The British journal of general practice : the journal of the Royal College of General Practitioners
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The management of asymptomatic cervical polyps has long been debated due to the scarcity of literature and guidelines regarding the need for polypectomy. While the majority of cervical polyps are diagnosed incidentally by GPs during routine cervical smears, there are no clear recommendations on referral pathways for further histological investigations. ⋯ This study supported the evidence that most cervical polyps are benign. However, inappropriate referrals prompt more education on cervical pathologies. Furthermore, there is a need for robust guidelines on the management of asymptomatic cervical polyps in general practice. To lessen the financial burden of managing cervical polyps in a secondary care setting, workshops on polyp removal can be developed for GPs.
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In 2020, the Chronic Disease Management (CDM) programme was introduced in Ireland. This programme resources GPs to review public (GMS) patients, diagnosed with eight named chronic diseases, twice yearly according to a structured protocol. This pay for performance initiative has been widely adopted by GPs. However, it is hypothesised that private patients (PPs) receive a poorer standard of care, as they may be reluctant to attend due to the cost involved. ⋯ Limiting Pay for Performance to the care of GMS patients only, based on age or income, promotes inverse inequality. We argue that CDM care should be offered to all patients.
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Early Intervention in Psychosis (EIP) services offer treatment to people experiencing a first episode of psychosis. Service users may be referred from primary care and discharged directly back at the end of their time in an EIP service. ⋯ GPs have a key role in supporting people within EIP services, specifically monitoring and managing physical health. Inclusion of GPs in planning discharge from EIP services is vital.
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Frequent attenders (defined as the top 10% of health care users or those making ≥10 visits per year) account for 30-50% of GP consultations. This has significant resource implications. ⋯ Frequent attenders presented due to their medical complexity or mental health disorders rather than medically unexplained symptoms. Most interactions with a GP are understandable.
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It is estimated 20-70% of those living with a dementia diagnosis experience dementia-related psychosis (D-RP). D-RP results in decreased quality of life, increased carer burden, increased rapid cognitive decline, increased need for primary care support, and earlier care/nursing home admission, all which come at a considerable cost to the NHS. Antipsychotic medications prescribed by primary care services are typically used as treatment but have short-term efficacy and dangerous side effects. Effective management with the use of non-pharmacological interventions could safely improve the quality of life of those living with dementia, as well as reduce burden on primary care services and GPs. ⋯ Future RCTs should focus on specifically improving D-RP, as this was not the primary aim for many interventions.