The British journal of general practice : the journal of the Royal College of General Practitioners
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This study was based in an isolated rural practice, and it identified 107 frequent attenders (1.95% of the practice population), who created five times the consultation workload of a similar group matched for age and sex. The general practitioners (GPs) classified 60 (56%) of these patients as attending for clinically inexplicable reasons. This subgroup had higher rates of long-term medication and hospital referral, and more free access to primary health care. The study also identified very high levels of kinship and relationship by marriage within this group (47%).
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Understanding laboratory testing in diagnostic uncertainty: a qualitative study in general practice.
Better knowledge of the professional's motives for ordering laboratory tests in the case of diagnostic uncertainty may lead to interventions directed at reducing unnecessary testing. ⋯ The decision to request laboratory testing is the result of a complex interaction of considerations that are often conflicting. Designers of interventions meant to improve the ordering of tests should be aware of the numerous determinants, and take contextual variables into account.
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Patients with chronic or complex medical or psychiatric conditions are treated by many practioners, including general practitioners (GPs). Formal liaison between primary and specialist is often assumed to offer benefits to patients. The aim of this study was to assess the efficacy of formal liaison of GPs with specialist service providers on patient health outcomes, by conducting a systematic review of the published literature in MEDLINE, EMBASE, PsychINFO, CINAHL and Cochrane Library databases using the following search terms: 'family physician': synonyms of 'patient care planning', 'patient discharge' and 'patient care team'; and synonyms of 'randomised controlled trials'. ⋯ Cost effectiveness could not be determined. In conclusion, formal liaison between GPs and specialist services leaves most physical health outcomes unchanged, but improves functional outcomes in chronically mentally ill patients. It may confer modest long-term health benefits through improvements in patient concordance with treatment programmes and more effective clinical practice.
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Randomized Controlled Trial Clinical Trial
Improving uptake of influenza vaccination among older people: a randomised controlled trial.
The uptake of influenza vaccination among older people is suboptimal. Contact with a doctor or nurse is associated with older people deciding to accept influenza vaccination. ⋯ Combining home-based over- 75 health checks with influenza vaccination can improve uptake among older patients. However this intervention is likely to be costly and its effect on influenza vaccination rates is modest. The difference in uptake is greater among those who do not routinely comeforwardfor vaccination and a more viable option may be to target these patients.