The British journal of general practice : the journal of the Royal College of General Practitioners
-
Multicenter Study
Communicating about expected course and re-consultation for respiratory tract infections in children: an exploratory study.
Acute respiratory tract infection is the commonest reason for children consulting, and about one-fifth re-consult for the same illness episode. Fifty-nine audiotape recordings from nine general practitioners (GPs) consulting with children with acute respiratory tract infections were examined. ⋯ A patient information leaflet was given out only once. Providing carers with an evidence-based account of the likely clinical course and communicating specific triggers to re-consult may help them manage more of these illness episodes without re-consulting.
-
Comparative Study
A comparison of irritable bowel syndrome patients managed in primary and secondary care: the Episode IBS study.
It is thought that people with irritable bowel syndrome (IBS) who consult secondary care have more severe symptomatology than those treated mainly in primary care. ⋯ High levels of physical and psychological morbidity were present in population-based volunteers managed in both primary and secondary care. This study suggests that patients with IBS managed solely in primary care are affected as much as those attending secondary care.
-
Multicenter Study
Prevalence of irritable bowel syndrome: a community survey.
Irritable bowel syndrome (IBS) is a common health problem affecting a substantial proportion of the population. Many individuals with symptoms of IBS do not seek medical attention or have stopped consulting because of disillusionment with current treatment options. Such patients may choose to re-consult with the advent of new therapies with a resulting impact on health services. ⋯ Quality of life was significantly reduced in patients with IBS. There is a substantial burden on primary healthcare services despite over half of those with symptoms also self- medicating. The Rome II diagnostic criteria identified those most affected by their symptoms and are a valid clinical tool. Population-based health surveys will need to supplement the Rome criteria with questions aiming to identify patients formally diagnosed but whose symptoms are currently under control if prevalence is to be reliably estimated.
-
The General Medical Services (GMS) contract has focused the attention of United Kingdom (UK) general practitioners (GPs) on the provision of high quality routine care for patients with chronic disease. The quality markers defined by the contract endorse the need for objective diagnosis and structured care recommended by the British Thoracic Society/Scottish Intercollegiate Guideline Network (BTS-SIGN) guideline for the management of asthma and the National Institute for Clinical Excellence (NICE) guideline on the management of chronic obstructive pulmonary disease (COPD). In this paper the key recommendations of these guidelines and their implementation in the pragmatic world of general practice are discussed, with specific focus on diagnosis, monitoring, management, self-management and delivery of care.
-
Opportunistic testing and screening for genital chlamydia infection in sexually active women under the age of 25 years can lead to a reduction in chlamydia infection and its related morbidity. ⋯ The Department of Health needs to be aware of the extreme pressures that primary care staff are under, and the potential barriers to any screening implementation. Efforts to increase chlamydia screening in this setting should be accompanied by clear guidance and education. Any chlamydia clinics or increased testing must have appropriate financial and staff resources. Genitourinary medicine (GUM) clinics, or level three practices with GUM expertise, will need to be increased in parallel with testing in primary care to provide appropriate contact tracing and follow-up.