The European journal of general practice
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Due to concerns about both costs and drug resistance, reducing antibiotic prescribing is a strategic aim for the UK National Health Service. A nationwide public education campaign launched in October 1999 (CATNAP) addressed this. The objectives were 1) to assess public attitudes to antibiotic use in a district with high antibiotic prescribing where a nationwide public education campaign was locally enhanced; 2) to assess the impact of the campaign on prescribing of antibiotics locally. ⋯ Using this study design and this method of locally enhancing a public education campaign, the locally enhanced campaign did not appear to influence the public's attitudes towards antibiotic prescribing in an area of high prescribing. Assessment of the attitudes of those who had definitely been exposed to the campaign and its messages to, and by, GPs might be more likely to produce a demonstrable change in attitudes.
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Evidence-based medicine (EBM) has stimulated a proliferation of clinical guidelines and prescribing protocols which aim to increase quality and improve equity of healthcare through the standardisation of treatment and access to resources. The containment of rising prescribing costs is a major concern of European healthcare systems, which has led to a more overt rationing of resources. However, prescribing guidelines and cost-containment strategies reduce the capacity of health professionals to involve patients in discussion and choice of treatment and consequently work against the objectives of patient-centred medicine (PCM), which are a priority of current UK healthcare policy. Little is known about the impact of prescribing guidelines or cost-containment strategies on the practice of medicine in the primary care sector, their effect on relations between doctors and patients, and the ways in which laymen and professionals evaluate and respond to strategies for more 'rational' prescribing. ⋯ An outcome of the conflicting pressures to which the doctors were subject in their efforts to meet clinical need while also reducing the cost of PPIs was the reinforcement of widespread assumptions and negative patient stereotypes relating to a 'mythology' of PPI prescribing. The prevalence of such stereotypes inhibits the reflexivity in medical practice, which is required for doctors to perceive and respond more constructively to patient perspectives of illness and treatment. Such typifications also function to justify the rationing of treatment on the basis of inappropriate judgements about the deservingness or moral worth of patients. The study illustrates the adverse impact on medical practice of GPs' responses to the competing pressures of meeting patient needs while complying with prescribing incentives and guidelines. It highlights the incompatibility of different policies relating to cost containment and patient-centred medicine and may help to explain the systematic inertia which appears to have hindered the development of genuinely patient-centred medicine over the last few decades.
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Falls are a common and serious cause of disability and death amongst the growing older population. As most falls are multifactorial, effective fall prevention strategies require a package of measures to be addressed in parallel (medication review and modification; detection and treatment of postural hypotension and heart disease; strength and balance exercise training for muscle weakness and instability; home hazard modification). ⋯ Much of the expertise and skills for effective fall prevention already exists within the primary care team. Responsibility for injury prevention extends beyond general practice, but the primary care team must be prepared to play its part.
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Multicenter Study
Straightforward consultation or complicated condition? General practitioners' perceptions of low back pain.
Low back pain is a common condition in general practice and represents a significant part of a general practitioner's workload. However, despite guidelines, back pain still presents considerable challenges to clinicians. ⋯ GPs adopt a bio-mechanistic approach to LBP which appears to work well for the majority of patients, as the natural history of low back pain dictates that most patients will recover. However, this approach to low back pain fails at the margins and this is evident by the significant minority of persistent sufferers and the GP's reaction to them. Expanding patient-centredness to explore psychological and social dimensions in relation to low back pain presents an ongoing challenge in general practice.