ABSTRACT
BACKGROUND: Most skin cancers diagnosed in Australia, including melanomas, are identified and managed in a primary care setting. Most skin cancers have the diagnosis confirmed by histopathology, and surgical excision is the most common form of treatment. Therefore, it is important that all primary care doctors in Australia are competent and confident in the diagnostic sampling and surgical management of skin cancers. OBJECTIVE: This article considers the process of performing biopsies and excisions from the skin to diagnose or treat skin cancers. DISCUSSION: Primary care is the appropriate setting for the management of most skin cancers in Australia. Small simple lesions can be sampled for diagnosis and excised as definitive treatment of the tumour. This can be simpler, cheaper and more efficient for the patient compared to the hospital setting, allows the resources of speciality care to be used for more difficult scenarios and be quite a satisfying part of providing primary care.
Subject(s)
General Practice , Skin Neoplasms , Humans , Skin Neoplasms/diagnosis , Skin Neoplasms/surgery , General Practice/methods , General Practice/trends , Australia , Biopsy/methods , Melanoma/diagnosis , Melanoma/surgery , Skin/pathologySubject(s)
General Practice , Humans , Australia , General Practice/methods , General Practice/trendsABSTRACT
OBJECTIVES: Inappropriate prescribing of antibiotics is a key driver of antimicrobial resistance. This study aimed to describe urine sampling rates and antibiotic prescribing for patients with lower urinary tract infections (UTIs) in English general practice. DESIGN: A retrospective population-based study using administrative data. SETTING: IQVIA Medical Research Database (IMRD) data from general practices in England, 2015-2022. PARTICIPANTS: Patients who have consulted with an uncomplicated UTI in England general practices captured in the IMRD. OUTCOME MEASURES: Trends in UTI episodes (episodes were defined as UTI diagnosis codes occurring within 14 days of each other), testing and antibiotic prescribing on the same day as initial UTI consultation were assessed from January 2015 to December 2022. Associations, using univariate and multivariate logistic regressions, were examined between consultation and demographic factors on the odds of a urine test. RESULTS: There were 743 350 UTI episodes; 50.8% had a urine test. Testing rates fluctuated with an upward trend and large decline in 2020. Same-day UTI antibiotic prescribing occurred in 78.2% of episodes. In multivariate modelling, factors found to decrease odds of a urine test included age ≥85 years (0.83, 95% CI 0.82 to 0.84), consultation type (remote vs face to face, 0.45, 95% CI 0.45 to 0.46), episodes in London compared with the South (0.74, 95% CI 0.72 to 0.75) and increasing practice size (0.77, 95% CI 0.76 to 0.78). Odds of urine tests increased in males (OR 1.11, 95% CI 1.10 to 1.13), for those episodes without a same-day UTI antibiotic (1.10, 95% CI 1.04 to 1.16) for episodes for those with higher deprivation status (Indices of Multiple Deprivation 8 vs 1, 1.51, 95% CI 1.48 to 1.54). Compared with 2015, 2016-2019 saw increased odds of testing while 2020 and 2021 saw decreases, with 2022 showing increased odds. CONCLUSION: Urine testing for UTI in general practice in England showed an upward trend, with same-day antibiotic prescribing remaining consistent, suggesting greater alignment to national guidelines. The COVID-19 pandemic impacted testing rates, though as of 2022, they began to recover.
Subject(s)
Anti-Bacterial Agents , General Practice , Practice Patterns, Physicians' , Urinalysis , Urinary Tract Infections , Humans , England/epidemiology , Urinary Tract Infections/diagnosis , Urinary Tract Infections/drug therapy , Urinary Tract Infections/urine , Urinary Tract Infections/epidemiology , Male , Female , Retrospective Studies , General Practice/trends , Anti-Bacterial Agents/therapeutic use , Middle Aged , Aged , Urinalysis/methods , Practice Patterns, Physicians'/trends , Practice Patterns, Physicians'/statistics & numerical data , Aged, 80 and over , Adult , Inappropriate Prescribing/statistics & numerical data , Adolescent , Young Adult , Logistic ModelsABSTRACT
BACKGROUND: General practitioners manage a significant proportion of inflammatory and neoplastic skin conditions on a daily basis. Various surgical techniques can be employed to aid in diagnosis, including punch biopsies, shave biopsy, shave excision, incisional biopsy, curettage and formal excision with closure. Requiring minimal equipment, shave procedures are quick to perform, produce good cosmetic outcomes and minimise costs. OBJECTIVE: Our aim is to discuss shave procedures in detail and highlight the difference between shave biopsies and shave excisions, as well as the role they each have in diagnosing an array of benign, inflammatory and malignant skin conditions, including melanocytic lesions. DISCUSSION: Shave procedures performed on suitable lesions by trained practitioners can be used for sampling or removing suspect lesions. Where the intent is complete removal, margin involvement is rare given good lesion selection and technique.
Subject(s)
General Practice , Humans , General Practice/methods , General Practice/trends , Biopsy/methods , Biopsy/instrumentation , Skin Diseases/surgery , Skin Diseases/diagnosisABSTRACT
BACKGROUND: It is crucial to understand the trends in paediatric antibiotic prescribing and serious and nonserious infections to improve antibiotic prescribing practices for children in ambulatory care. OBJECTIVES: Assessing trends in paediatric antibiotic prescribing and infection incidence in general practice from 2002 to 2022. METHODS: In this retrospective cohort study using INTEGO network data from 162â507 patients in Flanders (Belgium), we calculated antibiotic prescribing rates and proportions alongside incidence rates of serious and nonserious infections, stratified by age (0-1, 2-6, 7-12â years) and municipality. We performed autoregressive moving average time-series analyses and seasonality analyses. RESULTS: From 2002 to 2022, antibiotic prescribing rate decreased significantly: 584/1000 person-years (PY) (95% CI 571-597) to 484/1000PY (95% CI 478-491); so did antibiotic overall prescribing proportion: 46.3% (95% CI 45.1-47.6) to 23.3% (95% CI 22.9-23.7) (59.3% amoxicillin and 17.8% broad spectrum). Prescribing proportions dropped significantly for nonserious (45.6% to 20.9%) and increased for serious infections (64.1% to 69.8%). Proportions significantly dropped for acute suppurative otitis media (74.7% to 64.1%), upper respiratory tract infections (44.9% to 16.6%), bronchitis/bronchiolitis (73.6% to 44.1%) and acute tonsillopharyngitis (59.5% to 21.7%), while significantly increasing for pneumonia (65.2% to 80.2%). Nonserious and serious infection incidence rates increased from 785/1000PY and 34.2/1000PY to 1223/1000PY and 64.1/1000PY, respectively. Blood and CRP testing proportions increased significantly. CONCLUSIONS: Antibiotic prescribing in general practice for children declined from 2002 to 2022. Further targeted antibiotic stewardship initiatives are needed to reduce the use of broad-spectrum antibiotics and antibiotic prescribing for conditions such as otitis media and bronchitis/bronchiolitis.
Subject(s)
Anti-Bacterial Agents , General Practice , Humans , Anti-Bacterial Agents/therapeutic use , Child , Child, Preschool , Infant , General Practice/statistics & numerical data , General Practice/trends , Female , Male , Retrospective Studies , Longitudinal Studies , Infant, Newborn , Incidence , Belgium/epidemiology , Practice Patterns, Physicians'/trends , Practice Patterns, Physicians'/statistics & numerical data , Registries , Respiratory Tract Infections/drug therapy , Respiratory Tract Infections/epidemiology , Drug Prescriptions/statistics & numerical data , Otitis Media/drug therapy , Otitis Media/epidemiologyABSTRACT
BACKGROUND: Increasing numbers of young people (adolescents aged 12-17 years and young adults aged 18-25 years) are using e-cigarettes. Although the extent of the health effects is currently unknown, young people are at risk of developing nicotine dependence and, as a result, find it difficult to cease use of e-cigarettes. They might seek help from their general practitioner (GP) to do so. OBJECTIVE: This article summarises the available evidence for e-cigarette cessation in young people and suggests a rational approach to assist GPs seeing young people seeking help for e-cigarette cessation. DISCUSSION: There is limited evidence to support best treatment options for e-cigarette cessation in young people. An approach based on the experience from tobacco cessation in adults and adapted for young people might assist. Management that supports family and school engagement, with behavioural interventions, nicotine replacement therapy, other pharmacological interventions and ongoing review as appropriate for the young person's age and developmental milestones, might help successful e-cigarette cessation.
Subject(s)
Electronic Nicotine Delivery Systems , General Practice , Humans , Adolescent , Electronic Nicotine Delivery Systems/statistics & numerical data , Child , General Practice/methods , General Practice/trends , General Practice/statistics & numerical data , Young Adult , Smoking Cessation/methods , Smoking Cessation/statistics & numerical data , Adult , MaleABSTRACT
OBJECTIVE: Our objective was to examine referral patterns for people with musculoskeletal complaints presenting to Australian general practitioners (GPs). METHODS: This longitudinal analysis from the Population Level Analysis Reporting (POLAR) database includes 133,279 patients with low back (≥18 years old) or neck, shoulder, and/or knee (≥45 years old) complaints seen by 4,538 GPs across 269 practices from 2014 through 2018. Referrals to allied health and medical and/or surgical specialists were included. We determined the number of patients with referrals and GPs who made referrals and examined their timing, associations, and trends over time. RESULTS: A total of 43,666 patients (33%) received and 3,053 GPs (67%) made at least one referral. Most referrals were to allied health (n = 25,830, 19%), followed by surgeons (n = 18,805, 14%). Surgical referrals were higher for knee complaints (n = 6,140, 24%) compared with low back, neck, and shoulder complaints (range 8%-15%). The referral category varied predominantly by body region followed by gender, socioeconomic status, and primary health network. Time to allied health referral ranged between median (interquartile range [IQR]) 14 days (0-125 days) for neck complaints and 56 days (5-177 days) for knee complaints. Surgical referrals occurred sooner for those with knee complaints (15 days, IQR 0-128 days). There was a 2.2% (95% confidence interval [CI] 1.9%-2.4%) annual increase in the proportion of allied health referrals and a 1.9% (95% CI 1.6%-2.1%) decrease in surgical referrals across all sites. CONCLUSION: One-third of patients receive, and two-thirds of GPs make, referrals for musculoskeletal complaints. Understanding the reasons for referral and differences between GPs who refer more and less frequently may identify factors that explain variations in practice.
Subject(s)
Databases, Factual , General Practice , Primary Health Care , Referral and Consultation , Humans , Referral and Consultation/statistics & numerical data , Referral and Consultation/trends , Male , Female , Middle Aged , Adult , Primary Health Care/statistics & numerical data , General Practice/statistics & numerical data , General Practice/trends , Australia/epidemiology , Longitudinal Studies , Aged , Practice Patterns, Physicians'/trends , Practice Patterns, Physicians'/statistics & numerical data , Musculoskeletal Diseases/diagnosis , Musculoskeletal Diseases/therapy , Musculoskeletal Diseases/epidemiology , Young Adult , Adolescent , Time FactorsABSTRACT
Un reciente artículo publicado por Fuerza de Tareas de Servicios Preventivos de EE.UU. (en inglés, USPSTF), comunicó los resultados de una revisión enfocada a identificar cuestiones vinculadas a la perspectiva de género en la elaboración de las recomendaciones que esta institución emite regularmente. En esa publicación los autores reconocieron que el sexo biológico y la identidad de género no son habitualmente tenidos en cuenta en los estudios de investigación, lo que constituye una barrera para implementar recomendaciones que optimicen una práctica clínica inclusiva. A partir de esa comunicación, la autora de este artículo editorial considera aspectos vinculados con el género que se reflejan en nuestro pensamiento, lenguaje y abordaje clínico, situándolos en el contexto de los cambios culturales y normativos sucedidos en Argentina durante las últimas dos décadas. (AU)
A recent article published by the US Preventive Services Task Force (USPSTF) reported the results of a review focused on identifying gender-related issues in the development of the recommendations this institution regularly issues. In that publication, the authors recognised that biological sex and gender identity are often not taken into account in research studies, which constitutes a barrier when it comes to implementing recommendations that optimise inclusive clinical practice. Based on that communication, the author of this article examines aspects related to gender that are reflected in our way of thinking, language and clinical approach, placing them in the context of the cultural and regulatory changes that have taken place in Argentina over the last two decades. (AU)
Subject(s)
Humans , General Practice/trends , Scholarly Communication/trends , Gender Diversity , Gender Perspective , Gender Identity , Social Inclusion , Argentina , Social Change , Transgender Persons , Sexual and Gender MinoritiesSubject(s)
COVID-19/prevention & control , Diagnostic Services/trends , Facilities and Services Utilization/trends , Health Services Accessibility/trends , Neoplasms/diagnosis , Practice Patterns, Physicians'/trends , State Medicine/trends , England , General Practice/trends , Health Policy , Humans , Referral and Consultation/trendsABSTRACT
COVID-19 continues to pose major challenges for GP practice and emergency rooms across Germany. Even if there is now a certain routine, the optimal treatment of patients is still difficult. This article provides an overview of the aspects of caring for COVID-19 patients in GP practice and emergency rooms and the changes since the beginning of the pandemic.
Subject(s)
COVID-19/therapy , Emergency Service, Hospital/statistics & numerical data , General Practice/methods , COVID-19/complications , COVID-19/epidemiology , Emergency Service, Hospital/trends , General Practice/standards , General Practice/trends , Germany/epidemiology , Humans , Risk FactorsABSTRACT
BACKGROUND: Health services internationally have been compelled to change their methods of service delivery in response to the global COVID-19 pandemic, to mitigate the spread of infection amongst health professionals and patients. In Aotearoa/New Zealand, widespread electronic delivery of prescriptions (e-prescribing) was enabled. The aim of the research was to explore patients' experiences of how lockdown, changes to prescribing and the interface between general practices and community pharmacy affected access to prescription medications. METHOD: The research employed a mixed-method approach. This included an online survey (n = 1,010) and in-depth interviews with a subset of survey respondents (n = 38) during the first COVID-19 lockdown (March-May 2020). Respondents were recruited through a snowballing approach, starting with social media and email list contacts of the research team. In keeping with the approach, descriptive statistics of survey data and thematic analysis of qualitative interview and open-ended questions in survey data were combined. RESULTS: For most respondents who received a prescription during lockdown, this was sent directly to the pharmacy. Most people picked up their medication from the pharmacy; home delivery of medication was rare (4%). Survey and interview respondents wanted e-prescribing to continue post-lockdown and described where things worked well and where they encountered delays in the process of acquiring prescription medication. CONCLUSIONS: E-prescribing has the potential to improve access to prescription medication and is convenient for patients. The increase in e-prescribing during lockdown highlighted how the system could be improved, through better feedback about errors, more consistency across practices and pharmacies, more proactive communication with patients, and equitable prescribing costs.
Subject(s)
COVID-19 , Delivery of Health Care , Electronic Prescribing , General Practice , Health Services Accessibility , Patient Preference/statistics & numerical data , Attitude of Health Personnel , COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control/methods , Community Pharmacy Services/standards , Community Pharmacy Services/statistics & numerical data , Delivery of Health Care/organization & administration , Delivery of Health Care/standards , Electronic Prescribing/economics , Electronic Prescribing/standards , Electronic Prescribing/statistics & numerical data , Female , General Practice/methods , General Practice/trends , Health Services Accessibility/organization & administration , Health Services Accessibility/trends , Humans , Male , Middle Aged , New Zealand/epidemiology , Quality Improvement , SARS-CoV-2 , Surveys and QuestionnairesABSTRACT
BACKGROUND: Early in the COVID-19 pandemic, general practices were asked to expand triage and to reduce unnecessary face-to-face contact by prioritizing other consultation modes, e.g., online messaging, video, or telephone. The current study explores the potential barriers and facilitators general practitioners experienced to expanding triage systems and their attitudes towards triage during the COVID-19 pandemic. METHOD: A mixed-method study design was used in which a quantitative online survey was conducted along with qualitative interviews to gain a more nuanced appreciation for practitioners' experiences in the United Kingdom. The survey items were informed by the Theoretical Domains Framework so they would capture 14 behavioral factors that may influence whether practitioners use triage systems. Items were responded to using seven-point Likert scales. A median score was calculated for each item. The responses of participants identifying as part-owners and non-owners (i.e., "partner" vs. "non-partner" practitioners) were compared. The semi-structured interviews were conducted remotely and examined using Braun and Clark's thematic analysis. RESULTS: The survey was completed by 204 participants (66% Female). Most participants (83%) reported triaging patients. The items with the highest median scores captured the 'Knowledge,' 'Skills,' 'Social/Professional role and identity,' and 'Beliefs about capabilities' domains. The items with the lowest median scores captured the 'Beliefs about consequences,' 'Goals,' and 'Emotions' domains. For 14 of the 17 items, partner scores were higher than non-partner scores. All the qualitative interview participants relied on a phone triage system. Six broad themes were discovered: patient accessibility, confusions around what triage is, uncertainty and risk, relationships between service providers, job satisfaction, and the potential for total digital triage. Suggestions arose to optimize triage, such as ensuring there is sufficient time to conduct triage accurately and providing practical training to use triage efficiently. CONCLUSIONS: Many general practitioners are engaging with expanded triage systems, though more support is needed to achieve total triage across practices. Non-partner practitioners likely require more support to use the triage systems that practices take up. Additionally, practical support should be made available to help all practitioners manage the new risks and uncertainties they are likely to experience during non-face-to-face consultations.
Subject(s)
COVID-19 , General Practice , General Practitioners , Remote Consultation , Triage , Attitude of Health Personnel , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/therapy , Clinical Competence , England/epidemiology , Female , General Practice/organization & administration , General Practice/standards , General Practice/trends , General Practitioners/psychology , General Practitioners/standards , Health Knowledge, Attitudes, Practice , Humans , Infection Control/methods , Infection Control/standards , Male , Practice Patterns, Physicians'/ethics , Practice Patterns, Physicians'/trends , Remote Consultation/ethics , Remote Consultation/methods , Risk Management/trends , SARS-CoV-2 , Triage/ethics , Triage/methods , Triage/organization & administration , Triage/standardsABSTRACT
BACKGROUND: Attempts to manage the COVID-19 pandemic have led to radical reorganisations of health care systems worldwide. General practitioners (GPs) provide the vast majority of patient care, and knowledge of their experiences with providing care for regular health issues during a pandemic is scarce. Hence, in a Danish context we explored how GPs experienced reorganising their work in an attempt to uphold sufficient patient care while contributing to minimizing the spread of COVID-19. Further, in relation to this, we examined what guided GPs' choices between telephone, video and face-to-face consultations. METHODS: This study consisted of qualitative interviews with 13 GPs. They were interviewed twice, approximately three months apart in the initial phase of the pandemic, and they took daily notes for 20 days. All interviews were audio recorded, transcribed, and inductively analysed. RESULTS: The GPs re-organised their clinical work profoundly. Most consultations were converted to video or telephone, postponed or cancelled. The use of video first rose, but soon declined, once again replaced by an increased use of face-to-face consultations. When choosing between consultation forms, the GPs took into account the need to minimise the risk of COVID-19, the central guidelines, and their own preference for face-to-face consultations. There were variations over time and between the GPs regarding which health issues were dealt with by using video and/or the telephone. For some health issues, the GPs generally deemed it acceptable to use video or telephone, postpone or cancel appointments for a short term, and in a crisis situation. They experienced relational and technical limitations with video consultation, while diagnostic uncertainty was not regarded as a prominent issue CONCLUSION: This study demonstrates how the GPs experienced telephone and video consultations as being useful in a pandemic situation when face-to-face consultations had to be severely restricted. The GPs did, however, identify several limitations similar to those known in non-pandemic times. The weighing of pros and cons and their willingness to use these alternatives shifted and generally diminished when face-to-face consultations were once again deemed viable. In case of future pandemics, such alternatives seem valuable, at least for a short term.
Subject(s)
Attitude of Health Personnel , COVID-19/prevention & control , General Practice/trends , Practice Patterns, Physicians'/trends , Remote Consultation/trends , COVID-19/epidemiology , Clinical Decision-Making/methods , Denmark/epidemiology , General Practice/methods , General Practice/organization & administration , Humans , Interviews as Topic , Pandemics , Physician-Patient Relations , Practice Patterns, Physicians'/organization & administration , Qualitative Research , Remote Consultation/methods , Remote Consultation/organization & administration , Telephone , VideoconferencingABSTRACT
BACKGROUND: The emergence of the COVID-19 pandemic has raised concerns about the potential decrease in access and utilisation of general practice services and its impact on patient care. In March 2020, the Australian Government introduced telehealth services to ensure that people more vulnerable to COVID-19 do not delay routine care from their general practitioners. Evidence about patients' experience of telehealth and its impact on patient care is scarce. This study aimed to investigate the experience with telehealth by Australian general practice patients at high risk of poor health outcomes during the COVID-19 pandemic. METHODS: Semi-structured telephone interviews were conducted with 30 patients from nine general practices in metropolitan Adelaide (May-June 2020). Participants were identified by their regular doctor as being at high risk of poor health outcomes. Interviews sought participants' perspectives and experiences about telehealth services in the general practice setting during COVID-19, and the value of offering continued telehealth services post pandemic. Interviews were recorded and transcribed verbatim. Data were analysed using a coding structure developed based on deductive codes derived from the research questions and any additional concepts that emerged inductively from interviews. RESULTS: Participants expressed satisfaction with telehealth including convenient and timely access to general practice services. Yet, participants identified challenges including difficulties in expressing themselves and accessing physical exams. Prescription renewal, discussing test results and simple follow-ups were the most common reasons that telehealth was used. Telehealth was mainly via phone that better suited those with low digital literacy. Participants indicated that an existing doctor-patient relationship was important for telehealth services to be effective. Subjects believed that telehealth services should be continued but needed to be combined with opportunities for face-to-face consultations after the COVID-19 pandemic was over. CONCLUSIONS: The expansion of telehealth supported access to general practice including chronic disease management during the COVID-19 pandemic. In the future, telehealth in Australia is likely to have a stronger place in primary healthcare policy and practice and an increased acceptance amongst patients.
Subject(s)
COVID-19 , Chronic Disease , General Practice , Physician-Patient Relations , Risk Assessment/methods , Telemedicine , Australia/epidemiology , COVID-19/epidemiology , COVID-19/prevention & control , Chronic Disease/epidemiology , Chronic Disease/therapy , Communicable Disease Control/methods , Female , General Practice/methods , General Practice/trends , Health Services Accessibility/organization & administration , Humans , Male , Middle Aged , Needs Assessment , Qualitative Research , SARS-CoV-2 , Telemedicine/methods , Telemedicine/organization & administrationABSTRACT
In a time of rapidly shifting evidence-based medicine, it is challenging to stay informed of research that modifies clinical practice. To enhance knowledge of practice-changing literature, a group of 7 internists reviewed titles and abstracts in 7 internal medicine journals with the highest impact factors and relevance to outpatient general internal medicine. Coronavirus disease-19 research was purposely excluded to highlight practice changes beyond the pandemic. New England Journal of Medicine (NEJM), The Lancet, Annals of Internal Medicine, Journal of the American Medical Association (JAMA), JAMA Internal Medicine, British Medical Journal (BMJ), and Public Library of Science (PLoS) Medicine were reviewed. The following collections of article synopses and databases were also reviewed: American College of Physicians Journal Club, NEJM Journal Watch, BMJ Evidence-Based Medicine, McMaster/DynaMed Evidence Alerts, and Cochrane Reviews. A modified Delphi method was used to gain consensus based on relevance to outpatient internal medicine, impact on practice, and strength of evidence. Clusters of articles pertaining to the same topic were considered together. In total, 7 practice-changing articles were included.
Subject(s)
COVID-19 , General Practice/trends , Internal Medicine/trends , Outpatients , SARS-CoV-2 , HumansABSTRACT
The approach to hypertensive emergiencies (HE) and urgencies (HU) may be different according to local clinical practice, despite recent guidelines and position papers recommendations. The Italian Society of Hypertension (Società Italiana della Ipertensione Arteriosa, SIIA) developed an online survey, in order to explore the awareness, management and treatment of HU in Italy, sending by e mail a 12 items questionnaire to the members of the SIIA. The results show that the definition of HU was correctly identified by 62% of the responders. Most physicians identified the role of pharmacological therapy or legal/illegal substances abuse as possible cause of BP elevation; the use of a benzodiazepine drugs was considered worthwhile by 65% of responders. The prescription of diagnostic test and drug administration significantly differed from guidelines recommendations and only 57% of the physicians reported to treat HU with oral drug administration. Sub-lingual nifedipine was prescribed by 13% or responders. This survey shows the need to further spread the updated scientific information on the management and treatment of HE and HU, along with the improvement of the interrelationship with the general practitioner health system in Italy.
Subject(s)
Antihypertensive Agents/therapeutic use , Blood Pressure/drug effects , General Practice/trends , Hypertension/drug therapy , Practice Patterns, Physicians'/trends , Adolescent , Adult , Aged , Drug Utilization/trends , Emergencies , Female , Guideline Adherence/trends , Health Care Surveys , Humans , Hypertension/diagnosis , Hypertension/epidemiology , Hypertension/physiopathology , Italy/epidemiology , Male , Middle Aged , Practice Guidelines as Topic , Risk Factors , Treatment Outcome , Young AdultABSTRACT
BACKGROUND: The number of patients with dementia is forecast to grow continuously. However, there are indications that the incidence and prevalence is falling in high-income countries. OBJECTIVE: To examine whether any effects of declining incidence and prevalence rates of dementia and mild cognitive impairment (MCI) were evident in Germany between 2015 and 2019. METHODS: The analysis was based on 797 general and 132 specialists (neurological/psychiatric) practices and included 10.1 million patients aged 18 years and older who visited between January 2014 and December 2019 one of the practitioners. The prevalence and incidence of dementia and MCI were demonstrated descriptively. RESULTS: Between 2015 and 2019, the prevalence (incidence) of dementia decreased from 2.18%(0.44%) in 2015 to 2.07%(0.35%) in 2019. A relatively large decrease in the prevalence (incidence) of dementia was observed in patients aged 80 and older, at -1.47%(-0.62%), compared to younger patients, at -0.40%(-0.18%). By contrast, the prevalence and incidence of MCI have remained constant over the years (0.19%to 0.22%and 0.06%, respectively). Overall, the number of patients diagnosed with dementia decreased slightly by 1%while the number of patients diagnosed with MCI increased by 17%. CONCLUSION: Our results confirmed the reduction in the prevalence and incidence of dementia and revealed a decrease in the number of patients with dementia despite continued demographic changes. Future studies are warranted to determine whether the results are caused by changing risk and lifestyle factors or changes in medical diagnosis and treatment behavior of the practitioners.
Subject(s)
Cognitive Dysfunction/epidemiology , Dementia/epidemiology , General Practice/trends , Neurology/trends , Germany/epidemiology , Humans , Incidence , PrevalenceABSTRACT
BACKGROUND: Acute red eye in a child is a common ocular presentation in general practice. It can arise from a wide spectrum of pathologies and involve various ocular structures. OBJECTIVE: The aim of this article is to provide a framework for the general practitioner to assess and manage a child presenting with a red eye, with a focus on cases that require immediate referral. DISCUSSION: Most paediatric red eyes are benign and can be safely managed in general practice. However, this requires thorough history-taking and examination together with the ruling out of red flags. Assessment of a child with a red eye may pose specific challenges that can usually be overcome by focused history-taking and opportunistic examination. Urgent referral for examination under sedation or anaesthesia is indicated when there is suspicion of a vision-threatening cause and/or assessment in the clinic is unsuccessful.