The British journal of general practice : the journal of the Royal College of General Practitioners
-
Multicenter Study
The value of the GP's clinical judgement in predicting dementia: a multicentre prospective cohort study among patients in general practice.
Clinical judgement is intrinsic to diagnostic strategies in general practice; however, empirical evidence for its validity is sparse. ⋯ In this sample of patients in familiar doctor-patient relationships, the GP's clinical judgement holds additional value for predicting dementia, complementing test performance and patients' self-reports. Existing and emerging primary care-based dementia risk models should consider the GP's judgement as one predictor. Results underline the importance of the GP-patient relationship.
-
Multicenter Study Observational Study
Nausea and vomiting of pregnancy and resource implications: the NVP Impact Study.
Nausea and vomiting of pregnancy (NVP) is the most prevalent medical condition associated with pregnancy. The Royal College of Obstetricians and Gynaecologists published its first guidelines for management of NVP in 2016, although many current treatments are off label, with only one recently licensed treatment for NVP in the UK. ⋯ There is considerable variation in current management practices for NVP outside of recently published guidelines, and this may result in substantial resource use and avoidable financial impact to the NHS.
-
Multicenter Study
Patient experience of home and waiting room blood pressure measurement: a qualitative study of patients with recently diagnosed hypertension.
Out-of-office blood pressure (BP) measurement is advocated to confirm hypertension diagnosis. However, little is known about how primary care patients view and use such measurement. ⋯ Home and practice waiting room measurements have overlapping but differing roles for patients. Waiting room BP monitors may be a useful out-of-office measurement modality for patients unwilling and/or unable to measure and record their BP at home.
-
Multicenter Study
Effectiveness of an intervention to optimise the use of mirabegron for overactive bladder: a quasi-experimental study in primary care.
Overactive bladder is a composite of lower urinary tract storage symptoms. Pharmacological treatment is widely employed despite markedly modest efficacy data, adverse effects, and costs for the health system. ⋯ The structured intervention showed optimisation in the use of mirabegron. When considering discontinuation it is necessary to provide clear data on the benefits and/or risks for patients and their caregivers, as such information is a precondition for shared decision making.
-
Multicenter Study
Alternatives to the face-to-face consultation in general practice: focused ethnographic case study.
NHS policy encourages general practices to introduce alternatives to the face-to-face consultation, such as telephone, email, e-consultation systems, or internet video. Most have been slow to adopt these, citing concerns about workload. This project builds on previous research by focusing on the experiences of patients and practitioners who have used one or more of these alternatives. ⋯ Experience of implementing alternatives to the face-to-face consultation suggests that changes in patient access and staff workload may be both modest and gradual. Practices planning to implement them should consider carefully their reasons for doing so and involve the whole practice team.