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1.
Thomas E Cowling Matthew J Harris Hilary C Watt Daniel C Gibbons Azeem Majeed 《The British journal of general practice》2014,64(624):e434-e439
Background
The annual number of unplanned attendances at accident and emergency (A&E) departments in England increased by 11% (2.2 million attendances) between 2008–2009 and 2012–2013. A national review of urgent and emergency care has emphasised the role of access to primary care services in preventing A&E attendances.Aim
To estimate the number of A&E attendances in England in 2012–2013 that were preceded by the attending patient being unable to obtain an appointment or a convenient appointment at their general practice.Design and setting
Cross-sectional analysis of a national survey of adults registered with a GP in England.Method
The number of general practice consultations in England in 2012–2013 was estimated by extrapolating the linear trend of published data for 2000–2001 to 2008–2009. This parameter was multiplied by the ratio of attempts to obtain a general practice appointment that resulted in an A&E attendance to attempts that resulted in a general practice consultation estimated using the GP Patient Survey 2012–2013. A sensitivity analysis varied the number of consultations by ±12% and the ratio by ±25%.Results
An estimated 5.77 million (99.9% confidence interval = 5.49 to 6.05 million) A&E attendances were preceded by the attending patient being unable to obtain a general practice appointment or a convenient appointment, comprising 26.5% of unplanned A&E attendances in England in 2012–2013. The sensitivity analysis produced values between 17.5% and 37.2% of unplanned A&E attendances.Conclusion
A large number of A&E attendances are likely to be preceded by unsuccessful attempts to obtain convenient general practice appointments in England each year. 相似文献2.
Mariko Carey Hannah Small Sze Lin Yoong Allison Boyes Alessandra Bisquera Rob Sanson-Fisher 《The British journal of general practice》2014,64(620):e122-e127
Background
General practice is a common setting for the provision of weight-management advice, as well as the treatment of depression. While there is some evidence of a reciprocal relationship between obesity and depression, there are limited data about the rates of depression among general practice patients who are underweight, normal weight, overweight, and obese.Aim
To explore the prevalence of depression among underweight, normal weight, overweight, and obese general practice patients.Design and setting
A cross-sectional survey was conducted in 12 Australian general practices.Method
Patients aged ≥18 years and older who were presenting for general practice care were eligible to participate. Consenting patients completed a touchscreen computer survey assessing self-reported weight and height. Depression was assessed by the Patient Health Questionnaire-9 (PHQ-9), with a score of ≥10 used to indicate possible depression.Results
Data were obtained from 3361 participants. The prevalence of depression was 24% (95% confidence interval [CI] = 11.86 to 39.28) among underweight participants, 11% (95% CI = 8.5 to 14.0) among normal weight participants, 12% (95% CI = 0.9 to 15.2) among overweight participants, and 23% (95% CI = 17.8 to 29.0) among obese participants. The prevalence of depression was higher for women than for men across all weight categories except underweight.Conclusion
Weight and depression demonstrated a U-shaped relationship, with higher prevalence of depression observed among underweight and obese general practice patients. These conditions may act as red flags for opportunistic screening of depression in the general practice setting. 相似文献3.
Factors associated with enablement in general practice: cross-sectional study using routinely-collected data. 总被引:1,自引:0,他引:1
BACKGROUND: Quality-improvement activities are most often focused on clinical quality indicators. However, patient evaluations are important additional indicators of the quality of general practice consultations, including measures of satisfaction or enablement (that is, the extent to which the consultation enhances the patient's feelings of confidence and ability to cope). There is limited evidence concerning factors associated with enablement in UK general practice. AIM: To identify patient and practice characteristics associated with enablement scores following general practice consultations. DESIGN OF STUDY: Cross-sectional survey using a large routinely-collected dataset of patient evaluations of general practice (190,038 individual patient responses). SETTING: A total of 1031 UK general practices. METHOD: Relationships between health, demographic factors, evaluations of general practice care, and patient self-reported enablement were estimated using multiple regression. RESULTS: The primary predictor of enablement was positive patient evaluation of the GPs' communication. Reported continuity of care accounted for a lower proportion of the variance. Of the included patient demographic variables, ethnicity was a key predictor, with patients from minority ethnic groups reporting greater enablement once other factors were controlled. CONCLUSION: The current results provide support for the construct validity of the enablement measure. However, if enablement is to become a valid and useful measure of quality, it is necessary to understand the mechanisms by which enablement is increased in certain patients and practices. Detailed qualitative research may also be required to explain the relatively high scores of ethnic minority responders, despite lower overall satisfaction scores, and to understand why some items included in the enablement measure are regarded as 'not applicable' by a substantial minority of patients. 相似文献
4.
Sivatharan Vedavanam Nicholas Steel Joanne Broadbent Susan Maisey Amanda Howe 《The British journal of general practice》2009,59(559):e32-e37
Background
Depression is a leading cause of disease and disability internationally, and is responsible for many primary care consultations. Little is known about the quality of primary care for depression in the UK.Aim
To determine the prevalence of good-quality primary care for depression, and to analyse variations in quality by patient and practice characteristics.Design of study
Retrospective observational study.Setting
Eighteen general practices in England.Method
Medical records were examined for 279 patients. The percentage of eligible participants diagnosed with depression who received the care specified by each of six quality indicators in 2002 and 2004 was assessed. Associations between quality achievement and age, sex, patient deprivation score, timepoint, and practice size were estimated using logistic regression.Results
There was very wide variation in achievement of different indicators (range 1–97%). Achievement was higher for indicators referring to treatment and follow-up than for indicators referring to history taking. Achievement of quality indicators was low overall (37%). Quality did not vary significantly by patient or practice characteristics.Conclusion
There is substantial scope for improvement in the quality of primary care for depression, if the highest achievement rates could be matched for all indicators. Given the lack of variation by practice characteristics, system-level and educational interventions may be the best ways to improve quality. The equitable distribution of quality by patient deprivation score is an important achievement that may be challenging to maintain as quality improves. 相似文献5.
I-Hao Cheng Ann Drillich Peter Schattner 《The British journal of general practice》2015,65(632):e171-e176
Background
Refugees and asylum seekers often struggle to use general practice services in resettlement countries.Aim
To describe and analyse the literature on the experiences of refugees and asylum seekers using general practice services in countries of resettlement.Design and setting
Literature review using systematic search and narrative data extraction and synthesis methodologies. International, peer-reviewed literature published in English language between 1990 and 2013.Method
Embase, Ovid MEDLINE, PsycINFO, CSA Sociological Abstracts, and CINAHL databases were searched using the terms: refugee, asylum seeker, experience, perception, doctor, physician, and general practitioner. Titles, abstracts and full texts were reviewed and were critically appraised. Narrative themes describing the refugee or asylum seeker’s personal experiences of general practice services were identified, coded, and analysed.Results
From 8722 papers, 85 were fully reviewed and 23 included. These represented the experiences of approximately 864 individuals using general practice services across 11 countries. Common narrative themes that emerged were: difficulties accessing general practice services, language barriers, poor doctor–patient relationships, and problems with the cultural acceptability of medical care.Conclusion
The difficulties refugees and asylum seekers experience accessing and using general practice services could be addressed by providing practical support for patients to register, make appointments, and attend services, and through using interpreters. Clinicians should look beyond refugee stereotypes to focus on the needs and expectations of the individual. They should provide clear explanations about unfamiliar clinical processes and treatments while offering timely management. 相似文献6.
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Natasha J Verbakel Maaike Langelaan Theo JM Verheij Cordula Wagner Dorien LM Zwart 《The British journal of general practice》2015,65(634):e319-e329
Background
A constructive safety culture is essential for the successful implementation of patient safety improvements.Aim
To assess the effect of two patient safety culture interventions on incident reporting as a proxy of safety culture.Design and setting
A three-arm cluster randomised trial was conducted in a mixed method study, studying the effect of administering a patient safety culture questionnaire (intervention I), the questionnaire complemented with a practice-based workshop (intervention II) and no intervention (control) in 30 general practices in the Netherlands.Method
The primary outcome, the number of reported incidents, was measured with a questionnaire at baseline and a year after. Analysis was performed using a negative binomial model. Secondary outcomes were quality and safety indicators and safety culture. Mixed effects linear regression was used to analyse the culture questionnaires.Results
The number of incidents increased in both intervention groups, to 82 and 224 in intervention I and II respectively. Adjusted for baseline number of incidents, practice size and accreditation status, the study showed that practices that additionally participated in the workshop reported 42 (95% confidence interval [CI] = 9.81 to 177.50) times more incidents compared to the control group. Practices that only completed the questionnaire reported 5 (95% CI = 1.17 to 25.49) times more incidents. There were no statistically significant differences in staff perception of patient safety culture at follow-up between the three study groups.Conclusion
Educating staff and facilitating discussion about patient safety culture in their own practice leads to increased reporting of incidents. It is beneficial to invest in a team-wise effort to improve patient safety. 相似文献9.
Peter J Gill Braden O’Neill Peter Rose David Mant Anthony Harnden 《The British journal of general practice》2014,64(629):e752-e757
Background
Child health care is an important part of the UK general practice workload; in 2009 children aged <15 years accounted for 10.9% of consultations. However, only 1.2% of the UK’s Quality and Outcomes Framework pay-for-performance incentive points relate specifically to children.Aim
To improve the quality of care provided for children and adolescents by defining a set of quality indicators that reflect evidence-based national guidelines and are feasible to audit using routine computerised clinical records.Design and setting
Multi-step consensus methodology in UK general practice.Method
Four-step development process: selection of priority issues (applying nominal group methodology), systematic review of National Institute for Health and Care Excellence (NICE) and Scottish Intercollegiate Guidelines Network (SIGN) clinical guidelines, translation of guideline recommendations into quality indicators, and assessment of their validity and implementation feasibility (applying consensus methodology used in selecting QOF indicators).Results
Of the 296 national guidelines published, 48 were potentially relevant to children in primary care, but only 123 of 1863 recommendations (6.6%) met selection criteria for translation into 56 potential quality indicators. A further 13 potential indicators were articulated after review of existing quality indicators and standards. Assessment of the validity and feasibility of implementation of these 69 candidate indicators by a clinical expert group identified 35 with median scores 8 on a 9-point Likert scale. However, only seven of the 35 achieved a GRADE rating >1 (were based on more than expert opinion).Conclusion
Producing valid primary care quality indicators for children is feasible but difficult. These indicators require piloting before wide adoption but have the potential to raise the standard of primary care for all children. 相似文献10.
Emma C Richards Thomas E Cowling Elinor J Gunning Matthew J Harris Michael A Soljak Naomi Nowlan Kanika Dharmayat Nur Johari Azeem Majeed 《The British journal of general practice》2015,65(641):e806-e812
Background
The NHS Choices website (www.nhs.uk) provides data on the opening hours of general practices in England. If the data are accurate, they could be used to examine the benefits of extended hours.Aim
To determine whether online data on the opening times of general practices in England are accurate regarding the number of hours in which GPs provide face-to-face consultations.Design and setting
Cross-sectional comparison of data from NHS Choices and telephone survey data reported by general practice staff, for a nationally representative sample of 320 general practices (December 2013 to September 2014).Method
GP face-to-face consultation times were collected by telephone for each sampled practice for each day of the week. NHS Choices data on surgery times were available online. Analysis was based on differences in the number of surgery hours (accounting for breaks) and the times of the first and last consultations of the day only between the two data sources.Results
The NHS Choices data recorded 8.8 more hours per week than the survey data on average (40.1 versus 31.2; 95% confidence interval [CI] = 7.4 to 10.3). This was largely accounted for by differences in the recording of breaks between sessions. The data were more similar when only the first and last consultation times were considered (mean difference = 1.6 hours; 95% CI = 0.9 to 2.3).Conclusion
NHS Choices data do not accurately measure the number of hours in which GPs provide face-to-face consultations. They better record the hours between the first and last consultations of the day. 相似文献11.
Connolly A Iliffe S Gaehl E Campbell S Drake R Morris J Martin H Purandare N 《The British journal of general practice》2012,62(595):e91-e98
Background
Primary care services are often the main healthcare service for people with dementia; as such, good-quality care at this level is important.Aim
To measure the quality of care provided to people with dementia in general practice using routinely collected data, and to explore associated patient and practice factors.Design and setting
Observational, cross-sectional review of medical records from general practices (n = 52) in five primary care trusts.Method
A total of 994 people with dementia were identified from dementia registers. An unweighted quality-of-care score was constructed using information collected in the annual dementia review, together with pharmacological management of cognitive and non-cognitive symptoms. Multilevel modelling was carried out to identify factors associated with quality-of-care scores.Results
In total, 599 out of 745 (80%) patients with dementia had received an annual dementia review; however, a social care review or discussion with carers was evident in just 305 (51%) and 367 (61%) of those 599 cases, respectively. Despite high prevalence of vascular disease, over a quarter (n = 259, 26%) of all patients with dementia were prescribed antipsychotics; only 57% (n = 148) of these had undergone medication review in the previous 6 months. Those with vascular dementia who were registered with single-handed practices received poorer quality of care than those registered with practices that had more than one GP.Conclusion
Although the number of people with dementia with a record of an annual dementia review is high, the quality of these reviews is suboptimal. The quality score developed in this study could be used as one source of data to identify weaknesses in practice activity that need to be corrected, and so would be of value to commissioners and regulators, as well as practices themselves. 相似文献12.
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Peter Griffiths Trevor Murrells Jill Maben Simon Jones Mark Ashworth 《The British journal of general practice》2010,60(570):e36-e48
Background
In many UK general practices, nurses have been used to deliver results against the indicators of the Quality and Outcomes Framework (QOF), a ‘pay for performance’ scheme.Aim
To determine the association between the level of nurse staffing in general practice and the quality of clinical care as measured by the QOF.Design of the study
Cross-sectional analysis of routine data.Setting
English general practice in 2005/2006.Method
QOF data from 7456 general practices were linked with a database of practice characteristics, nurse staffing data, and census-derived data on population characteristics and measures of population density. Multi-level modelling explored the relationship between QOF performance and the number of patients per full-time equivalent nurse. The outcome measures were achievement of quality of care for eight clinical domains as rated by the QOF, and reported achievement of 10 clinical outcome indicators derived from it.Results
A high level of nurse staffing (fewer patients per full-time equivalent practice-employed nurse) was significantly associated with better performance in 4/8 clinical domains of the QOF (chronic obstructive pulmonary disease, coronary heart disease, diabetes, and hypertension, P = 0.004 to P<0.001) and in 4/10 clinical outcome indicators (diabetes: glycosylated haemoglobin [HbA1C] ≤7.4%, HbA1C ≤10% and total cholesterol ≤193 mg/dl; and stroke: total cholesterol ≤5 mmol/L, P = 0.0057 to P<0.001).Conclusion
Practices that employ more nurses perform better in a number of clinical domains measured by the QOF. This improved performance includes better intermediate clinical outcomes, suggesting real patient benefit may be associated with using nurses to deliver care to meet QOF targets. 相似文献15.
Edward G Tyrrell Elizabeth Orton Laila J Tata Denise Kendrick 《The British journal of general practice》2012,62(605):e827-e833
Background
Preschool children have a high risk of poisoning. While medicines prescribed by primary care are potential poisoning agents, the risk factors for poisoning from medication are not well described.Aim
To identify risk factors for medicinal and non-medicinal poisoning in preschool children.Design and setting
Population-based nested case-control study using The Health Improvement Network primary care database 1988–2004.Method
Conditional logistic regression was used to identify child, maternal, and social risk factors for medicinal (1316 cases) and non-medicinal poisoning (503 cases), using 17 709 controls matched on general practice.Results
Poisoning by medicines was independently associated with deprivation (test for trend P<0.001), maternal age (P<0.001), birth order (P<0.001), maternal alcohol misuse (odds ratio [OR] = 5.44, 95% confidence interval [CI] = 1.99 to 14.91), and perinatal depression (OR = 1.54, 95% CI = 1.26 to 1.88). Living in a household with two or more adults lowered the odds of injury compared to single-parent households (OR = 0.85, 95% CI = 0.74 to 0.96) and the odds varied by age, being highest in 2 year olds (OR = 9.61, 95% CI = 7.73 to 11.95). Non-medicinal poisoning was associated with deprivation (P = 0.001), maternal age (P<0.001), and birth order (P<0.001). The odds were raised in 1 year olds (OR = 5.44, 95% CI = 4.07 to 7.26) and 2 year olds (OR = 5.07, 95% CI = 3.73 to 6.90) compared to those aged <1 year.Conclusion
Primary care data can be used to target interventions to children at risk of poisoning. This is pertinent when prescribing for children/family members, as prescribed medications may become poisoning agents. Prompt identification of maternal depression and alcohol misuse, and delivery of poisoning-prevention interventions at this stage may help prevent poisonings. 相似文献16.
17.
Trevor Murrells Jane Ball Jill Maben Mark Ashworth Peter Griffiths 《The British journal of general practice》2015,65(639):e642-e648
Background
Diabetes affects around 3.6 million people in the UK. Previous research found that general practices employing more nurses delivered better diabetes care, but did not include data on individual patient characteristics or consultations received.Aim
To examine whether the proportion of consultations with patients with diabetes provided by nurses in GP practices is associated with control of diabetes measured by levels of glycated haemoglobin (HbA1c).Design and setting
A retrospective observational study using consultation records from 319 649 patients with diabetes from 471 UK general practices from 2002 to 2011.Method
Hierarchical multilevel models to examine associations between proportion of consultations undertaken by nurses and attaining HbA1c targets over time, controlling for case-mix and practice level factors.Results
The proportion of consultations with nurses has increased by 20% since 2002 but patients with diabetes made fewer consultations per year in 2011 compared with 2002 (11.6 versus 16.0). Glycaemic control has improved and was more uniformly achieved in 2011 than 2002. Practices in which nurses provide a higher proportion of consultations perform no differently to those where nurse input is lower (lowest versus highest nurse contact tertile odds ratio [OR] [confidence interval {95% CI}]: HbA1c ≤53 mmol/mol (7%) 2002, 1.04 [95% CI = 0.87 to 1.25] and 2011, 0.95 [95% CI = 0.87 to 1.03]; HbA1c ≤86 mmol/mol (10%) 2002, 0.97 [95% CI = 0.73 to 1.29] and 2011, 0.95 [95% CI = 0.86 to 1.04]).Conclusion
Practices that primarily use GPs to deliver diabetes care could release significant resources with no adverse effect by switching their services towards nurse-led care. 相似文献18.
Carolyn Tarrant Andrew M Colman Tim Stokes 《The British journal of general practice》2008,58(556):780-783
Recent changes to the organisation and delivery of primary care in the UK have the potential to reduce continuity of care markedly, but it is not clear how this will have an impact on patient trust. This study aims to test the associations between specific aspects of continuity in the GP–patient relationship, and patient trust, informed by the theoretical framework of behavioural game theory. A cross-sectional survey of patients in three Leicestershire general practices was conducted. Regression analysis showed that ratings of the GP''s interpersonal care, past experience of cooperation, and expectation of continuing care from the GP were all independent predictors of patient trust. These findings highlight the value of longitudinal aspects of the GP–patient relationship. 相似文献
19.
Rachel Scantlebury Gillian Rowlands Stevo Durbaba Peter Schofield Kalwant Sidhu Mark Ashworth 《The British journal of general practice》2015,65(639):e649-e654
Background
Demand for England’s accident and emergency (A&E) services is increasing and is particularly concentrated in areas of high deprivation. The extent to which primary care services, relative to population characteristics, can impact on A&E is not fully understood.Aim
To conduct a detailed analysis to identify population and primary care characteristics associated with A&E attendance rates, particularly those that may be amenable to change by primary care services.Design and setting
This study used a cross-sectional population-based design. The setting was general practices in England, in the year 2011–2012.Method
Multivariate linear regression analysis was used to create a model to explain the variability in practice A&E attendance rates. Predictor variables included population demographics, practice characteristics, and measures of patient experiences of primary care.Results
The strongest predictor of general practice A&E attendance rates was social deprivation: the Index of Multiple Deprivation (IMD-2010) (β = 0.3. B = 1.4 [95% CI =1.3 to 1.6]), followed by population morbidity (GPPS responders reporting a long-standing health condition) (β = 0.2, B = 231.5 [95% CI = 202.1 to 260.8]), and knowledge of how to contact an out-of-hours GP (GPPS question 36) (β = −0.2, B = −128.7 [95% CI =149.3 to −108.2]). Other significant predictors included the practice list size (β = −0.1, B = −0.002 [95% CI = −0.003 to −0.002]) and the proportion of patients aged 0–4 years (β = 0.1, B = 547.3 [95% CI = 418.6 to 676.0]). The final model explained 34.4% of the variation in A&E attendance rates, mostly due to factors that could not be modified by primary care services.Conclusion
Demographic characteristics were the strongest predictors of A&E attendance rates. Primary care variables that may be amenable to change only made a small contribution to higher A&E attendance rates. 相似文献20.
Martin Marshall James Mountford Kirsten Gamet Gulsen Gungor Conor Burke Robyn Hudson Steve Morris Nishma Patel Phil Koczan Rob Meaker Cyril Chantler Christopher Michael Roberts 《The British journal of general practice》2014,64(629):e745-e751