Family practice
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There is concern that patients may be remaining on selective serotonin reuptake inhibitors (SSRIs) longer than is clinically indicated. Previous research has explored patients' experiences of taking SSRIs and decisions about starting medication. There has been less research into patients' reasons for long-term use and their views and experiences of discontinuation. ⋯ Patients prescribed SSRI medication need to be reassured that, as with starting medication, thinking about or actually stopping medication is a task that will not be managed in isolation, but with the support of their GP.
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Randomized Controlled Trial
The use of mixed methodology in evaluating complex interventions: identifying patient factors that moderate the effects of a decision aid.
Mixed method research, the combined use of qualitative and quantitative methods, is increasingly popular in health services research, especially as a way to examine 'complex interventions'. This paper seeks to provide a case example of the use of mixed methods in the analysis of a complex intervention (a computerized interactive decision aid) to test whether their use affords insights into potential moderators of the intervention (i.e. patient factors that were associated with the impact of the intervention). ⋯ Mixed methods can illuminate different aspects of an intervention or provide greater insight into particular issues. Health service researchers need to be aware that the qualitative and quantitative results may be discrepant, and methods need to be developed to deal with such discrepancies. However, exploring seemingly discrepant results can lead to greater insight and the development of new hypotheses and avenues of research.
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Diagnosing suspected left ventricular systolic dysfunction (LVSD) in the community is a challenge for GPs. We developed and validated a clinical prediction rule (CPR) for LVSD based on history, examination and electrocardiogram (ECG). ⋯ The derived CPR provides quantitative estimates of post-test probability for LVSD. This rule requires further validation in other populations and settings because of the difficulties encountered in the validation cohort.
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Co-morbidity may influence GPs' treatment decisions for patients with anxiety. However, knowledge about differences in the pharmacological treatment of anxiety disorders in patients with and without co-morbidity is lacking. ⋯ Our results indicate that psychiatric co-morbidity in anxious patients leads to higher prescription levels of both antidepressants and benzodiazepines. Chronic somatic co-morbidity and co-morbid social problems also lead to higher prescription levels of benzodiazepines, but does not seem to influence GPs' prescribing of antidepressants. The prescription pattern of benzodiazepines was inconsistent with guideline recommendations.