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Br J Gen Pract ; 70(691): 84-85, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32001474
Br J Gen Pract ; 69(682): e356-e362, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30803982


BACKGROUND: Despite patient preference and many known benefits, continuity of care is in decline in general practice. The most common method of measuring continuity is the Usual Provider of Care (UPC) index. This requires a number of appointments per patient and a relatively long timeframe for accuracy, reducing its applicability for day-to-day performance management. AIM: To describe the St Leonard's Index of Continuity of Care (SLICC) for measuring GP continuity regularly, and demonstrate how it has been used in service in general practice. DESIGN AND SETTING: Analysis of appointment audit data from 2016-2017 in a general practice with 8823-9409 patients and seven part-time partners, in Exeter, UK. METHOD: The percentage of face-to-face appointments for patients on each doctor's list, with the patient's personal doctor (the SLICC), was calculated monthly. The SLICC for different demographic groupings of patients (for example, sex and frequency of attendance) was compared. The UPC index over the 2 years was also calculated, allowing comparisons between indices. RESULTS: In the 2-year study period, there were 35 622 GP face-to-face appointments; 1.96 per patient per year. Overall, 51.7% (95% confidence interval = 51.2 to 52.2) of GP appointments were with the patients' personal doctor. Patients aged ≥65 years had a higher level of continuity with 64.9% of appointments being with their personal doctor. The mean whole-practice UPC score was 0.61 (standard deviation 0.23), with 'usual provider' being the personal GP for 52.8% and a trainee or locum for 8.1% of patients. CONCLUSION: This method could provide working GPs with a simple way to track continuity of care and inform practice management and decision making.

Agendamento de Consultas , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Medicina de Família e Comunidade , Medicina Geral , Adulto , Idoso , Demografia , Medicina de Família e Comunidade/normas , Medicina de Família e Comunidade/estatística & dados numéricos , Feminino , Medicina Geral/normas , Medicina Geral/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Relações Médico-Paciente , Indicadores de Qualidade em Assistência à Saúde , Reino Unido
BMJ Open ; 8(6): e021161, 2018 06 28.
Artigo em Inglês | MEDLINE | ID: mdl-29959146


OBJECTIVE: Continuity of care is a long-standing feature of healthcare, especially of general practice. It is associated with increased patient satisfaction, increased take-up of health promotion, greater adherence to medical advice and decreased use of hospital services. This review aims to examine whether there is a relationship between the receipt of continuity of doctor care and mortality. DESIGN: Systematic review without meta-analysis. DATA SOURCES: MEDLINE, Embase and the Web of Science, from 1996 to 2017. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Peer-reviewed primary research articles, published in English which reported measured continuity of care received by patients from any kind of doctor, in any setting, in any country, related to measured mortality of those patients. RESULTS: Of the 726 articles identified in searches, 22 fulfilled the eligibility criteria. The studies were all cohort or cross-sectional and most adjusted for multiple potential confounding factors. These studies came from nine countries with very different cultures and health systems. We found such heterogeneity of continuity and mortality measurement methods and time frames that it was not possible to combine the results of studies. However, 18 (81.8%) high-quality studies reported statistically significant reductions in mortality, with increased continuity of care. 16 of these were with all-cause mortality. Three others showed no association and one demonstrated mixed results. These significant protective effects occurred with both generalist and specialist doctors. CONCLUSIONS: This first systematic review reveals that increased continuity of care by doctors is associated with lower mortality rates. Although all the evidence is observational, patients across cultural boundaries appear to benefit from continuity of care with both generalist and specialist doctors. Many of these articles called for continuity to be given a higher priority in healthcare planning. Despite substantial, successive, technical advances in medicine, interpersonal factors remain important. PROSPERO REGISTRATION NUMBER: CRD42016042091.

Continuidade da Assistência ao Paciente/normas , Mortalidade , Relações Médico-Paciente , Médicos/normas , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Satisfação do Paciente , Ensaios Clínicos Controlados Aleatórios como Assunto
Med Educ ; 2018 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-29603331
BMJ Open ; 7(2): e014045, 2017 02 14.
Artigo em Inglês | MEDLINE | ID: mdl-28196950


OBJECTIVES: To clarify the relationship between social deprivation and age as two factors associated with emergency admissions to hospital. DESIGN: Emergency admissions for 12 months were analysed for patients in the NHS NEW Devon CCG. Social deprivation was measured by the Index of Multiple Deprivation (IMD). Logistic regression models estimated the separate and combined effects of social deprivation and age on the risk of emergency admissions for people aged under and over 65. SETTING: East Devon, UK-area of the NEW Devon CCG. POPULATION: 765 861 patients in the CCG database. MAIN OUTCOME MEASURE: Emergency admission to any English hospital. RESULTS: Age (p<0.001) and social deprivation (p<0.001) were significantly associated with emergency admission to hospital, but there was a significant interaction between age and social deprivation (p<0.001). From the third quintile of age upwards, age progressively overtakes deprivation and age has a dominant effect on emergency admissions over the age of 65. The effect of age was J-shaped in all deprivation groups, increasing exponentially after age 40. For patients under 65, age and social deprivation had similar risks for emergency admissions, the differences in risk between the top and bottom quintiles of IMD and age being ∼1.5 and 0.9 percentage points. In patients over 65, age had a much greater effect on the risk of admissions than social deprivation, the differences in risk between the top and bottom quintiles of IMD and age being ∼2.8 and 18.7 percentage points. CONCLUSIONS: Risk curves for all social groups have similar shapes, implying a common biological pattern for ageing in any social group. Over age 65, the biological effects of ageing outweigh the social effects of deprivation. Our model enables CCGs to anticipate and plan for emergency admissions to hospital. These findings provide a new logic for allocating resources to different populations.

Fatores Etários , Admissão do Paciente/estatística & dados numéricos , Isolamento Social , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Emergências , Feminino , Alocação de Recursos para a Atenção à Saúde , Nível de Saúde , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Regionalização , Características de Residência , Fatores Socioeconômicos , Reino Unido , Adulto Jovem
Genome Biol ; 15(3): R45, 2014 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-24580780


BACKGROUND: Sensing and responding to ambient temperature is important for controlling growth and development of many organisms, in part by regulating mRNA levels. mRNA abundance can change with temperature, but it is unclear whether this results from changes in transcription or decay rates, and whether passive or active temperature regulation is involved. RESULTS: Using a base analog labelling method, we directly measured the temperature coefficient, Q10, of mRNA synthesis and degradation rates of the Arabidopsis transcriptome. We show that for most genes, transcript levels are buffered against passive increases in transcription rates by balancing passive increases in the rate of decay. Strikingly, for temperature-responsive transcripts, increasing temperature raises transcript abundance primarily by promoting faster transcription relative to decay and not vice versa, suggesting a global transcriptional process exists that controls mRNA abundance by temperature. This is partly accounted for by gene body H2A.Z which is associated with low transcription rate Q10, but is also influenced by other marks and transcription factor activities. CONCLUSIONS: Our data show that less frequent chromatin states can produce temperature responses simply by virtue of their rarity and the difference between their thermal properties and those of the most common states, and underline the advantages of directly measuring transcription rate changes in dynamic systems, rather than inferring rates from changes in mRNA abundance.

Arabidopsis/genética , Resposta ao Choque Térmico/genética , Transcrição Genética , Arabidopsis/fisiologia , Proteínas de Arabidopsis/genética , Proteínas de Arabidopsis/metabolismo , Cromatina/genética , Cromatina/metabolismo , Regulação da Expressão Gênica de Plantas , Histonas/genética , Histonas/metabolismo , Transcriptoma
Curr Biol ; 20(16): 1493-7, 2010 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-20705468


Plants exhibit a wide variety of growth rates that are known to be determined by genetic and environmental factors, and different plants grow optimally at different temperatures, indicating that this is a genetically determined character. Moderate decreases in ambient temperature inhibit vegetative growth, but the mechanism is poorly understood, although a decrease in gibberellin (GA) levels is known to be required. Here we demonstrate that the basic helix-loop-helix transcription factor SPATULA (SPT), previously known to be a regulator of low temperature-responsive germination, mediates the repression of growth by cool daytime temperatures but has little or no growth-regulating role under warmer conditions. We show that only daytime temperatures affect vegetative growth and that SPT couples morning temperature to growth rate. In seedlings, warm temperatures inhibit the accumulation of the SPT protein, and SPT autoregulates its own transcript abundance in conjunction with diurnal effects. Genetic data show that repression of growth by SPT is independent of GA signaling and phytochrome B, as previously shown for PIF4. Our data suggest that SPT integrates time of day and temperature signaling to control vegetative growth rate.

Proteínas de Arabidopsis/fisiologia , Arabidopsis/crescimento & desenvolvimento , Fatores de Transcrição Hélice-Alça-Hélice Básicos/fisiologia , Temperatura Ambiente , Arabidopsis/efeitos dos fármacos , Arabidopsis/metabolismo , Arabidopsis/efeitos da radiação , Regulação da Expressão Gênica de Plantas/efeitos da radiação , Giberelinas/farmacologia , Luz , RNA Mensageiro/metabolismo , Transdução de Sinais/efeitos da radiação