The British journal of general practice : the journal of the Royal College of General Practitioners
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Diverting patients to the community is one of the solutions to mitigate overcrowding in emergency departments, which is the role of the Frailty In-Reach service. ⋯ We successfully improved the triage system within the Frailty In-Reach service with digital technology.
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Problematic polypharmacy is an increasingly common clinical scenario in part due to increasing multimorbidity and application of multiple single condition guidelines. It is a challenging problem requiring a multifaceted management approach. This includes deprescribing, which is the structured dose reduction or stopping of medications. Qualified GPs struggle with deprescribing due to existing barriers, but little is known about how trainee GPs feel about this skill. ⋯ This study explored the complex area of problematic polypharmacy and deprescribing as relating to final year GP trainees. It identified key skills that trainees feel they need to manage this task in practice. Importantly, it also recognises barriers to be overcome before confident deprescribing can be performed. Potential improvements in training are identified with suggestions for educational opportunities.
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Reducing suicide risk in middle-aged males (40-54 years) is a national priority. People have often presented to their GP within 3 months before suicide thus highlighting an opportunity for early intervention. ⋯ Clinical factors were identified that GPs should be alert to when assessing middle-aged males. Personalised holistic management may have a role in preventing suicide in these individuals.
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There is a paucity of research about how under 5-year-olds utilise primary care in the UK, despite having one of the highest consultation rates of any age group. A greater understanding of the factors influencing health within this age group can inform targeted health promotion. ⋯ Most reasons for attendance for children under 5 years to primary care are for acute, self-limiting conditions. Some of these could potentially be managed by increasing access to community care services. By focusing on the influence of the broader determinants of health, health promotion efforts have the opportunity to reduce barriers to health care and improve outcomes.
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Prisoners have considerable health needs, are relatively high users of health care and often die prematurely. Prison healthcare research has typically focused on specific problems such as substance misuse, but 'routine' primary care has received less attention. Strong primary care systems are associated with better population outcomes. Identifying inappropriate variations in care will inform strategies to close gaps in health care and reduce preventable deaths. ⋯ We found substantial scope for improvement and marked variations in quality which were largely unaltered after adjustment for prison and prisoner characteristics.