The British journal of general practice : the journal of the Royal College of General Practitioners
-
The improvement of general practitioner (GP) availability has been suggested as a factor influencing the rise in attendance rates at accident and emergency departments (AEDs) in the United Kingdom, particularly in innercity areas. However, previous studies suggest that only 3-6% of patients attempt to contact their GP before attending the AED, and measures of the availability of appointments in the surgery are not associated with AED self-referral rates. ⋯ AED attendance rates were below the national average. GP referral and admission rates to AEDs from inner urban practices mirror national rates. High rates of primary care attendance occurred in younger age groups, with more than expected occurring out of hours. The reduction in case follow-up within the AED must be supported by improvements in communication with GPs, and an expansion of practice-based nursing. Practices that are geographically close, and with similar sociodemographic features, may have different AED attendance rates. This has important implications for resource allocation in primary care.
-
We reasoned that relief of faecal impaction could be achieved if a bolus of polyethylene glycol/electrolyte solution was delivered to the caecum over a few hours. Thus, 16 patients with faecal impaction (duration of constipation 5-23 days) were treated in an open study with up to three daily treatments of one litre of polyethylene glycol/electrolyte solution daily, taken orally over 4-6 hours. ⋯ Only one patient was faecally incontinent and the only side-effect was an increase in borborygmi. Polyethylene glycol/electrolyte solution, given as a treatment dose of one litre daily for up to three days, is a highly effective and acceptable oral therapy for faecal impaction.
-
Studies have shown that bereaved individuals suffer increased rates of physical and mental ill health. Bereavement support has recently been advocated as an area of prevention in primary care, with suggestions that general practitioners (GPs) should adopt protocols for the active follow-up of their bereaved patients, which relies on the early notification of deaths by hospitals and hospices. Little is known about the routine care currently provided by GPs and primary health care teams (PHCTs) to support their bereaved patients. ⋯ GPs perceive hospitals to be slower than hospices at notifying deaths, particularly in the first 24 hours. They are divided over whether bereavement support should be proactive or reactive. Keeping a practice death register, discussing deaths together, and identifying newly bereaved relatives are activities related to providing routine bereavement care.
-
Poor mental health and high stress levels have been reported in staff working in general practice. Little is known about how practices are tackling these and other issues of health at work in the absence of an established occupational healthcare service. ⋯ The study revealed substantial neglect of workplace health issues with many practices falling foul of health and safety legislation. This report should help general practices identify issues to tackle to improve their workplace health, and the Health at Work in the NHS project to focus on areas where their targeted help will be most worthwhile.