Family practice
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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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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.
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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.