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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Review Meta Analysis
Educational and organisational interventions used to improve the management of hypertension in primary care: a systematic review.
The optimal way in which to organise and deliver care to patients with hypertension has not been clearly identified. ⋯ General practices and community-based clinics need to have an organised system of regular follow-up and review of their hypertensive patients. Antihypertensive drug therapy should be implemented by means of a vigorous stepped care approach when patients do not reach target blood pressure levels. These findings have important implications for recommendations concerning implementation of structured delivery of care in hypertension guidelines.
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Review Meta Analysis
Self-help books for depression: how can practitioners and patients make the right choice?
Depression is a common and important public health problem most often treated by GPs. A self-help approach is popular with patients, yet little is known about its effectiveness. ⋯ There are a number of self-help books for the treatment of depression readily available. For the majority, there is little direct evidence for their effectiveness. There is weak evidence that suggests that bibliotherapy, based on a cognitive behavioural therapy approach is useful for some people when they are given some additional guidance. More work is required in primary care to investigate the cost-effectiveness of self-help and the most suitable format and presentation of materials.
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Review Meta Analysis
Motivational interviewing: a systematic review and meta-analysis.
Motivational Interviewing is a well-known, scientifically tested method of counselling clients developed by Miller and Rollnick and viewed as a useful intervention strategy in the treatment of lifestyle problems and disease. ⋯ Motivational interviewing in a scientific setting outperforms traditional advice giving in the treatment of a broad range of behavioural problems and diseases. Large-scale studies are now needed to prove that motivational interviewing can be implemented into daily clinical work in primary and secondary health care.
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Review Meta Analysis Comparative Study
Corticosteroid injections for painful shoulder: a meta-analysis.
There are no systematic reviews of corticosteroids for shoulder pain that calculate the numbers needed to treat. ⋯ Subacromial injections of corticosteroids are effective for improvement for rotator cuff tendonitis up to a 9-month period. They are also probably more effective than NSAID medication. Higher doses may be better than lower doses for subacromial corticosteroid injection for rotator cuff tendonitis.