The British journal of general practice : the journal of the Royal College of General Practitioners
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Multicenter Study
Patients' and clinicians' experiences of consultations in primary care for sleep problems and insomnia: a focus group study.
Insomnia affects around one-third of adults in the UK. Many sufferers seek help from primary care. ⋯ Better management of insomnia should take into account the perceptions and interactions of patients and practitioners. Practitioners need to empathise, listen, elicit patients' beliefs and expectations, assess sleep better, and offer a range of treatments, including cognitive and behavioural therapies, tailored to individual needs. Practitioner education should incorporate understanding of patients' decision-making processes, the clinicians' role during the consultation, and how to negotiate and deliver strategies for resolving sleep problems.
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Multicenter Study Comparative Study
Comparison of face-to-face and telephone consultations in primary care: qualitative analysis.
There is evidence that telephone consultations in general practice are typically shorter than face-to-face consultations and that fewer problems are presented in them. ⋯ Doctors in general practice do not substantially change their communicative behaviour on the telephone. Telephone consultations are shorter and include less problem disclosure than face-to-face meetings, partly because they are typically mono-topical and partly because of intrinsic differences between the two channels.
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The Quality and Outcomes Framework (QOF) is a pioneering attempt to improve the quality of primary care in the UK through the use of financial rewards. Despite its achievements, there are concerns that the QOF may offer poor value for money. ⋯ For most indicators that can be assessed, QOF incentive payments are likely to be a cost-effective use of resources for a high proportion of primary care practices, even if the QOF achieves only modest improvements in care. However, only a small subset of the indicators has been considered, and no account has been taken of the costs of administering the QOF scheme.
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Multicenter Study
Family history in primary care: understanding GPs' resistance to clinical genetics--qualitative study.
National and local evaluations of clinical genetics service pilots have experienced difficulty in engaging with GPs. ⋯ The likely effectiveness of educational policy interventions aimed at GPs that focus solely on knowledge deficit models, is questionable. There is a need to acknowledge how appropriate practice is constructed by GPs, within the context of accepted generalist roles and related identities.
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The links between obstructive sleep apnoea and hypertension are well established; obstructive sleep apnoea is reported in up to 30% of patients with hypertension, although it is frequently underdiagnosed. Physicians can assess the degree of sleepiness by administering the Epworth Sleepiness Scale, but the large number of patients with hypertension makes this strategy difficult for busy physicians to implement. Obese patients form a subgroup at higher risk for obstructive sleep apnoea, which can be targeted for screening. ⋯ In obese patients with hypertension examined in this study, the prevalence of obstructive sleep apnoea prevalence is about 10%. CPAP significantly ameliorates the blood pressure control. This simple screening and treatment strategy may be easily adopted in primary care.