Family practice
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Randomized Controlled Trial Multicenter Study
Prevalence and predictors of polypharmacy among older primary care patients in Germany.
Older people consume an increasing amount of medication. Polypharmacy is associated with an elevated risk of adverse health outcomes resulting in hospitalizations and sometimes death. ⋯ This older general practice population in Germany is among the top pharmaceutical user group of European study samples. Apart from disease-specific determinants, GPs should be aware that low subjective health and medication disagreement are independent predictors of polypharmacy.
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To identify the clinical features of colorectal cancer presenting as a surgical emergency. ⋯ The majority of patients destined to have an emergency presentation of colorectal cancer have reported symptoms of their cancer to their doctor well before the emergency. Some emergency presentations should therefore be preventable.
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Protected learning time (PLT) schemes have been set up in primary care across the UK. There is little published evidence of their effectiveness. ⋯ PLT schemes can contribute to beneficial changes in prescribing across a large geographical area.
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Despite asthma being primarily managed in general practice and primary care, there is little research into the issues and tools which may impact on managing poorly controlled asthma in this setting. ⋯ Our findings indicate that guidelines are seen as providing the 'why' of helping asthma patients' self-manage but not the 'what to...' or 'how to...' communicate. Poor professional-patient communication seems largely to explain the poor uptake of SMPs and guideline use in general practice and primary care. This limitation is more obvious to professionals when they are working with patients with poorly controlled asthma. There is a need to identify key communication skills for effective professional-patient partnership in adult asthma management, and to develop robust strategies for effectively training GPs and PNs in enhancing these skills.
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Clinical Trial
Logistic support service improves processes and outcomes of diabetes care in general practice.
Guidelines for type 2 diabetes care in general practice are well known and accepted, but the implementation falls short. ⋯ Simple logistic support by the DSS proved to have the capacity to implement type 2 diabetes guidelines in general practice.