Family practice
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A blood pressure (BP) difference between the upper limbs is often encountered in primary care. Knowledge of its prevalence and importance in the accurate measurement of BP is poor, representing a source of error. Current hypertension guidelines do not emphasize this. ⋯ An IAD and asymptomatic PVD are common in a primary care hypertensive population. Magnitude of the IAD is inversely correlated with ABPI, supporting the hypotheses that IADs are causally linked to PVD, and that IAD is a useful marker for the presence of PVD. Consequently, detection of an IAD should prompt the clinician to screen subjects for other signs of vascular disease and target them for aggressive cardiovascular risk factor modification.
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To investigate the perceived barriers among GPs towards introducing participation in randomized controlled trials (RCTs) to patients presenting with depression during consultations. ⋯ Depressed patients were often viewed as vulnerable and in need of protection and it was seen as difficult and intrusive to introduce research. Patients were not always given the choice to participate in research in the same way that they are encouraged to participate in treatment decision making. A lack of skills in introducing research could be addressed with training through the new Primary Care Research Network. A more radical change in clinician attitudes and policy may be needed in order to give research a higher priority within primary care.
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We examined the relationship between predisposing factors, enabling factors and need-related factors with consultation for knee pain in general practice. ⋯ Need-related factors appeared to be associated with the decision to consult about knee pain. Neither the presence of self-reported selected co-morbid conditions nor the total number of co-morbid conditions was related to consultations for knee pain. Nevertheless, 50% of those with severely disabling knee pain still did not consult for it. Further investigation of this is important in order to optimize care for patients with knee pain and co-morbid disease.
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Palliative care is an important, complex aspect of primary care, requiring a multidisciplinary approach. The Gold Standards Framework (GSF), a programme used by over 3,000 UK practices, aims to facilitate high-quality palliative care through the introduction of systematic clinical and organizational processes. Quality payments for palliative care are available to UK practices which maintain registers and hold multidisciplinary meetings. ⋯ Effective palliative care requires good team relationships and robust processes. While GSF can enable such improvements, quality measures focusing on processes alone are inadequate to distinguish good practice, questioning the effectiveness of current quality measures in UK general practice.
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Multiple chronic conditions occurring in the same individual are associated with adverse health outcomes. In family practice, individuals are seen who, over time, may experience many different symptoms, illnesses and chronic diseases. Measures for defining multimorbidity, which incorporate the diverse range of health problems seen in population-based family practice, remain to be developed. We have investigated whether routinely collected consultation data could be used as the basis for a simple classification of multimorbidity that reflects an individual's overall health status. ⋯ Multimorbidity defined by using routinely collected family practice consultation data and classified by count and by severity was associated with poorer physical function. This approach offers the potential for systematic use of routine records to classify multimorbidity and to identify groups with high likelihood of poor physical status for needs assessment and targeted intervention.