The British journal of general practice : the journal of the Royal College of General Practitioners
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Review Meta Analysis Comparative Study
Comparing the cost of nurse practitioners and GPs in primary care: modelling economic data from randomised trials.
The role of nurse practitioners in primary care has recently expanded. While there are some outcome data available for different types of consultations, little is known about the relative cost. ⋯ Employing a nurse practitioner in primary care is likely to cost much the same as employing a salaried GP according to currently available data. There is considerable variability of qualifications and experience of nurse practitioners, which suggests that skill-mix decisions should depend on the full range of roles and responsibilities rather than cost.
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Homelessness affects many people in contemporary society with consequences for individuals and the wider community. Homeless people experience poorer levels of general physical and mental health than the general population and there is a substantial international evidence base which documents multiple morbidity. Despite this, they often have problems in obtaining suitable health care. ⋯ As multiple morbidity is common among homeless people, accessible and available primary health care is a pre-requisite for effective health interventions. This requires addressing barriers to provision and multi-agency working so that homeless people can access the full range of health and social care services. There are examples of best practice in the treatment and retention of homeless people in health and social care and such models can inform future provision.
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This discussion paper reviews the health impacts, physical and mental, of domestic violence and explores the link between domestic violence and psychological symptoms. This paper focuses more on posttraumatic stress disorder (PTSD) than depression and low self-esteem because doctors are less familiar with PTSD. The barriers preventing health workers from detecting domestic violence are reviewed and the fear of health professionals that asking about trauma can harm patients is explored. ⋯ It is argued that it is inadvisable to try to implement a policy of screening for domestic violence in general practice when the public health model is currently inappropriate. The paper discusses why the diagnostic frameworks of depression and PTSD are helpful in general practice, not only in detecting domestic violence but in working with the patient to establish trust and ways forward that can be tailored to meet the needs of the patient and their children. Patients' and professionals' dilemmas about what to do once domestic violence is detected are briefly explored.
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Recommendations suggest that all patients with diabetes who use insulin should home test their blood glucose. Recommendations for those not using insulin remain contradictory. These recommendations are in part based upon the assumption that people with diabetes cannot make an accurate estimate. ⋯ The majority of patients with diabetes in this study could not accurately estimate their blood glucose levels indicating that home testing may be a necessary part of diabetes self care. Home testing may also function as a form of biofeedback to facilitate an improved ability to estimate blood glucose levels.
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In recent years there has been a growth in the use of the telephone consultation for healthcare problems. This has developed, in part, as a response to increased demand for GP and accident and emergency department care. ⋯ Although telephone consultation appears to have the potential to reduce GP workload, questions remain about its effect on service use. Further rigorous evaluation is needed with emphasis on service use, safety, cost, and patient satisfaction.