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1.
High Blood Press Cardiovasc Prev ; 28(2): 151-157, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33544372

RESUMO

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.


Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Medicina Geral/tendências , Hipertensão/tratamento farmacológico , Padrões de Prática Médica/tendências , Adolescente , Adulto , Idoso , Uso de Medicamentos/tendências , Emergências , Feminino , Fidelidade a Diretrizes/tendências , Pesquisas sobre Serviços de Saúde , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
2.
Aust J Gen Pract ; 49(11): 745-751, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33123716

RESUMO

METHOD: A national cross-sectional online survey of Australian general practitioners was conducted in April and May 2020, with 572 respondents. RESULTS: The COVID-19 pandemic in Australia has resulted in major changes to general practice business models. Most practices have experienced increased workload and reduced income. DISCUSSION: Australian general practices have undertaken major innovation and realignment to respond to staff safety and patient care challenges during the COVID-19 pandemic. Increased administration, reduced billable time, managing staffing and pivoting to telehealth service provision have negatively affected practice viability. Major sources of information for general practice are primary care-specific, but many practices turn to colleagues for support and resources.


Assuntos
Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus , Medicina Geral , Pandemias , Pneumonia Viral , Gestão de Riscos , Atitude do Pessoal de Saúde , Austrália/epidemiologia , Betacoronavirus , Defesa Civil/normas , Defesa Civil/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Estudos Transversais , Medicina Geral/organização & administração , Medicina Geral/tendências , Clínicos Gerais , Pesquisas sobre Serviços de Saúde , Humanos , Mortalidade , Inovação Organizacional , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Gestão de Riscos/organização & administração , Gestão de Riscos/tendências , Telemedicina/estatística & dados numéricos
5.
J Med Internet Res ; 22(10): e19415, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32812887

RESUMO

In many countries, private companies provide primary care services based predominantly on offering video consultations via smartphones. One example is Babylon GP at Hand (BGPaH), which offers video consultations to National Health Service patients, 24 hours a day, and has grown rapidly in London over the last 3 years. The development of this type of service has been controversial, particularly in the United Kingdom, but there has been little formal published evaluation of these services in any country. This paper outlines the main controversies about the use of privately provided video consultation services for primary care and shows how they are informed by the limited evaluations that have been conducted, particularly the evaluation of BGPaH. This paper describes the advantages of these services in terms of convenience, speed of access, the ability to consult without traveling or face-to-face patient-doctor contact, and the possibility of recruiting doctors who cannot work in conventional settings or do not live near the patients. It also highlights the concerns and uncertainties about quality and safety, demand, fragmentation of care, impact on other health services, efficiency, and equity. There are questions about whether private primary care services based on video consultations have a sustainable business model and whether they will undermine other health care providers. During the recent COVID-19 pandemic, the use of video consulting has become more widespread within conventional primary care services, and this is likely to have lasting consequences for the future delivery of primary care. It is important to understand the extent to which lessons from the evaluation of BGPaH and other private services based on a video-first model are relevant to the use of video consulting within conventional general practices, and to consider the advantages and disadvantages of these developments, before video consultation-based services in primary care become more widely established.


Assuntos
Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/tendências , Encaminhamento e Consulta , Telemedicina/métodos , Telemedicina/tendências , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Feminino , Medicina Geral/métodos , Medicina Geral/tendências , Serviços de Saúde , Humanos , Masculino , Pandemias , Relações Médico-Paciente , Pneumonia Viral/epidemiologia , Medicina Estatal/tendências , Reino Unido
6.
SEMERGEN, Soc. Esp. Med. Rural Gen. (Ed. Impr.) ; 46(supl.1): 42-46, ago. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-192611

RESUMO

OBJECTIVE: To evaluate the prevalence and associated factors with SARS-CoV-2 infection in general practitioners and nurses of primary care centers and nursing homes in the health area of León (Spain). MATERIALS AND METHODS: Cross-sectional study in a convenience sample of professionals from 30 health centers and 30 nursing homes from the primary care management division of the Healthcare Area of Leon. The work center, type of profession, COVID-19 infection, level of exposure, compliance with preventive measures, isolation (if required) and diagnostic tests carried out were collected. The determination of infection was made by differentiated rapid diagnostic test (dRDT), using a finger-stick whole-blood sample. The association of variables with infection was assessed by multivariable non-conditional logistic regression. The true prevalence of SARS-CoV-2 infection was calculated according to two scenarios for RDT (Sensitivity=0.6 and Specificity=0.985; Sensitivity=0.8 and Specificity=1). RESULTS: The true prevalence of SARS-CoV-2 infection was between 4.9% - 11.0%. The observed prevalence was 5.9%, being higher in nursing home compared to primary care centers (9.5% vs. 5.5%). No statistically significant differences were observed by sex, type of professional, level of exposure or compliance with preventive measures. CONCLUSIONS: The prevalence of SARS-CoV-2 infection in this group is low. A high number of professionals remain susceptible to SARS-CoV-2 infection and therefore protective measures should be taken, especially in nursing home professionals


OBJETIVO: Evaluar la prevalencia y los factores asociados a la infección por SARS-CoV-2 en médicos y enfermeras de centros de atención primaria y residencias de ancianos del área de salud de León (España). MATERIAL Y MÉTODOS: Estudio observacional realizado en una muestra de conveniencia de profesionales de 30 centros de salud y 30 residencias de ancianos, de la Gerencia de Atención Primaria del área de salud de León. Se recogió información del centro de trabajo, tipo de profesión, infección por COVID-19, nivel de exposición, cumplimiento de medidas preventivas, aislamiento (si fue requerido) y test diagnósticos realizados. La determinación de infección fue llevada a cabo mediante prueba de diagnóstico rápido diferenciado (PDRd), usando muestra de sangre capilar. La asociación de las variables con la infección se evaluó mediante regresión logística multivariable no condicional. La prevalencia real de infección por SARS-CoV-2 fue calculada de acuerdo a dos escenarios para el PDRd (Sensibilidad=0,6 y Especificidad=0,985; Sensibilidad=0,8 y Especificidad=1). RESULTADOS: La prevalencia real de infección por SARS-CoV-2 se encontró entre 4,9%-11,0%. La prevalencia observada fue de 5,9%, siendo mayor en trabajadores de residencias de ancianos que de centros de salud de atención primaria (9,5% vs 5,5%). No hubo diferencias estadísticamente significativas por sexo, tipo de profesional, nivel de exposición o cumplimiento de medidas preventivas. CONCLUSIONES: La prevalencia de la infección por el SARS-CoV-2 en este grupo es baja. Un gran número de profesionales siguen siendo susceptibles a la infección por el SARS-CoV-2 y, por lo tanto, medidas de protección deben ser adoptadas, especialmente en los profesionales de las residencias de ancianos


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Infecções por Coronavirus/epidemiologia , Síndrome Respiratória Aguda Grave/epidemiologia , Vírus da SARS/isolamento & purificação , Transmissão de Doença Infecciosa do Paciente para o Profissional/estatística & dados numéricos , Estudos Transversais , Prevalência , Cuidados de Enfermagem/tendências , Medicina Geral/tendências , Pessoal de Saúde/estatística & dados numéricos , Exposição Ocupacional/estatística & dados numéricos , Precauções Universais/métodos
7.
Arch Cardiovasc Dis ; 113(6-7): 401-419, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32473996

RESUMO

BACKGROUND: Guidelines have been published concerning patient management after hospitalization for heart failure. The French national healthcare database (Systèmenationaldesdonnéesdesanté; SNDS) can be used to compare these guidelines with real-life practice. AIMS: To study healthcare utilization 30 days before and after hospitalization for heart failure, and the variations induced by the exclusion of institutionalized patients, who are less exposed to outpatient healthcare utilization. METHODS: We identified the first hospitalization for heart failure in 2015 of adult beneficiaries of the health insurance schemes covering 88% of the French population, who were alive 30 days after hospitalization. Outpatient healthcare utilization rates during the 30 days after hospitalization and the median times to outpatient care, together with their interquartile ranges, were described for all patients, and for a subgroup excluding institutionalized patients. RESULTS: Among the 104,984 patients included (mean age 79 years; 52% women), 74% were non-institutionalized (mean age 78 years; 47% women). The frequencies of at least one consultation after hospitalization and the median times to consultation were 69% (total sample) vs. 78% (subgroup excluding institutionalized patients) and 8 days (interquartile range 3; 16) vs. 7 days (3; 15) for general practitioners, 20% vs. 21% and 14 days (7; 23) vs. 16 days (9; 24) for cardiologists and 58% vs. 69% and 3 days (1; 9) vs. 2 days (1; 7) for nurses, with reimbursement of diuretics in 77% vs. 86%, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers in 48% vs. 55% and beta-blockers in 55% vs. 63%. Departmental variations, excluding institutionalized patients, were large: general practice consultations (interquartile range 74%; 83%), cardiology consultations (11%; 23%) and nursing care (68%; 77%). CONCLUSIONS: Low outpatient healthcare utilization rates, long intervals to first healthcare utilization and departmental variations indicate a mismatch between guidelines and real-life practice, which is accentuated when including institutionalized patients.


Assuntos
Assistência Ambulatorial/tendências , Recursos em Saúde/tendências , Disparidades em Assistência à Saúde/tendências , Insuficiência Cardíaca/terapia , Programas Nacionais de Saúde , Admissão do Paciente , Alta do Paciente , Padrões de Prática Médica/tendências , Idoso , Idoso de 80 Anos ou mais , Cardiologistas/tendências , Bases de Dados Factuais , Uso de Medicamentos/tendências , Feminino , França , Medicina Geral/tendências , Fidelidade a Diretrizes/tendências , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Serviços de Enfermagem/tendências , Guias de Prática Clínica como Assunto , Encaminhamento e Consulta/tendências , Fatores de Tempo
9.
Aust J Gen Pract ; 49(5): 288-292, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32416654

RESUMO

BACKGROUND: The number of people living with and beyond cancer is increasing substantially. Primary care has an important role in the ongoing management of cancer survivors. OBJECTIVE: The aim of this article is to outline common concerns of cancer survivors, evidence to support the role of general practitioners (GP) in survivorship care and key aspects of primary care-led survivorship care. DISCUSSION: Clinical trials have shown that, in particular circumstances and with well­designed models, GP-led care is as effective as oncology specialist-led care. Regardless of the model of care, general practice has key roles in care coordination, management of multimorbidity, secondary prevention and health promotion, management of psychosocial care and promotion of self-management. Communication and collaboration between GPs and specialist cancer services is critical to support patients and healthcare providers in the delivery of care.


Assuntos
Sobreviventes de Câncer/psicologia , Medicina Geral/métodos , Assistência ao Paciente/métodos , Papel Profissional/psicologia , Austrália , Medicina Geral/tendências , Humanos , Assistência ao Paciente/psicologia , Sobrevivência
10.
Aust J Gen Pract ; 49(5): 280-287, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32416655

RESUMO

BACKGROUND AND OBJECTIVES: Currently when undergoing Australian general practice training, a registrar must determine when clinical supervision is needed. The aim of this study was to identify situations in early Australian general practice training requiring closer supervision and consider how this can be achieved. METHOD: The study used a qualitative approach involving 75 registrars, supervisors and medical educators from seven focus groups in Victoria and Tasmania. RESULTS: Eighty circumstances in which a registrar should call their general practice supervisor were identified. Participants indicated the 'call for help' list should be modified early in the term after considering the registrar's prior experience, and through the term as supervision and teaching identifies readiness for independent practice. DISCUSSION: The size of the list developed by the focus groups reflects the breadth of general practice. It is a 'call for help' list rather than a safety checklist as it is not exclusively concerned with high-risk scenarios and includes broad triggers to call for help. The 'call for help' list is an aid to patient safety and the supervisor-registrar alliance.


Assuntos
Medicina Geral/educação , Corpo Clínico Hospitalar/educação , Adulto , Feminino , Grupos Focais/métodos , Medicina Geral/tendências , Humanos , Masculino , Corpo Clínico Hospitalar/tendências , Pesquisa Qualitativa , Tasmânia , Vitória
12.
Aust J Gen Pract ; 49(4): 189-193, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32233344

RESUMO

BACKGROUND: The benefit of exercise in the prevention and management of type 2 diabetes (T2D) has a strong evidence base, so it is important to ensure exercise is part of every patient's management plan. OBJECTIVE: This article reviews the evidence for exercise in T2D and the factors affecting a patient's willingness to commence and sustain enough exercise to gain benefit. The article offers tips about how to safely and effectively prescribe the 'medicine' of exercise for all, even the frailest patients; who to stabilise before an exercise program should begin; and how to use the skills of an accredited exercise physiologist (AEP) to deliver the best 'prescription' possible. DISCUSSION: General practitioners and their teams, along with other healthcare providers such as AEPs, can increase the amount of exercise medicine a patient receives. This is the case for those at risk of developing T2D, those with T2D and those with the many comorbidities associated with T2D.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Terapia por Exercício/métodos , Diabetes Mellitus Tipo 2/fisiopatologia , Diabetes Mellitus Tipo 2/psicologia , Terapia por Exercício/instrumentação , Terapia por Exercício/tendências , Medicina Geral/instrumentação , Medicina Geral/métodos , Medicina Geral/tendências , Promoção da Saúde/métodos , Promoção da Saúde/tendências , Humanos
13.
Aust J Gen Pract ; 49(4): 215-220, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32233348

RESUMO

BACKGROUND AND OBJECTIVES: Whole-person care (WPC) is a key characteristic of general practice, but it may not be consistently practised. Previous articles in this series suggest a model of WPC that views patients as multidimensional persons; has length, breadth and depth of scope; is founded on a strong doctor-patient relationship and involves a healthcare team. This article reports factors that general practitioners (GPs) believe affect their provision of WPC. METHOD: Semi-structured interviews were conducted with 20 Australian GPs or general practice registrars and analysed using grounded theory methodology. RESULTS: Participants identified overarching factors (time, perceived value of WPC) and factors related to immediate (interpersonal dynamic), local (practice structure, relationship between care providers) and broader (health system structure) contexts that affect WPC. They volunteered practical suggestions to support WPC. DISCUSSION: GPs believe that multiple factors acting at micro and macro levels affect WPC provision. These findings provide a basis for strategies to support WPC.


Assuntos
Medicina Geral/métodos , Assistência Centrada no Paciente/métodos , Pessoalidade , Austrália , Medicina Geral/tendências , Teoria Fundamentada , Humanos , Assistência Centrada no Paciente/tendências , Relações Médico-Paciente , Pesquisa Qualitativa , Fatores de Tempo
14.
Aust J Gen Pract ; 49(3): 107-110, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32113205

RESUMO

BACKGROUND: Latent tuberculosis infection (LTBI) is an asymptomatic condition that may progress to active tuberculosis (TB), sometimes decades after exposure. Most people with active TB in Australia have not had recent contact and have been unaware of their risk. Tests for LTBI are available, allowing for diagnosis and preventive therapy to avoid active disease. OBJECTIVE: The aim of this article is to review current approaches to the diagnosis and management of LTBI, with particular focus on the Australian general practice setting. Groups at elevated risk of having LTBI and progressing to active disease are outlined. Recent research into the prevalence and distribution of LTBI in Australia is reviewed, and Australian guidelines for testing and treatment are summarised. DISCUSSION: LTBI occurs in an estimated 5% of all Australian residents. However, this is a particular issue for those born in TB-endemic countries. Approximately 17% of all overseas-born Australian residents, but only 0.4% of Australian-born residents, have LTBI. Appropriate diagnosis and management is an important long-term health promotion activity, and many people with LTBI can be managed safely and effectively in Australian general practice settings.


Assuntos
Medicina Geral/métodos , Tuberculose Latente/terapia , Idoso , Austrália/epidemiologia , Emigrantes e Imigrantes/estatística & dados numéricos , Feminino , Medicina Geral/tendências , Humanos , Tuberculose Latente/epidemiologia , Tuberculose Latente/fisiopatologia , Masculino , Programas de Rastreamento/métodos , Prevalência , Adulto Jovem
15.
Aust J Gen Pract ; 49(3): 139-144, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32113208

RESUMO

BACKGROUND AND OBJECTIVES: Whole-person care (WPC) is a defining feature of general practice, but it may not be consistently implemented. These authors conducted a qualitative study to define WPC and determine factors that influence its provision. Part one of this series suggested a model of WPC. Its foundation is the doctor-patient relationship; this article reports the findings concerning this theme. METHOD: Semi-structured interviews were conducted with 20 Australian GPs or general practice registrars and analysed using grounded theory methodology. RESULTS: GPs viewed the doctor-patient relationship as foundational to WPC, facilitating knowledge of the patient, trust and management. Participants' descriptions of the doctor-patient relationship were multidimensional, encompassing interacting professional, personal and business-transactional dimensions. DISCUSSION: The results suggest that a multidimensional doctor-patient relationship underpins WPC. It is not adequately described by a consumerist/contractual model; future work could further elucidate its nature. This relationship must be valued to provide quality WPC.


Assuntos
Relações Médico-Paciente , Atitude do Pessoal de Saúde , Austrália , Medicina Geral/métodos , Medicina Geral/tendências , Humanos , Entrevistas como Assunto/métodos , Assistência Centrada no Paciente/métodos , Assistência Centrada no Paciente/tendências , Pesquisa Qualitativa
16.
Ned Tijdschr Geneeskd ; 1632020 03 19.
Artigo em Holandês | MEDLINE | ID: mdl-32191407

RESUMO

Over the past 10 years there have been significant developments in general practice regarding diagnostics, differentiation of competences of general practitioners, cooperation within primary care and with secondary care, task delegation and patient information provision. Less progress has been made in other areas: E-health applications are rarely used, and there is no clear guideline for an integrated policy in patients with multimorbidity. General practitioners also continue to suffer from excessive regulatory pressure, excessive protocols and standardization. In the coming decade, GPs will continue to work in accordance with the core values ​​of their profession: 'person-oriented', 'medical-generalist', 'continuous' and 'jointly'. Their function to provide guidance is becoming increasingly important. In addition, more diagnostics and treatment will take place at the interface between general practice and secondary care. Chronic care will focus more on the needs and wishes of the individual patient. GPs retain their important role in terminal palliative care and emergency care.


Assuntos
Prestação Integrada de Cuidados de Saúde/tendências , Medicina Geral/tendências , Clínicos Gerais/tendências , Atenção Primária à Saúde/tendências , Atenção Secundária à Saúde/tendências , Feminino , Humanos , Masculino
17.
Aust J Gen Pract ; 49(1-2): 73-78, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32008260

RESUMO

BACKGROUND: Gamma hydroxybutyrate (GHB) is an illicit drug commonly used in music festival, party and 'chemsex' settings. Most people who use GHB do so occasionally, without dependent use or withdrawal symptoms. However, a minority of users experience harms including unconsciousness and respiratory collapse in overdose. Adverse interactions can also occur when GHB is used with other drugs (eg methamphetamine), necessitating assessment, management or onward referral by general practitioners. OBJECTIVE: This article describes the use of GHB, with a contemporary update on principles of assessment and management in general practice, brief intervention and harm-minimisation strategies, and indicators for referral to a specialist in dependent use. DISCUSSION: The assessment and management of individuals with GHB-related harms in general practice is supported by an awareness of the context of use, familiarity with targeted harm-minimisation advice and cognisance of markers of risk indicating onward referral to specialist addiction services when appropriate.


Assuntos
Oxibato de Sódio/análise , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Adjuvantes Anestésicos/efeitos adversos , Adjuvantes Anestésicos/análise , Overdose de Drogas/diagnóstico , Overdose de Drogas/terapia , Medicina Geral/métodos , Medicina Geral/tendências , Humanos , Oxibato de Sódio/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/psicologia
18.
Aust J Gen Pract ; 49(1-2): 54-60, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32008275

RESUMO

BACKGROUND AND OBJECTIVES: Whole-person care (WPC) is a core value of general practice and is particularly relevant with increasing population multimorbidity. However, WPC has lacked consensus definition, and some argue that it is not consistently practised. The aim of this study was to determine Australian general practitioners' (GPs') understanding of WPC and factors affecting its provision. This article (the first in a three-part series) describes GPs' understanding of WPC. METHOD: Semi-structured interviews were conducted with 20 Australian GPs or general practice registrars and analysed using grounded theory methodology. RESULTS: Four themes encapsulated GPs' understanding of WPC: 1) treats patients as multidimensional persons; 2) length, breadth and depth of scope; 3) based on the foundation of a doctor-patient relationship; and 4) may involve team-based care. DISCUSSION: WPC encompasses several defining characteristics of generalism. Previous evidence supports the efficacy of several of its dimensions. The current findings provide a basis for education, self-reflection and assessment of implementation and outcomes of WPCs.


Assuntos
Medicina Geral/métodos , Adulto , Atitude do Pessoal de Saúde , Austrália , Estudos de Coortes , Feminino , Medicina Geral/tendências , Clínicos Gerais , Humanos , Entrevistas como Assunto/métodos , Masculino , Pessoa de Meia-Idade , Assistência Centrada no Paciente , Relações Médico-Paciente , Pesquisa Qualitativa
19.
Rev Med Suisse ; 16(678): 128-132, 2020 Jan 22.
Artigo em Francês | MEDLINE | ID: mdl-31967755

RESUMO

General internal medicine is particularly concerned by the shift from stationary to ambulatory care, a shift that unfortunately is more often discussed from an economic perspective than from the angle of evidence. This article presents the results of studies and reviews published in 2019 that investigated the effectiveness of ambulatory instead of stationary care.


Assuntos
Assistência Ambulatorial , Medicina Geral , Medicina Interna , Instituições de Assistência Ambulatorial , Medicina Geral/tendências , Humanos , Medicina Interna/tendências
20.
PLoS One ; 15(1): e0227688, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31929588

RESUMO

OBJECTIVE: To describe general practitioner's (GP's) current management of rotator cuff related shoulder pain (RCRP) in Australia and identify if this is consistent with recommended care and best available evidence. The secondary aim was to determine if GP management of RCRP changed over time. METHODS: Data about management of RCRP by Australian GPs was extracted from the Bettering the Evaluation of Care of Health program database over its final five years (April 2011-March 2016). Patient and GP characteristics and encounter management data were extracted. Results are reported using descriptive statistics with point estimates and 95% confidence intervals. A secondary analysis over a 16 year period (2000-2016) examined management data for RCRP in four year periods. RESULTS: RCRP was the most common shoulder condition managed by GPs at 5.12 per 1,000 encounters; and at an estimated 732,000 times nationally in 2015-2016. Management rate was higher among male patients (5.5 per 1000 encounters c.f. 4.8 for female patients) and was highest in the 45-64 year old age group (8.6 per 1000). RCRP was most frequently managed with medications (54.7%), steroid injection (19.5%) followed by non-steroidal anti-inflammatory drugs (NSAIDs) (19.1%). Imaging was ordered for 43.4% (ultrasound 41.2% and x-ray 11.6%) of all RCRP presentations (new and returning). Over half (53.0%) of new RCRP presentations were referred for ultrasound imaging. In the 16 year period 2000-16 ultrasound imaging more than doubled from 19.1% to 41.9% of management occasions. In parallel, prescribed steroid injection increased from 9.8% to 19.7%. CONCLUSION: The usual care provided by GPs for RCRP relies on the use of ultrasound and steroid injection. This is not consistent with recommended care and clinical guidelines that recommend these are delayed until after 6-12 weeks of NSAID medication, exercise and activity modification. There has been a significant increase in the rate of steroid injection and ultrasound imaging, which may be due in part to policy change.


Assuntos
Medicina Geral/métodos , Manguito Rotador , Dor de Ombro/etiologia , Dor de Ombro/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos Transversais , Gerenciamento Clínico , Feminino , Medicina Geral/tendências , Humanos , Lactente , Recém-Nascido , Injeções , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/tendências , Estudos Prospectivos , Manguito Rotador/diagnóstico por imagem , Dor de Ombro/epidemiologia , Esteroides/administração & dosagem , Ultrassonografia , Adulto Jovem
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