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1.
Ulster Med J ; 90(3): 151-156, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34815593

RESUMO

Background: Evidence of initiatives to support General Practitioners (GPs) during the Covid-19 pandemic is scant. Aim: To understand the impact of a novel method of providing support in the early stages of the pandemic. Design and setting: A mixed-methods study of GPs working in a socially deprived area of Belfast. Method: A survey was distributed to GPs who had attended a series of educational meetings at the beginning of the COVID-19 pandemic. The survey incorporated the Warwick Edinburgh Mental Wellbeing Scale and questions about the virtual meetings. Follow-up interviews were undertaken with five GPs to further explore their lived experiences and their perceptions of the virtual support forum. Results: The Covid-19 pandemic resulted in a measurable diminution of emotional well-being in GPs in North and West Belfast. Attendees rated a series of virtual meetings highly and described the following themes (and subthemes): a sudden traumatic change (emotional response, fight or flight, painful reminders of the status of general practice in the NHS); a coming together (stepping up to take responsibility, sharing of information, feeling of affirmation); reflections on what worked (calming facilitation, careful selection of speakers, creating the right atmosphere, ownership and autonomy) and building future direction (defining future direction, capitalising on lesson learned). Conclusion: The virtual meetings harnessed the instinct to come together witnessed at the beginning of the pandemic, and as well as sharing valuable information, also provided emotional support along with a sense of comradeship, ownership and autonomy. How this fits in: GPs did not feel included or supported at the outset of the pandemic. Coming together with fellow professionals was a welcome source of support. Professional support can be delivered using a virtual platform. Continued professional development is more acceptable than explicit emotional support, but when done well can bolster resilience and emotional well-being.


Assuntos
COVID-19 , Medicina Geral , Clínicos Gerais , Humanos , Pandemias , SARS-CoV-2
2.
Eur J Gen Pract ; 27(1): 313-319, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34743668

RESUMO

BACKGROUND: Coeliac disease (CD) is a highly prevalent (∼1%) disease that allegedly remains undiagnosed in over 80% of the cases because of atypical symptoms or silent disease. Currently, it is unknown how GPs deal with (suspected) CD. OBJECTIVES: This study aimed to better understand the diagnostic approach and the clinical reasoning process of GPs concerning CD and concurrently address diagnostic pitfalls. METHODS: A questionnaire with case vignettes to assess the knowledge, diagnostic reasoning pattern and practice for CD by GPs was developed. It was sent through academic GP research networks (encompassing over 1500 GPs) in two large cities and to smaller practices in rural areas. The questionnaire was composed of seven background questions, 13 questions related to four case vignettes and six additional CD-related questions. RESULTS: Responses were received from 106 GPs. Knowledge on risk factors for CD and appropriate testing of at-risk populations was limited. Twenty-two percent would diagnose CD in adults exclusively based on serology, without histopathological confirmation. In total, 99% would refer a newly diagnosed patient to a dietitian to initiate a gluten-free diet (GFD). In the absence of symptoms, only 33% would initiate a GFD. CONCLUSION: The results of this study have given us insight into the diagnostic process of GPs encountering patient with gluten-related complaints. Multiple serology test is available and used, while a positive serology test is not always followed up by a gastroduodenal biopsy to confirm the diagnosis. Most GPs would refer a symptomatic CD patient to a dietician for a GFD.


Assuntos
Doença Celíaca , Medicina Geral , Clínicos Gerais , Adulto , Doença Celíaca/diagnóstico , Doença Celíaca/terapia , Dieta Livre de Glúten , Humanos , Inquéritos e Questionários
3.
Eur J Gen Pract ; 27(1): 339-345, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34789061

RESUMO

BACKGROUND: Most COVID-19 patients experience a mild course of the disease and can be managed in general practice. However, in the early pandemic, most research was conducted in secondary care. OBJECTIVES: This scoping review aimed to identify original research published within the first year of the pandemic relevant to general practice regarding symptomatic, non-hospitalised patients with mild to moderate COVID-19 disease to provide an overview of published research. METHODS: PubMed was searched for studies written in English, Swedish, Danish, or Norwegian published before 1 April 2021. Two authors screened all titles and abstracts and identified full texts. RESULTS: We screened 1303 titles and abstracts and retrieved 128 full texts. An additional 44 full-texts were obtained from references. After full-text reading, 79 articles were included, six of which were conducted in general practice, 20 in the community, 42 in hospitals, and 11 in other settings. Therapy and harm were investigated in randomised controlled trials in 11 out of 17 studies; the diagnosis was investigated using a diagnostic accuracy design in four out of 26 studies and prognosis in prospective studies in 10 out of 21 studies. The remaining 15 studies had other research questions. CONCLUSION: Although general practitioners in most countries must have been involved in managing patients with COVID-19, little research has been published from general practice during the first year of the pandemic. General practice research environments must be able to respond quickly in case of future pandemics.


Assuntos
COVID-19 , Medicina Geral , Humanos , Pandemias , Estudos Prospectivos , SARS-CoV-2
4.
Rev Med Suisse ; 17(758): 1939-1942, 2021 Nov 10.
Artigo em Francês | MEDLINE | ID: mdl-34755944

RESUMO

The ambition of personalized medicine now also concerns the prevention of chronic diseases, based on genetic risk profiles. The objective of this project was to describe the perception and attitudes of patients and general practitioners (GP) on this issue, in order to consider the consequences on the health system. The study included two axes, patients (questionnaire survey) and GPs (consensus study using the Delphi method), preceded by a qualitative exploratory phase. The study showed that genetic screening for disease risk factors was not a priority, either for patients or for GPs. On the other hand, the role of the GP in the use of these tests will probably be predominant. This implies the need for training and availability of up-to-date information.


Assuntos
Medicina Geral , Clínicos Gerais , Atitude , Atitude do Pessoal de Saúde , Doença Crônica , Humanos , Motivação , Medicina de Precisão
5.
Int J Public Health ; 66: 635508, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34744588

RESUMO

Objectives: We aimed to explore the impact of the Swiss shutdown in spring 2020 on the intensity of health services use in general practice. Methods: Based on an electronic medical records database, we built one patient cohort each for January-June 2019 (control, 173,523 patients) and 2020 (179,086 patients). We used linear regression to model weekly consultation counts and blood pressure (BP) and glycated hemoglobin (HbA1c) measurement counts per 100 patients and predicted non-shutdown values. Analyses were repeated for selected at-risk groups and different age groups. Results: During the shutdown, weekly consultation counts were lower than predicted by -17.2% (total population), -16.5% (patients with hypertension), -17.5% (diabetes), -17.6% (cardiovascular disease), -15.7% (patients aged <60 years), -20.4% (60-80 years), and -14.5% (>80 years). Weekly BP counts were reduced by -35.3% (total population) and -35.0% (hypertension), and HbA1c counts by -33.2% (total population) and -29.8% (diabetes). p-values <0.001 for all reported estimates. Conclusion: Our results document consequential decreases in consultation counts and chronic disease monitoring during the shutdown. It is crucial that health systems remain able to meet non-COVID-19-related health care needs.


Assuntos
COVID-19 , Utilização de Instalações e Serviços , Medicina Geral , Pandemias , COVID-19/epidemiologia , Utilização de Instalações e Serviços/estatística & dados numéricos , Humanos , Estudos Retrospectivos
7.
BMC Fam Pract ; 22(1): 207, 2021 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-34666678

RESUMO

BACKGROUND: Continuity of care, in particular personal continuity, is a core principle of general practice and is associated with many benefits such as a better patient-provider relationship and lower mortality. However, personal continuity is under pressure due to changes in society and healthcare. This affects older patients more than younger patients. As the number of older patients will double the coming decades, an intervention to optimise personal continuity for this group is highly warranted. METHODS: Following the UK Medical Research Council framework for complex Interventions, we will develop and evaluate an intervention to optimise personal continuity for older patients in general practice. In phase 0, we will perform a literature study to provide the theoretical basis for the intervention. In phase I we will define the components of the intervention by performing surveys and focus groups among patients, general practitioners, practice assistants and practice nurses, concluded by a Delphi study among members of our group. In phase II, we will test and finalise the intervention with input from a pilot study in two general practices. In phase III, we will perform a stepped wedge cluster randomised pragmatic trial. The primary outcome measure is continuity of care from the patients' perspective, measured by the Nijmegen Continuity Questionnaire. Secondary outcome measures are level of implementation, barriers and facilitators for implementation, acceptability and feasibility of the intervention. In phase IV, we will establish the conditions for large-scale implementation. DISCUSSION: This is the first study to investigate an intervention for improving personal continuity for older patients in general practice. If proven effective, our intervention will enable General practitioners to improve the quality of care for their increasing population of older patients. The pragmatic design of the study will enable evaluation in real-life conditions, facilitating future implementation. TRIAL REGISTRATION NUMBER: Netherlands Trial Register, trial NL8132 . Registered 2 November 2019.


Assuntos
Medicina Geral , Clínicos Gerais , Atenção à Saúde , Medicina de Família e Comunidade , Humanos , Projetos Piloto , Ensaios Clínicos Pragmáticos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto
9.
N Z Med J ; 134(1543): 51-58, 2021 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-34695076

RESUMO

AIM: Gout is a health equity issue for Maori and Pacific peoples because disparities in quality of care exist. This study aims to describe domains of access that may contribute to the optimisation of gout care and, therefore, address health inequity. METHODS: The practice management system at one general practice in Auckland was used to identify enrolled patients with gout, using disease codes and medication lists. Barriers to access for the cohort were investigated using staff knowledge and the practice management system. The general practice is uniquely situated within an urban marae (traditional meeting house) complex serving a predominantly Maori community. This enables a focus on domains of access other than cultural safety. RESULTS: Of 3,095 people enrolled at the practice, 268 were identified as having gout. Of these, 94% had at least one other long-term health condition. The majority of people with gout enrolled at the practice have employment roles incongruent with the clinic's opening hours. CONCLUSIONS: Social circumstances, such as employment and availability of transport, should be actively discussed with all patients and recorded in the practice management system. Reorientation of health services, including hours of access, is evidentially required to ensure optimal management of gout and possibly other health conditions.


Assuntos
Serviços Comunitários de Farmácia/organização & administração , Gota/tratamento farmacológico , Gota/etnologia , Equidade em Saúde/organização & administração , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Medicina Geral/economia , Supressores da Gota/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Grupo com Ancestrais Oceânicos
10.
PLoS One ; 16(10): e0258674, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34648595

RESUMO

BACKGROUND: The inclusion of pharmacists into general practices in Australia has expanded in recent years. This systematic review aimed to synthesise the literature of qualitative and quantitative studies, and identify the knowledge gaps, related to pharmacists working in general practice in Australia. METHODS: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, EBSCOhost, EMBASE, and the Cochrane Library were searched from the inception of databases to January 2021. The search was focused on studies investigating general practice pharmacists in Australia. The quality of each study was appraised using the Mixed Method Appraisal Tool criteria. The narrative synthesis approach was utilised to describe data due to the heterogeneity among study designs and measures. RESULTS: Twenty-five studies were included in this review. General practice pharmacists engaged in various non-dispensing patient care services, with medication management reviews being the primary activity reported. General practice pharmacists' characteristics and an environment with a willingness of collaboration were the notable influencing factors for successfully including pharmacists in general practices. Factors that posed a challenge to the adoption of general practice pharmacists were lack of funding and other resources, poorly defined roles, and absence of mentoring/training. CONCLUSION: This review has summarised the characteristics, activities, benefits, barriers, and facilitators of including pharmacists in general practices in Australia. General practice pharmacists are well accepted by stakeholders, and they can engage in a range of patient-centred activities to benefit patients. There is a need for more robust research to explore the patient and economic outcomes related to clinical activities that a pharmacist can perform in general practice, as a foundation to developing an appropriate and sustainable funding model. The findings of this review will be beneficial for pharmacists, researchers, policymakers, and readers who wish to implement the role of general practice pharmacists in the future.


Assuntos
Medicina Geral/métodos , Farmacêuticos , Austrália , Humanos , Papel Profissional
11.
J Med Internet Res ; 23(10): e28923, 2021 10 13.
Artigo em Inglês | MEDLINE | ID: mdl-34643544

RESUMO

BACKGROUND: Participant recruitment remains a barrier to conducting clinical research. The disabling nature of a stroke, which often includes functional and cognitive impairments, and the acute stage of illness at which patients are appropriate for many trials make recruiting patients particularly complex and challenging. In addition, people aged 65 years and older, which includes most stroke survivors, have been identified as a group that is difficult to reach and is commonly underrepresented in health research, particularly clinical trials. Digital media may provide effective tools to support enrollment efforts of stroke survivors in clinical trials. OBJECTIVE: The objective of this study was to compare the effectiveness of general practice (traditional) and digital (online) methods of recruiting stroke survivors to a clinical mobility study. METHODS: Recruitment for a clinical mobility study began in July 2018. Eligible study participants included individuals 18 years and older who had a single stroke and were currently ambulatory in the community. General recruiting practice included calling individuals listed in a stroke registry, contacting local physical therapists, and placing study flyers throughout a university campus. Between May 21, 2019, and June 26, 2019, the study was also promoted digitally using the social network Facebook and the search engine marketing tool Google AdWords. The recruitment advertisements (ads) included a link to the study page to which users who clicked were referred. Primary outcomes of interest for both general practice and digital methods included recruitment speed (enrollment rate) and sample characteristics. The data were analyzed using the Lilliefors test, the Welch two-sample t test, and the Mann-Whitney test. Significance was set at P=.05. All statistical analyses were performed in MATLAB 2019b. RESULTS: Our results indicate that digital recruitment methods can address recruitment challenges regarding stroke survivors. Digital recruitment methods allowed us to enroll study participants at a faster rate (1.8 participants/week) compared to using general practice methods (0.57 participants/week). Our findings also demonstrate that digital and general recruitment practices can achieve an equivalent level of sample representativeness. The characteristics of the enrolled stroke survivors did not differ significantly by age (P=.95) or clinical scores (P=.22; P=.82). Comparing the cost-effectiveness of Facebook and Google, we found that the use of Facebook resulted in a lower cost per click and cost per enrollee per ad. CONCLUSIONS: Digital recruitment can be used to expedite participant recruitment of stroke survivors compared to more traditional recruitment practices, while also achieving equivalent sample representativeness. Both general practice and digital recruitment methods will be important to the successful recruitment of stroke survivors. Future studies could focus on testing the effectiveness of additional general practice and digital media approaches and include robust cost-effectiveness analyses. Examining the effectiveness of different messaging and visual approaches tailored to culturally diverse and underrepresented target subgroups could provide further data to move toward evidence-based recruitment strategies.


Assuntos
Medicina Geral , Mídias Sociais , Acidente Vascular Cerebral , Ensaios Clínicos como Assunto , Humanos , Internet , Seleção de Pacientes , Acidente Vascular Cerebral/terapia , Sobreviventes
12.
BMJ Open ; 11(10): e054044, 2021 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-34686558

RESUMO

OBJECTIVE: We sought to explore physician perspectives on the prescribing of cannabinoids to patients to gain a deeper understanding of the issues faced by prescriber and public health advisors in the rollout of medicinal cannabis. DESIGN: A thematic qualitative analysis of 21 in-depth interviews was undertaken to explore the narrative on the policy and practice of medicinal cannabis prescribing. The analysis used the Diffusion of Innovations (DoI) theoretical framework to model the conceptualisation of the rollout of medicinal cannabis in the Australian context. SETTING: Informants from the states and territories of Victoria, New South Wales, Tasmania, Australian Capital Territory, and Queensland in Australia were invited to participate in interviews to explore the policy and practice of medicinal cannabis prescribing. PARTICIPANTS: Participants included 21 prescribing and non-prescribing key informants working in the area of neurology, rheumatology, oncology, pain medicine, psychiatry, public health, and general practice. RESULTS: There was an agreement among many informants that medicinal cannabis is, indeed, a pharmaceutical innovation. From the analysis of the informant interviews, the factors that facilitate the diffusion of medicinal cannabis into clincal practice include the adoption of appropriate regulation, the use of data to evaluate safety and efficacy, improved prescriber education, and the continuous monitoring of product quality and cost. Most informants asserted the widespread assimilation of medicinal cannabis into practice is impeded by a lack of health system antecedents that are required to facilitate safe, effective, and equitable access to medicinal cannabis as a therapeutic. CONCLUSIONS: This research highlights the tensions that arise and the factors that influence the rollout of cannabis as an unregistered medicine. Addressing these factors is essential for the safe and effective prescribing in contemporary medical practice. The findings from this research provides important evidence on medicinal cannabis as a therapeutic, and also informs the rollout of potential novel therapeutics in the future.


Assuntos
Cannabis , Medicina Geral , Maconha Medicinal , Médicos , Humanos , Maconha Medicinal/uso terapêutico , Vitória
13.
BMJ Open ; 11(10): e051684, 2021 10 25.
Artigo em Inglês | MEDLINE | ID: mdl-34697116

RESUMO

OBJECTIVE: Pharmacists are increasingly contributing to the skill mix of general practice surgeries to help alleviate pressures faced by UK doctors working in primary care. However, they need support in overcoming barriers to their integration. The purpose of this work was to evaluate a programme designed to support pharmacists' transition to working in general practice settings. We explored the learning needs of pharmacists', the barriers and enablers to their integration and provide recommendations based on our results. INTERVENTION: A qualitative evaluation of a 1-year transition programme in Wales starting in September 2018 to support pharmacists' transition to working in general practice settings. DESIGN AND SETTING: We employed an interpretative phenomenological approach involving 10 pharmacists across Wales enrolled on the transition to general practice training programme, and their tutors. Data were collected across two sequential phases: in phase 1 telephone interviews were held with pharmacists midway through their training; in phase 2, focus groups were conducted with both pharmacists and tutors towards the end of the programme. RESULTS: Pharmacists enter general practice settings with a variety of prior experience. The programme provided a framework that pharmacists found helpful to map their experience to but the programme needed to be flexible to individual learning needs. The tutor role was typically regarded as the most valuable component, but interaction with the wider general practice team was critical to ease the transition. Pharmacists encountered a lack of clarity about their role which impeded their integration into the workplace team. CONCLUSIONS: A formal programme with a designated tutor can support pharmacists' transition into general practice settings. The programme's competency framework facilitated reciprocal understanding of the pharmacist's role in the team, helped to manage expectations and enhanced collaborative practice. Recommendations to facilitate pharmacist integration into general practice settings are provided.


Assuntos
Medicina Geral , Farmacêuticos , Atitude do Pessoal de Saúde , Medicina de Família e Comunidade , Humanos , Papel Profissional , Pesquisa Qualitativa , País de Gales
14.
J Prim Health Care ; 13(2): 157-164, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34620297

RESUMO

INTRODUCTION Youth health outcomes are poor in New Zealand and have a life-long impact on individuals, whanau (family) and society. Little is known about how young people view their experiences of general practice care despite it being the most common place to access health care. AIM This study sought to explore young peoples' experiences of care in a selected, youth-friendly general practice. METHODS In-depth individual interviews with six young people. RESULTS Four themes were identified from young peoples' narratives in relation to their experiences of general practice care: going to the doctor is not easy for a young person; the attributes of staff make all the difference; specific youth-friendly consultation practices help young people; and a youth-friendly physical environment can help young people access services and feel safe. DISCUSSION Even though the study general practice had explicitly instituted youth-friendly initiatives, including offering no-charge consultations and specialist staff members, young people still described considerable barriers to attendance. Many barriers are practice-based and could be modified by staff training, provision of further youth care staff roles and consideration of environmental changes. Other barriers such as waiving prescription costs need government funding.


Assuntos
Medicina Geral , Adolescente , Atenção à Saúde , Emoções , Medicina de Família e Comunidade , Humanos , Nova Zelândia
15.
J Prim Health Care ; 13(2): 165-170, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34620298

RESUMO

INTRODUCTION Peripheral arterial disease is an increasingly prevalent chronic illness globally. The Ankle Brachial Pressure Index (ABPI) is a well-established, simple, relatively quick and non-invasive assessment useful in diagnosing and quantifying peripheral arterial disease. ABPIs may be currently underutilised in general practice. AIM To explore perspectives of health professionals on the role of the ABPI. METHODS One-to-one interviews were conducted with health professionals using snowball sampling. Questions centred around interviewees' education on, experience with and view on the usefulness of the ABPI in general practice. Interviews were recorded and used for thematic analysis. RESULTS Participants consisted of 13 health-care professionals: nine general practitioners, two vascular surgeons and two allied health professionals. Most general practitioners interviewed identified benefits of ABPIs use in primary care, including aiding peripheral arterial disease diagnostics, management, referral and triage. No general practitioners stated they had ever had formal training in undertaking ABPIs. Two of the nine general practitioners stated regular ABPI use in their practice. Participants who did not use ABPIs identified practical barriers to its use in general practice, including cost of equipment, length of time needed and perceived low patient need to justify cost. All interviewees agreed that there was a role for ABPI use in the community if barriers were overcome. DISCUSSION There was consensus among general practitioners that ABPI use is beneficial. Many general practitioners named similar practical barriers to more common use of ABPIs in general practice. They saw a role for ABPIs in primary care, although it may be more practical as a tool for specialised individual clinicians to use for communities, given practical barriers of cost, time and perceived low patient need. Formal training could be considered, as none of the interviewed general practitioners had ever had any.


Assuntos
Tornozelo , Medicina Geral , Hospitais , Humanos , Percepção , Atenção Primária à Saúde
16.
17.
BMC Infect Dis ; 21(1): 1044, 2021 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-34625049

RESUMO

BACKGROUND: Erythema migrans (EM) is the most common manifestation of Lyme borreliosis. Here, we examined EM patients in Norwegian general practice to find the proportion exposed to tick-transmitted microorganisms other than Borrelia, and the impact of co-infection on the clinical manifestations and disease duration. METHODS: Skin biopsies from 139/188 EM patients were analyzed using PCR for Neoehrlichia mikurensis, Rickettsia spp., Anaplasma phagocytophilum and Babesia spp. Follow-up sera from 135/188 patients were analyzed for spotted fever group (SFG) Rickettsia, A. phagocytophilum and Babesia microti antibodies, and tested with PCR if positive. Day 0 sera from patients with fever (8/188) or EM duration of ≥ 21 days (69/188) were analyzed, using PCR, for A. phagocytophilum, Rickettsia spp., Babesia spp. and N. mikurensis. Day 14 sera were tested for TBEV IgG. RESULTS: We detected no microorganisms in the skin biopsies nor in the sera of patients with fever or prolonged EM duration. Serological signs of exposure against SFG Rickettsia and A. phagocytophilum were detected in 11/135 and 8/135, respectively. Three patients exhibited both SFG Rickettsia and A. phagocytophilum antibodies, albeit negative PCR. No antibodies were detected against B. microti. 2/187 had TBEV antibodies without prior immunization. There was no significant increase in clinical symptoms or disease duration in patients with possible co-infection. CONCLUSIONS: Co-infection with N. mikurensis, A. phagocytophilum, SFG Rickettsia, Babesia spp. and TBEV is uncommon in Norwegian EM patients. Despite detecting antibodies against SFG Rickettsia and A. phagocytophilum in some patients, no clinical implications could be demonstrated.


Assuntos
Coinfecção , Medicina Geral , Ixodes , Animais , Coinfecção/epidemiologia , Eritema , Seguimentos , Humanos , Laboratórios
18.
BMC Fam Pract ; 22(1): 206, 2021 10 19.
Artigo em Inglês | MEDLINE | ID: mdl-34666688

RESUMO

INTRODUCTION: Central sensitization (CS) may explain the persistence of symptoms in patients with chronic pain and persistent physical symptoms (PPS). There is a need for assessing CS in the consultation room. In a recently published systematic review, we made an inventory of tests for CS. In this study we aimed to assess which tests might have added value, might be feasible and thus be suitable for use in general practice. METHODS: We conducted a Delphi study consisting of two e-mail rounds to reach consensus among experts in chronic pain and PPS. We invited 40 national and international experts on chronic pain and PPS, 27 agreed to participate. We selected 12 tests from our systematic review and additional searches; panellists added three more tests in the first round. We asked the panellists, both clinicians and researchers, to rate these 15 tests on technical feasibility for use in general practice, added value and to provide an overall judgement for suitability in general practice. RESULTS: In two rounds the panellists reached consensus on 14 of the 15 tests: three were included, eleven excluded. Included were the Central Sensitization Inventory (CSI), pressure pain thresholds (PPTs) and monofilaments. No consensus was reached on the Sensory Hypersensitivity Scale. CONCLUSION: In a Delphi study among an international panel of experts, three tests for measuring CS were considered to be suitable for use in general practice: the Central Sensitization Inventory (CSI), pressure pain thresholds (PPTs) and monofilaments.


Assuntos
Dor Crônica , Medicina Geral , Sensibilização do Sistema Nervoso Central , Dor Crônica/diagnóstico , Consenso , Técnica Delfos , Humanos
19.
Ned Tijdschr Tandheelkd ; 128(10): 503-511, 2021 Oct.
Artigo em Holandês | MEDLINE | ID: mdl-34709005

RESUMO

The number of frail home-dwelling elderly is increasing, and they are likely to retain their own dentition longer when ageing. With increasing age, the number of dental visits declines, while the number of visits to the general practitioners' (GP) clinics increases. The aim of this study was to assess the oral health status and dental visits of frail home-dwelling elderly that visit their GP. The study consisted of questionnaires and an oral examination. Subjective and objective oral health was determined by the Geriatric Oral Health Assessment Index-NL and the Oral Health Assessment Tool. Almost half of the frail elderly had not visited the dentist for over 2 years and a quarter had objective oral health problems. The educational level and the dental status were of influence on the dental visits and on their oral health. In about a third of the subjects, a subjective oral health problem was observed, which was influenced by the extent of the subject's frailty. A multidisciplinary approach can improve the oral health status of frail home-dwelling elderly.


Assuntos
Idoso Fragilizado , Medicina Geral , Idoso , Assistência Odontológica , Avaliação Geriátrica , Humanos , Saúde Bucal
20.
N Z Med J ; 134(1544): 35-48, 2021 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-34695091

RESUMO

AIM: To explore patients' experiences of virtual consultations during the COVID-19 Alert Level 4 lockdown in New Zealand. METHOD: A single-practice retrospective phone survey exploring patients' satisfaction with the phone consultation process during Alert Level 4 lockdown. RESULTS: Of 259 eligible patients, 108 (42%) participated in the survey. Overall satisfaction with phone consultations was high, with a median score 9 out of 10 (95% CI 9-9). Participants were highly likely to recommend phone consultations to others, with a median score of 9 (95% CI 7-9). This was consistent across age groups, ethnicities and socioeconomic groupings. Men were less satisfied with phone consultations than women, with a 2 point (95% CI -3--1) lower median score than women, but they were not less likely to recommend phone consultations. Most participants found phone consultations to be convenient and time-saving and considered not seeing the doctor to be acceptable in the context of the lockdown. Few participants experienced technical difficulties over the phone. Issues of communication and appropriateness of consultations to the medium of the phone were raised. CONCLUSION: This single-centre study demonstrates the acceptability of phone consults for most patients presenting to general practice during a pandemic. These findings need further exploration in broader general practice settings and non-pandemic contexts.


Assuntos
COVID-19 , Medicina Geral , Satisfação do Paciente/estatística & dados numéricos , Telemedicina , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Comunicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Quarentena , Estudos Retrospectivos , Inquéritos e Questionários , Telefone
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