Family practice
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Comparative Study
The 'number needed to sample' in primary care research. Comparison of two primary care sampling frames for chronic back pain.
Sampling for primary care research must strike a balance between efficiency and external validity. For most conditions, even a large population sample will yield a small number of cases, yet other sampling techniques risk problems with extrapolation of findings. ⋯ The repeat prescription sampling method was approximately five times more efficient than the general population method. However demographic and clinical differences in the repeat prescription sample might hamper extrapolation of findings to the general population, particularly in an epidemiological study, and demonstrate that simple comparison with age and gender of the target population is insufficient.
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To develop a framework for general practice management made up of quality indicators shared by six European countries. ⋯ It proved to be possible to develop a European set of indicators for assessing the quality of practice management, despite the differences in health care systems and cultures in the six different countries. These indicators will now be used in a quality assessment procedure of practice management in nine European countries. While organizational indicators are part of the new GMS contract in the UK, this research shows that many practice management issues within primary care are also of relevance in other European countries.
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Though guidelines for the management of urinary tract infections (UTI) exist in several European countries, little is known about GPs' adherence, and the appropriateness of their management with regard to antibiotic resistance. ⋯ Most patients with urinary symptoms were not treated according to current guidelines, and GPs' diagnostic and therapeutic accuracy was low. Empirical treatment of all symptomatic patients is probably the most effective policy, but implies unnecessary antibiotic prescriptions.
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Joint pain is common in community-dwelling older adults. Osteoarthritis is the most likely cause and the most common diagnosis made in this age group by GPs. However, the level of agreement between patients and their GPs in this diagnosis is questionable and may have important implications for clinical care. ⋯ The level of agreement between a GP diagnostic code of osteoarthritis and patients' use of the term '(osteo)arthritis' is no greater than would be expected by chance alone. Discordance may be high in the use of the label osteoarthritis but is not direct evidence of a lack of shared understanding of this condition.
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UK Government policy increasingly encourages self-care of minor illnesses, including self-medication. Analgesics constitute a quarter of UK over-the-counter medicines sales, but concerns have been expressed about their potential for inappropriate use. ⋯ Our findings have demonstrated a high level of use of non-prescription analgesics amongst the general public, with significant potential for inappropriate use. As we move towards a culture of increased self-management of minor illness, this demonstrated need for improved pharmacovigilance of non-prescribed medicines must be addressed.