Family practice
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In primary care, many consultations address symptom-based complaints. Recovery from these complaints seldom exceeds placebo effects. Patient participation, because of its supposed effects on trust and patient expectancies, is assumed to benefit patients' recovery. While the idea is theoretically promising, it is still unclear what the effects of increased patient participation are on patient outcomes. Aim. To review the effects of controlled intervention studies aiming to improve patient participation in face-to-face primary care consultations on patient-oriented and/or disease-oriented outcomes. ⋯ Little research has been performed on health outcomes of interventions aiming to increase patient participation in general practice visits among patients suffering from symptom-based complaints. The results still are non-conclusive. The quality of the trials has been weak, possibly due to the complexity of the concept. This weak quality may explain the lack of conclusive results. Proposals for future research designs are offered.
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Patient and systematic factors within primary and secondary care contribute to delay in timely diagnosis of lung cancer. This qualitative study aimed to explore New Zealand service users' experiences of the pathway to lung cancer diagnosis, identify factors contributing to delay and provide advice for service improvement. ⋯ Reasons for diagnostic delay are complex and multifactorial. Solutions include community initiatives to educate and resource at-risk patients to seek help, supporting and resourcing primary care to increase timely referral and implementing strategies to reduce system complexity for GPs and patients, and the employment of care coordinators.
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Observational Study
Job satisfaction of practice assistants in general practice in Germany: an observational study.
Job satisfaction of practice staff is important for optimal health care delivery and for minimizing the turnover of non-medical professions. ⋯ Prioritizing initiatives to maintain high levels of, or to improve the job satisfaction of practice assistants, is important for recruitment and retention. It will also help to improve working conditions for both practice assistants and GPs and create an environment to provide better quality care.
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The test and retest opportunity afforded by reviewing a patient over time substantially increases the total gain in certainty when making a diagnosis in low-prevalence settings (the time-efficiency principle). This approach safely and efficiently reduces the number of patients who need to be formally tested in order to make a correct diagnosis for a person. Time, in terms of observed disease trajectory, provides a vital mechanism for achieving this task. It remains the best strategy for delivering near-optimal diagnoses in low-prevalence settings and should be used to its full advantage.