25 GPs, six nurses) participated.Method
A total of 1626 potentially eligible patients at high risk for cardiovascular disease were randomised to a practice nurse group (n = 808) or a GP group (n = 818) in 2006. In total, 701 patients were included in the trial. The Dutch guideline for cardiovascular risk management was used as the protocol, with standardised techniques for risk assessment. Changes in the following risk factors after 1 year were measured: lipids, systolic blood pressure, and body mass index. In addition, patients in the GP group received a brief questionnaire.Results
A larger decrease in the mean level of risk factors was observed in the practice nurse group compared with the GP group. After controlling for confounders, only the larger decrease in total cholesterol in the practice nurse group was statistically significant (P = 0.01, two-sided).Conclusion
Advanced practice nurses are achieving results, equal to or better than GPs for the management of risk factors. The findings of this study support the involvement of practice nurses in cardiovascular risk management in Dutch primary care. 相似文献3.
Annette Plüddemann Emma Wallace Clare Bankhead Claire Keogh Danielle Van der Windt Daniel Lasserson Rose Galvin Ivan Moschetti Karen Kearley Kirsty O’Brien Sharon Sanders Susan Mallett Uriell Malanda Matthew Thompson Tom Fahey Richard Stevens 《The British journal of general practice》2014,64(621):e233-e242
Background
The publication of clinical prediction rules (CPRs) studies has risen significantly. It is unclear if this reflects increasing usage of these tools in clinical practice or how this may vary across clinical areas.Aim
To review clinical guidelines in selected areas and survey GPs in order to explore CPR usefulness in the opinion of experts and use at the point of care.Design and setting
A review of clinical guidelines and survey of UK GPs.Method
Clinical guidelines in eight clinical domains with published CPRs were reviewed for recommendations to use CPRs including primary prevention of cardiovascular disease, transient ischaemic attack (TIA) and stroke, diabetes mellitus, fracture risk assessment in osteoporosis, lower limb fractures, breast cancer, depression, and acute infections in childhood. An online survey of 401 UK GPs was also conducted.Results
Guideline review: Of 7637 records screened by title and/or abstract, 243 clinical guidelines met inclusion criteria. CPRs were most commonly recommended in guidelines regarding primary prevention of cardiovascular disease (67%) and depression (67%). There was little consensus across various clinical guidelines as to which CPR to use preferentially. Survey: Of 401 responders to the GP survey, most were aware of and applied named CPRs in the clinical areas of cardiovascular disease and depression. The commonest reasons for using CPRs were to guide management and conform to local policy requirements.Conclusion
GPs use CPRs to guide management but also to comply with local policy requirements. Future research could focus on which clinical areas clinicians would most benefit from CPRs and promoting the use of robust, externally validated CPRs. 相似文献4.
Parinya Chamnan Rebecca K Simmons Stephen Sharp Nicholas J Wareham Simon J Griffin Hiroyuki Hori Kay-Tee Khaw 《The British journal of general practice》2010,60(577):e327-e334
Background
Population-based screening for cardiovascular disease (CVD) risk, incorporating blood tests, is proposed in several countries.Aim
The aim of this study was to evaluate whether a simple approach to identifying individuals at high risk of CVD using routine data might be effective.Design of study
Prospective cohort study (EPIC-Norfolk).Setting
Norfolk area, UK.Method
A total of 21 867 men and women aged 40–74 years, who were free from CVD and diabetes at baseline, participated in the study. The discrimination (the area under the receiver operating characteristic curve [aROC]), calibration, sensitivity/specificity, and positive/negative predictive value were evaluated for different risk thresholds of the Framingham risk equations and the Cambridge diabetes risk score (as an example of a simple risk score using routine data from electronic general practice records).Results
During 203 664 person-years of follow-up, 2213 participants developed a first CVD event (10.9 per 1000 person-years). The Cambridge diabetes risk score predicted CVD events reasonably well (aROC 0.72; 95% confidence interval [CI] = 0.71 to 0.73), while the Framingham risk score had the best predictive ability (aROC 0.77; 95% CI = 0.76 to 0.78). The Framingham risk score overestimated risk of developing CVD in this representative British population by 60%.Conclusion
A risk score incorporating routinely available data from GP records performed reasonably well at predicting CVD events. This suggests that it might be more efficient to use routine data as the first stage in a stepwise population screening programme to identify people at high risk of developing CVD before more time- and resource-consuming tests are used. 相似文献5.
Helen Atherton Yannis Pappas Carl Heneghan Elizabeth Murray 《The British journal of general practice》2013,63(616):e760-e767
Background
Reports suggest approximately 21–23% of GPs in the UK have consulted with patients using email, but little is known about the nature of this use and what it means for clinicians and patients in general practice.Aim
To understand the use of email consultation in general practice by investigating the experiences of existing users and views of experts.Design and setting
A qualitative study conducted in 2010 using purposive sampling and semi-structured interviews in general practice and community settings in some London boroughs.Method
A maximum variation sample of GPs and patients who had used email for consultation in general practice were recruited, as were policy and/or implementation experts. Interviews continued until saturation was achieved.Results
In total 10 GPs, 14 patients, and six experts were interviewed. Consultation by email was often triggered by logistic or practical issues; motivators for ongoing use were the benefits, such as convenience, for GPs and patients. Both GPs and patients reported concerns about safety and lack of guidance about the ‘rules of engagement’ in email consultations, with GPs also concerned about workload. In response, both groups attempted to introduce their own rules, although this only went some way to addressing uncertainty. Long term, participants felt there was a need for regulation and guidance.Conclusion
Consultations by email in general practice occur in an unregulated and unstructured way. Current UK policy is to promote consultations by email, making it crucial to consider the responsibility and workload faced by clinicians, and the changes required to ensure safe use; not doing so may risk safety breaches and result in suboptimal care for patients. 相似文献6.
David P Peiris Rohina Joshi Ruth J Webster Patrick Groenestein Tim P Usherwood Emma Heeley Fiona M Turnbull Alexandra Lipman Anushka A Patel 《Journal of medical Internet research》2009,11(4)
Background
Challenges remain in translating the well-established evidence for management of cardiovascular disease (CVD) risk into clinical practice. Although electronic clinical decision support (CDS) systems are known to improve practitioner performance, their development in Australian primary health care settings is limited.Objectives
Study aims were to (1) develop a valid CDS tool that assists Australian general practitioners (GPs) in global CVD risk management, and (2) preliminarily evaluate its acceptability to GPs as a point-of-care resource for both general and underserved populations.Methods
CVD risk estimation (based on Framingham algorithms) and risk-based management advice (using recommendations from six Australian guidelines) were programmed into a software package. Tool validation: Data from 137 patients attending a physician’s clinic were analyzed to compare the tool’s risk scores with those obtained from an independently programmed algorithm in a separate statistics package. The tool’s management advice was compared with a physician’s recommendations based on a manual review of the guidelines. Field test: The tool was then tested with 21 GPs from eight general practices and three Aboriginal Medical Services. Customized CDS-based recommendations were generated for 200 routinely attending patients (33% Aboriginal) using information extracted from the health record by a research assistant. GPs reviewed these recommendations during each consultation. Changes in CVD risk factor measurement and management were recorded. In-depth interviews with GPs were conducted.Results
Validation testing: The tool’s risk assessment algorithm correlated very highly with the independently programmed version in the separate statistics package (intraclass correlation coefficient 0.999). For management advice, there were only two cases of disagreement between the tool and the physician. Field test: GPs found 77% (153/200) of patient outputs easy to understand and agreed with screening and prescribing recommendations in 72% and 64% of outputs, respectively; 26% of patients had their CVD risk factor history updated; 73% had at least one CVD risk factor measured or tests ordered. For people assessed at high CVD risk (n = 82), 10% and 9%, respectively, had lipid-lowering and BP-lowering medications commenced or dose adjustments made, while 7% newly commenced anti-platelet medications. Three key qualitative findings emerged: (1) GPs found the tool enabled a systematic approach to care; (2) the tool greatly influenced CVD risk communication; (3) successful implementation into routine care would require integration with practice software, minimal data entry, regular revision with updated guidelines, and a self-auditing feature. There were no substantive differences in study findings for Aboriginal Medical Services GPs, and the tool was generally considered appropriate for use with Aboriginal patients.Conclusion
A fully-integrated, self-populating, and potentially Internet-based CDS tool could contribute to improved global CVD risk management in Australian primary health care. The findings from this study will inform a large-scale trial intervention. 相似文献7.
Cliodna AM McNulty Gemma Lasseter Neville Q Verlander Harry Yoxall Philippa Moore Sarah J O’Brien Mark Evans 《The British journal of general practice》2014,64(618):e24-e30
Background
The criteria used when GPs submit stool specimens for microbiological investigation are unknown.Aim
To determine what criteria GPs use to send stool specimens, and if they are consistent with national guidance, and whether GPs would prescribe an antibiotic before they receive a result.Design and setting
Questionnaire survey of 974 GPs in 172 surgeries in England.Method
GPs were sent a questionnaire (23 questions) based on national guidance.Results
Questionnaires were returned by 90% (154/172) of surgeries and 49% (477/968) of GPs. GPs reported sending stool specimens in about 50% of cases of suspected infectious diarrhoea, most commonly because of individual symptoms, rather than public health implications. Fewer considered sampling with antibiotic-associated diarrhoea post hospitalisation, or children with acute, painful, bloody diarrhoea; only 14% mentioned outbreaks as a reason. Nearly one-half of GPs reported they would consider antibiotics in suspected cases of Escherichia coli O157, which is contraindicated. Only 23% of GPs would send the recommended three specimens for ova, cysts, and parasites (OCP) examination. Although 89% of GPs gave some verbal advice on how to collect stool specimens, only 2% of GPs gave patients any written instructions.Conclusion
GPs need more education to address gaps in knowledge about the risks and diagnosis of different infections in suspected infectious diarrhoea, especially Clostridium difficile post-antibiotics, E. coli O157, and requesting OCPs. Advice on reports, tick boxes, or links to guidance on electronic request forms may facilitate this. 相似文献8.
Francisco Buitrago Juan Ignacio Calvo Verónica Redondo-López Lourdes Ca?ón-Barroso Leoncio Rodríguez-Pérez José Francisco Hinojosa-Díaz 《The British journal of general practice》2010,60(577):584-589
Background
Overweight and obesity are positively correlated with increased risk of morbidity and mortality.Aim
To evaluate whether obesity may be considered an independent cardiovascular risk factor in patients of ages from 35 to 74 years followed-up for 10 years.Design of study
Observational, longitudinal retrospective study.Setting
Primary care practices in Badajoz (Spain).Method
A cohort of 899 patients (mean 55.7 years; 58.2% female) without evidence of cardiovascular disease was studied.Results
A total of 33.5% of the population were obese (body mass index ≥30 kg/m2). Patients meeting the obesity criteria were more commonly female (36.6%) and were older, had higher mean values of blood pressure and triglycerides, higher percentages of diabetes, and higher coronary risk using either the original Framingham or the Framingham function calibrated for the Spanish population (Framingham-REGICOR). During the follow-up period, the rates of cardiovascular events and death in patients with obesity tended to be higher: 16.3% versus 11.7%, P = 0.056 and 4.7% versus 2.2%, P<0.05, respectively. In the final model of the logistic regression multivariate analysis, the significant predictors of cardiovascular events in patients with obesity were age, sex (male), diastolic blood pressure, diabetes, and smoking. The highest odds ratio corresponded to smoking (odds ratio 2.03; 95% confidence interval = 1.22 to 3.38).Conclusion
Obesity may not be considered an independent cardiovascular risk factor in patients aged from 35 to 74 years followed-up for 10 years. 相似文献9.
Jenny C Ingram Michael W Calnan Rosemary J Greenwood Terry Kemple Sarah Payne Michael Rossdale 《The British journal of general practice》2009,59(558):e16-e24
Background
Emergency admissions to hospital at night and weekends are distressing for patients and disruptive for hospitals. Many of these admissions result from referrals from GP out-of-hours (OOH) providers.Aim
To compare rates of referral to hospital for doctors working OOH before and after the new general medical services contract was introduced in Bristol in 2005; to explore the attitudes of GPs to referral to hospital OOH; and to develop an understanding of the factors that influence GPs when they refer patients to hospital.Design of study
Cross-sectional comparison of admission rates; postal survey.Setting
Three OOH providers in south-west England.Method
Referral rates were compared for 234 GPs working OOH, and questionnaires explored their attitudes to risk.Results
There was no change in referral rates after the change in contract or in the greater than fourfold variation between those with the lowest and highest referral rates found previously. Female GPs made fewer home visits and had a higher referral rate for patients seen at home. One-hundred and fifty GPs responded to the survey. Logistic regression of three combined survey risk items, sex, and place of visit showed that GPs with low ‘tolerance of risk’ scores were more likely to be high referrers to hospital (P<0.001).Conclusion
GPs'' threshold of risk is important for explaining variations in referral to hospital. 相似文献10.
Corine den Engelsen Paula S Koekkoek Merijn B Godefrooij Mark G Spigt Guy E Rutten 《The British journal of general practice》2014,64(627):e616-e626
Background
Many programmes to detect and prevent cardiovascular disease (CVD) have been performed, but the optimal strategy is not yet clear.Aim
To present a systematic review of cardiometabolic screening programmes performed among apparently healthy people (not yet known to have CVD, diabetes, or cardiometabolic risk factors) and mixed populations (apparently healthy people and people diagnosed with risk factor or disease) to define the optimal screening strategy.Design and setting
Systematic review of studies performed in primary care in Western countries.Method
MEDLINE, Embase, and CINAHL databases were searched for studies screening for increased cardiometabolic risk. Exclusion criteria were studies designed to assess prevalence of risk factors without follow-up or treatment; without involving a GP; when fewer than two risk factors were considered as the primary outcome; and studies constrained to ethnic minorities.Results
The search strategy yielded 11 445 hits; 26 met the inclusion criteria. Five studies (1995–2012) were conducted in apparently healthy populations: three used a stepwise method. Response rates varied from 24% to 79%. Twenty-one studies (1967–2012) were performed in mixed populations; one used a stepwise method. Response rates varied from 50% to 75%. Prevalence rates could not be compared because of heterogeneity of used thresholds and eligible populations. Observed time trends were a shift from mixed to apparently healthy populations, increasing use of risk scores, and increasing use of stepwise screening methods.Conclusion
The optimal screening strategy in primary care is likely stepwise, in apparently healthy people, with the use of risk scores. Increasing public awareness and actively involving GPs might facilitate screening efficiency and uptake. 相似文献11.
Benjamin J Gray Richard M Bracken Daniel Turner Kerry Morgan Stephen D Mellalieu Michael Thomas Sally P Williams Meurig Williams Sam Rice Jeffrey W Stephens 《The British journal of general practice》2014,64(627):e634-e640
Background
Validated risk equations are currently recommended to assess individuals to determine those at ‘high risk’ of cardiovascular disease (CVD). However, there is no longer a risk ‘equation of choice’.Aim
This study examined the differences between four commonly-used CVD risk equations.Design and setting
Cross-sectional analysis of individuals who participated in a workplace-based risk assessment in Carmarthenshire, south Wales.Method
Analysis of 790 individuals (474 females, 316 males) with no prior diagnosis of CVD or diabetes. Ten-year CVD risk was predicted by entering the relevant variables into the QRISK2, Framingham Lipids, Framingham BMI, and JBS2 risk equations.Results
The Framingham BMI and JBS2 risk equations predicted a higher absolute risk than the QRISK2 and Framingham Lipids equations, and CVD risk increased concomitantly with age irrespective of which risk equation was adopted. Only a small proportion of females (0–2.1%) were predicted to be at high risk of developing CVD using any of the risk algorithms. The proportion of males predicted at high risk ranged from 5.4% (QRISK2) to 20.3% (JBS2). After age stratification, few differences between isolated risk factors were observed in males, although a greater proportion of males aged ≥50 years were predicted to be at ‘high risk’ independent of risk equation used.Conclusions
Different risk equations can influence the predicted 10-year CVD risk of individuals. More males were predicted at ‘high risk’ using the JBS2 or Framingham BMI equations. Consideration should also be given to the number of isolated risk factors, especially in younger adults when evaluating CVD risk. 相似文献12.
Anne-C��cile Schieber Michelle Kelly-Irving Christine Rolland Anissa Afrite Chantal Cases Paul Dourgnon Pierre Lombrail Jean Pascal Thierry Lang 《The British journal of general practice》2011,61(584):e105-e111
Background
Understanding interactions between patients and GPs may be important for optimising communication during consultations and improving health promotion, notably in the management of cardiovascular risk factors.Aim
To explore the agreement between physicians and patients on the management of cardiovascular risk factors, and whether potential disagreement is linked to the patient''s educational level.Design of study
INTERMEDE is a cross-sectional study with data collection occurring at GPs'' offices over a 2-week period in October 2007 in France.Method
Data were collected from both patients and doctors respectively via pre- and post-consultation questionnaires that were ‘mirrored’, meaning that GPs and patients were presented with the same questions.Results
The sample consisted of 585 eligible patients (61% females) and 27 GPs. Agreement between patients and GPs was better for tangible aspects of the consultation, such as measuring blood pressure (κ = 0.84, standard deviation [SD] = 0.04), compared to abstract elements, like advising the patient on nutrition (κ = 0.36, SD = 0.04), and on exercise (κ = 0.56, SD = 0.04). Patients'' age was closely related to level of education: half of those without any qualification were older than 65 years. The statistical association between education and agreement between physicians and patients disappeared after adjustment for age, but a trend remained.Conclusion
This study reveals misunderstandings between patients and GPs on the content of the consultation, especially for health-promotion outcomes. Taking patients'' social characteristics into account, notably age and educational level, could improve mutual understanding between patients and GPs, and therefore, the quality of care. 相似文献13.
14.
Sarah Damery Linda Nichols Roger Holder Ronan Ryan Sue Wilson Sally Warmington Helen Stokes-Lampard Kaveh Manavi 《The British journal of general practice》2013,63(611):e370-e377
Background
UK HIV guidelines identify 37 clinical indicator conditions for adult HIV infection that should prompt an HIV test. However, few data currently exist to show their predictive value in identifying undiagnosed HIV.Aim
To identify symptoms and clinical diagnoses associated with HIV infection and assess their relative importance in identifying HIV cases, using data from The Health Improvement Network (THIN) general practice database.Design and setting
A case–control study in primary care.Method
Cases (HIV-positive patients) were matched to controls (not known to have HIV). Data from 939 cases and 2576 controls were included (n = 3515). Statistical analysis assessed the incidence of the 37 clinical conditions in cases and controls, and their predictive value in indicating HIV infection, and derived odds ratios (ORs) for each indicator condition.Results
Twelve indicator conditions were significantly associated with HIV infection; 74.2% of HIV cases (n = 697) presented with none of the HIV indicator conditions prior to diagnosis. The conditions most strongly associated with HIV infection were bacterial pneumonia (OR = 47.7; 95% confidence interval [CI] = 5.6 to 404.2) and oral candidiasis (OR = 29.4; 95% CI = 6.9 to 125.5). The signs and symptoms most associated with HIV were weight loss (OR = 13.4; 95% CI = 5.0 to 36.0), pyrexia of unknown origin (OR = 7.2; 95% CI = 2.8 to 18.7), and diarrhoea (one or two consultations).Conclusion
This is the first study to quantify the predictive value of clinical diagnoses related to HIV infection in primary care. In identifying the conditions most strongly associated with HIV, this study could aid GPs in offering targeted HIV testing to those at highest risk. 相似文献15.
Dekker F Neven AK Andriesse B Kernick D Ferrari MD Assendelft WJ 《The British journal of general practice》2012,62(597):e268-e274
Background
Despite the considerable impact of migraine, the use of preventive medication in primary care is limited. Only about 5% of migraine patients who qualify for prophylaxis actually receive it, and adherence is far from optimal.Aim
To explore the opinions of GPs regarding preventive medication for migraine.Design and setting
A qualitative focus group study in Dutch general practice.Method
Four focus groups (six GPs each) were formed. GPs were purposively sampled to acquire a range of participants, reflecting the more general GP population.Results
GPs perceived patients'' concerns about the impact of migraine and the potential benefits of prophylaxis. However, some were hesitant to start prescribing prophylaxis due to doubts about effectiveness, potential side effects, and the risk of developing drug dependency. GPs'' decisions were often based on considerations other than those presented in national guidelines, for example, the patient''s need to control their own problem. Many GPs placed responsibility for initiating prophylaxis with the patient.Conclusion
Various considerations hamper GPs from managing migraine with preventive medication, and various patient-related concerns cause GPs to deviate from national headache guidelines. 相似文献16.
Scott Wilkes Greg Rubin Ann Crosland Nicola Hall Alison Murdoch 《The British journal of general practice》2009,59(562):336-342
Background
Hysterosalpingography (HSG) is recommended as a first-line investigation for tubal assessment of infertile women. This investigation is not routinely available to GPs.Aim
To explore the perceptions and attitudes of patients and health professionals to open access HSG for the initial management of infertile couples in general practice.Design of study
A nested qualitative study using in-depth interviews with GPs, fertility specialists, and infertile couples.Setting
Northumberland, Newcastle upon Tyne, North Tyneside, South Tyneside, and Gateshead.Method
Participants were 39 interviewees: 12 GPs, five fertility specialists, and 13 infertile couples (nine interviewed with their partner).Results
Four themes emerged: personal factors; will it benefit patients, GPs, and fertility specialists?; professional factors; does it fit the role of a GP?; local context; do the skills exist in general practice?; and wider context; will it benefit the NHS? GPs who had used open access HSG, felt it was appropriate for general practice and would continue to use the service. All GPs, fertility specialists, and infertile couples who had experienced open access HSG wished the service to remain in place. The main barriers to its uptake were: infrequency with which infertility presents; lack of clarity on perceived responsibilities; difficulty keeping up to date, including assimilating guidelines; low clinical priority; and lack of support in authoritative guidance.Conclusion
Providing GPs with open access to HSG would allow a full initial assessment of the infertile couple and refer women with blocked tubes directly to tertiary care. While there is general support for the provision of such a facility, the majority of GPs perceive its use as being by a limited number of GPs who have a special interest in infertility. The study findings can inform future development of infertility services at the interface between primary and secondary/tertiary care. 相似文献17.
Background
Camera phones have become ubiquitous in the digital age. Patients are beginning to bring images recorded on their mobile phones to share with their GP during medical consultations.Aim
To explore GP perceptions about the effect of patient-initiated camera phone images on the consultation.Design and setting
An interview study of GPs based in rural and urban locations in Australia.Methods
Semi-structured telephone interviews with nine GPs about their experiences with patient-initiated camera phone images.Results
GPs described how patient-initiated camera phone photos and videos contributed to the diagnostic process, management and continuity of care. These images gave GPs in the study additional insight into the patient’s world. Potential harm resulting from inappropriate use of camera phones by patients was also identified.Conclusion
Patient-initiated camera phone images can empower patients by illustrating their narratives, thus contributing to improved communication in general practice. Potential harm could result from inappropriate use of these images. GPs shown images on patients’ camera phones should make the most of this opportunity for improved understanding of the patient’s world. There are however, potential medicolegal implications such as informed consent, protection of patient and doctor privacy, and the risk of misdiagnosis. 相似文献18.
19.
Andor E Simon Sabrina Jegerlehner Thomas M��ller Katja Cattapan-Ludewig Peter Frey Marcus Grossenbacher Erich Seifritz Daniel Umbricht 《The British journal of general practice》2010,60(578):e353-e359
Background
GPs are often the first point of contact for patients with prodromal schizophrenia. Early intervention, and therefore early detection, of schizophrenia is pivotal for the further disease course. However, recent studies have revealed that, due to its low prevalence in general practice and its insidious features, prodromal schizophrenia often remains unnoticed.Aim
To test whether a repeated sensitisation method using clinical vignettes can improve diagnostic knowledge of GPs.Design of study
Postal survey using anonymous questionnaires.Repeated sensitisation model using clinical vignettes.Setting
GPs in three distinct regions in Switzerland covering a general population of 1.43 million.Method
The study was conducted between September 2008 and October 2009. Questionnaires were sent to 1138 GPs at baseline, and at 6 and 12?months. After randomisation, 591 GPs were sensitised at 1, 3, and 5?months, while no sensitisation was carried out in the remaining 547 GPs.Results
The overall response rate was 66% (750 GPs).Sensitised GPs demonstrated a highly significant increase in diagnostic knowledge at 6 and at 12?months when compared to their own baseline knowledge scores and also to non-sensitised GPs (P<0.001). In particular, awareness of insidious features, such as functional decline and social withdrawal as signs of prodromal schizophrenia, accounted for this effect.Conclusion
Theoretical knowledge of prodromal schizophrenia among GPs can successfully be increased by repeated sensitisation models using clinical vignettes. 相似文献20.
Fiona M Walter Juliet A Usher-Smith Suresh Yadlapalli Eila Watson 《The British journal of general practice》2015,65(640):e761-e768