The European journal of general practice
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Patients with multimorbidity who frequently contact the general practice, use emergency care or have unplanned hospitalisations, may benefit from a proactive integrated care intervention. General practitioners are not always aware of who these 'high need' patients are. Electronic medical records are a potential source to identify them. ⋯ Among multimorbid populations various 'high need' groups exist. Patients with high needs for general practice care can be identified by their previous use of general practice care. To identify frequent ED visitors and persons with unplanned hospitalisations, additional information is needed.
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Background: eHealth promises to increase self-management and personalised medicine and improve cost-effectiveness in primary care. Paired with these promises are ethical implications, as eHealth will affect patients' and primary care professionals' (PCPs) experiences, values, norms, and relationships. Objectives: We argue what ethical implications related to the impact of eHealth on four vital aspects of primary care could (and should) be anticipated. ⋯ However, autonomy can also be compromised, e.g. in cases of persuasive technologies and eHealth can increase existing health disparities. (3) The delegation of tasks to a network of technologies and stakeholders requires attention for responsibility gaps and new responsibilities. (4) The triangulate relationship: patient-eHealth-PCP requires a reconsideration of the role of human interaction and 'humanness' in primary care as well as of shaping Shared Decision Making. Conclusion: Our analysis is an essential first step towards setting up a dedicated ethics research agenda that should be examined in parallel to the development and implementation of eHealth. The ultimate goal is to inspire the development of practice-specific ethical recommendations.
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Multicenter Study
Cancer screening and follow-up in general practice: A French nationwide cross-sectional study.
The overall activity of general practitioners (GPs) related to cancer screening and follow-up is poorly documented. ⋯ Around 5% of French general practice consultations include cancer screening or follow-up. Socio-economical inequalities demand further research.
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The World Health Organisation Alma-Ata Declaration on Primary Healthcare, and the more recent Astana Declaration from the Global Conference on Primary Healthcare, emphasise the involvement of individuals and communities in health decision-making about their individual health care, service delivery and policy development. Increasingly, health funding agencies and academic publishers like the BMJ require Public and Patient Involvement in health research. These imperatives cover health decision-making about different issues in different settings. ⋯ I use the social science concept of participatory spaces, to describe three overlapping forms of involvement - shared decision-making (SDM) in clinical care, community participation to develop services and Public and Patient Involvement in research. I refer to evidence of implementation challenges for these forms of involvement and provide insights about how to routinise them with reference to the need for these practices to make more sense to general practitioners, for general practitioners to have more time and resources to incorporate them into their daily work and for more research to understand the power dynamics involved. We need leadership in our discipline, and partnership working with policymakers, patient and community organisations, to progress these issues and enable us to optimise benefits for general practitioners, patients and the broader practice population.