Diagnosing infections: a qualitative view on prescription decisions in general practice over time

All practice-based health promotion projects conducted by Divisions of General Practice, funded in 1993 and 1994, are examined in this paper. The aims of the study are to describe their characteristics and evaluation; consider their effectiveness and appropriateness; and compare them with a sample funded in 1995 and 1996. Relevant information was analysed from project evaluation reports and summaries. Five immunisation, nine screening and 13 lifestyle counselling projects were funded in 1993-1994. The evaluation activities in these projects were variable, but the projects appeared to have desirable impacts. Evaluation findings indicate they have had high GP and consumer participation rates; lead to changes in GP knowledge and behaviour (for example, increased use of lifestyle counselling resources); and had positive impacts for consumers (for example, increases in immunisation and screening rates). Two immunisation, four screening and eight lifestyle counselling projects were funded in the second funding round in 1995 and the first in 1996. Although similar to the earlier projects, these projects often had a more systemic focus and made use of previously-developed knowledge and resources. Evaluation findings indicate that Divisional projects have increased GPs' capacity to engage in practice-based health promotion activities, and contributed to the achievement of the aims of the General Practice Strategy. Projects have improved the sophistication of their conceptualisation and design over time. Lessons from these projects point to particular policy implications for future funding arrangements, and these are discussed.

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Career specialty choices of UK medical graduates of 2015 compared with earlier cohorts: questionnaire surveys

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2017-135309 ◽

2018 ◽

Vol 94 (1110) ◽

pp. 191-197 ◽

Cited By ~ 16

Author(s):

Trevor William Lambert ◽

Fay Smith ◽

Michael J Goldacre

Keyword(s):

General Practice ◽

Response Rate ◽

Junior Doctors ◽

Medical Specialties ◽

Medical Graduates ◽

Questionnaire Surveys ◽

One Year ◽

Career Specialty ◽

Over Time

ObjectiveTo report the career specialty choices of UK medical graduates of 2015 one year after graduation and to compare these with the choices made at the same postgraduate stage by previous cohorts.DesignNational survey using online and postal questionnaires.SettingUK.ParticipantsUK-trained medical graduates.Main outcome measuresGrouped and individual specialty choices.ResultsThe response rate was 41.3% (3040/7095). Among the graduates of 2015, general practice (27.8% of first choices) and hospital medical specialties (26.5%) were the most frequent first choices of long-term career. First choices for general practice declined among women from 36.1% for the 2005–2009 cohorts to 33.3% for the 2015 cohort, and among men from 22.4% for the 2005–2009 cohorts to 19.3% for the 2015 cohort. First choices for surgery declined among men (from 29.5% for the 2005–2009 cohorts to 21.7% for the 2015 cohort), but not among women (12.3% for the 2005–2009 cohorts and 12.5% for the 2015 cohort). There was an increase in the percentage of first choices for anaesthesia, psychiatry, radiology and careers outside medicine. Anaesthesia, oncology, paediatrics and radiology increased in popularity over time among men, but not among women.ConclusionsCareer choices for general practice remain low. Other current shortage specialties, apart from radiology and psychiatry, are not showing an increase in the number of doctors who choose them. Large gender differences remain in the choices for some specialties. Further work is needed into the determinants of junior doctors’ choices for shortage specialties and those with large gender imbalances.

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Initiation and duration of selective serotonin reuptake inhibitor prescribing over time: UK cohort study

The British Journal of Psychiatry ◽

10.1192/bjp.bp.115.166975 ◽

2016 ◽

Vol 209 (5) ◽

pp. 421-426 ◽

Cited By ~ 15

Author(s):

Rachel L. McCrea ◽

Cormac J. Sammon ◽

Irwin Nazareth ◽

Irene Petersen

Keyword(s):

General Practice ◽

Cohort Study ◽

Serotonin Reuptake ◽

Selective Serotonin Reuptake Inhibitors ◽

Selective Serotonin ◽

Health Improvement ◽

The Health Improvement Network ◽

Media Reports ◽

Changes Over Time ◽

Over Time

BackgroundRecent media reports have focused on the large increase in antidepressants dispensed in England. We investigated this, focusing on selective serotonin reuptake inhibitors (SSRIs).AimsTo examine the rate of initiation of SSRIs over time and changes over time in the duration of prescribing episodes.MethodWe estimated initiation and duration of SSRI prescribing from 7 025 802 individuals aged over 18 years and registered with a general practice that contributed data to The Health Improvement Network.ResultsRates of SSRI initiation increased from 1.03 per 100 person-years in 1995 to 2.15 in 2001, but remained stable from then to 2012. The median duration of prescribing episodes increased from 112 to 169 days for episodes starting in 1995 to 2010.ConclusionsDespite media reports describing an increasing rate of antidepressant prescribing, SSRI initiation rates have stabilised since 2001. However, our results suggest that individuals who take SSRIs are receiving treatment for longer.

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Once tired, always tired? Limitations in function over time of tired patients in Dutch general practice

European Journal of General Practice ◽

10.1080/13814780701379030 ◽

2007 ◽

Vol 13 (2) ◽

pp. 67-74 ◽

Cited By ~ 6

Author(s):

E. G. H. Kenter ◽

I. M. Okkes ◽

S. K. Oskam ◽

H. Lamberts

Keyword(s):

General Practice ◽

Over Time

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Trends in attractiveness of general practice as a career: surveys of views of UK-trained doctors

British Journal of General Practice ◽

10.3399/bjgp17x689893 ◽

2017 ◽

Vol 67 (657) ◽

pp. e238-e247 ◽

Cited By ~ 10

Author(s):

Trevor W Lambert ◽

Fay Smith ◽

Michael J Goldacre

Keyword(s):

General Practice ◽

Overall Response Rate ◽

Response Rate ◽

Specialty Choice ◽

Hospital Practice ◽

Career Option ◽

Hospital Doctors ◽

Questionnaire Surveys ◽

The Uk ◽

Over Time

BackgroundIt is current UK policy to expand the numbers of newly qualified doctors entering training to become GPs, to meet increased demand.Aim To report on trends in young doctors’ views on the attractiveness of general practice as a career, compared with hospital practice.Design and setting Questionnaire surveys in the UK.MethodSurveys of doctors, 3 years after graduation, conducted in successive year-of-qualification cohorts between 1999 and 2015.ResultsThe overall response rate from contactable doctors was 55%. In response to the statement ‘General practice is more attractive than hospital practice for doctors at present’, 59% of doctors agreed in the 1999 survey, 77% in 2005, and only 36% in 2015. One-third of doctors agreed that their exposure to general practice had been insufficient for them to assess it as a career option, but this improved over time: agreement fell from 39% in 1999 to 28% in 2015. As a factor influencing specialty choice, enthusiasm for, and commitment to, the specialty was rated as very important by 65% of intending GPs in 2015, up from 49% in 1999; the corresponding figures for intending hospital doctors were 91% in 2015, up from 61% in 1999.ConclusionOver the 16 years covered by this study, the attractiveness of general practice has fallen relative to hospital practice. This may not necessarily reflect a decline in attractiveness of general practice in absolute terms; rather, it may reflect a greater increase, over time, in the appeal of hospital practice.

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Practice funding and socioeconomic deprivation in English general practices: a longitudinal study 2013–2017

British Journal of General Practice ◽

10.3399/bjgp18x697397 ◽

2018 ◽

Vol 68 (suppl 1) ◽

pp. bjgp18X697397 ◽

Cited By ~ 1

Author(s):

Louis S Levene ◽

Richard Baker ◽

John Bankart ◽

Nicola Walker ◽

Christopher Williams ◽

...

Keyword(s):

General Practice ◽

Correlation Coefficients ◽

Data Availability ◽

Health Needs ◽

Cross Sectional ◽

Interaction Terms ◽

Longitudinal Variations ◽

Important Health ◽

Random Slopes ◽

Over Time

BackgroundThe NHS general practice payment formula has no specific measures of socio-economic deprivation, an important health determinant. Variables related to population health needs are poor predictors of cross-sectional variations in practice payments. Additional years of payments data allow longitudinal analyses.AimDo deprivation scores predict variations in the slope over time of NHS practice payments, after adjusting for organisational and population factors?MethodThe sample was 6898 English practices with more than 500 patients, studied over 4 financial years, 2013–2014 to 2016–2017. The dependent variable was total NHS payments per registered patient (after deductions). The independent variable was the Index of Multiple Deprivation (IMD) 2015 score for each practice (range: 3.2 to 66.5). 17 Confounders were selected for conceptual plausibility and data availability at practice level, and included organisational variables and population variables A random intercepts and random slopes model was fitted to adjust for clustering of measurements within practices. The linear effects of independent variables on payments over time were modelled by fitting interaction terms (product of variable with year). Descriptive statistics and univariable analyses were undertaken.ResultsPractice IMD scores were very weak predictors of longitudinal variations in total payments’ slopes (4.9p/patient/1 unit increase in IMD). We also found that our confounders had very small predictive effects, and payments and IMD were not correlated in any year (Spearman correlation coefficients ranging from 0.01 to 0.06). The median of payments increased from £102.77 (2013–2014) to £115.43 (2016–2017).ConclusionTotal payments increased very slightly more in practices with higher deprivation scores. This suggests that the NHS general practice payment formula may not adequately compensate practices whose populations have greater health needs.

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Anticoagulation trends in adults aged 65 years and over with atrial fibrillation: a cohort study

Open Heart ◽

10.1136/openhrt-2021-001737 ◽

2021 ◽

Vol 8 (2) ◽

pp. e001737

Author(s):

Jenny Lund ◽

Catherine L Saunders ◽

Duncan Edwards ◽

Jonathan Mant

Keyword(s):

Atrial Fibrillation ◽

General Practice ◽

Cohort Study ◽

Oral Anticoagulant ◽

Age Group ◽

Direct Oral Anticoagulant ◽

Newly Diagnosed ◽

Survivor Function ◽

Time Period ◽

Over Time

ObjectiveTo describe patterns of anticoagulation prescription and persistence for those aged ≥65 years with atrial fibrillation (AF).MethodsDescriptive cohort study using electronic general practice records of patients in England, who attended an influenza vaccination aged ≥65 years and were diagnosed with AF between 2008 and 2018. Patients were stratified by 10-year age group and year of diagnosis. Proportion anticoagulated, type of anticoagulation (direct oral anticoagulant (DOAC) or warfarin) initiated at diagnosis and persistence with anticoagulation over time are reported.Results42 290 patients (49% female), aged 65–74 (n=11 722), 75–84 (n=19 055) and 85+ (n=11 513) years at AF diagnosis are included. Prescription of anticoagulation at diagnosis increased over the time period from 55% to 86% in people aged 65–74 years, from 54% to 86% in people aged 75–84 years and from 27% to 75% in people aged 85 years and over. By 2018, 92% of patients with newly diagnosed AF were started on a DOAC. Survivor function for 5-year persistence in patients prescribed DOAC was 0.80 (95% CI 0.77 to 0.82) and for warfarin 0.71 (95% CI 0.70 to 0.72). Survivor function for any anticoagulation at 5 years was 0.79 (95% CI 0.78 to 0.81), 0.73 (95% CI 0.72 to 0.75) and 0.58 (95% CI 0.59 to 0.64) for people aged 65–74, 75–84 and 85+ years, respectively.ConclusionsRates of anticoagulation in AF in those aged ≥65 years have increased from 2008 to 2018, over which time period there has been a shift from initiating anticoagulation with warfarin to DOAC. Persistence with anticoagulation is higher in people on DOACs than on warfarin and in people aged <85 years.

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A randomized controlled trial to evaluate the effectiveness and cost-effectiveness of psychodynamic counselling for general practice patients with chronic depression

Psychological Medicine ◽

10.1017/s0033291702006517 ◽

2003 ◽

Vol 33 (2) ◽

pp. 229-239 ◽

Cited By ~ 39

Author(s):

S. SIMPSON ◽

R. CORNEY ◽

P. FITZGERALD ◽

J. BEECHAM

Keyword(s):

Primary Care ◽

General Practice ◽

Randomized Controlled Trial ◽

Cost Effectiveness ◽

Controlled Trial ◽

Short Term ◽

Randomized Controlled ◽

And Control ◽

Experimental Group ◽

Over Time

Background. Counsellors have been employed in general practice with little evidence of effectiveness. This study examined the effectiveness and cost-effectiveness of short-term counselling in general practice for patients with chronic depression either alone or combined with anxiety.Method. A randomized controlled trial with an economic evaluation was carried out in Derbyshire. One hundred and forty-five patients were recruited at seven GP practices by screening using the Beck Depression Inventory. Both the experimental and control group received routine GP treatment but the experimental group were also referred to the practice counsellor. Depression, anxiety and other mental health symptoms, social and interpersonal functioning and social support were measured at baseline, 6 months and 12 months. Comprehensive costs were also estimated.Results. There was an overall significant improvement in the actual scores over time, but there were no significant differences between the two groups on any of the measures at either 6 or 12 months. However fewer experimental group patients were still ‘cases’ on the BDI than controls at 12 months. There were no significant differences in the mean total costs, aggregate costs of services, or any service-group costs except for primary care, between the experimental and control groups over time.Conclusions. This trial demonstrates only very limited evidence of improved outcomes in those referred to counselling and increased primary care treatment costs in the short-term. Stricter referral criteria to exclude the more severely depressed in the group (BDI[ges ]24) might have yielded more conclusive results.

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Changes in metabolic parameters in patients with severe mental illness over a 10-year period: A retrospective cohort study

Australian & New Zealand Journal of Psychiatry ◽

10.1177/0004867415625817 ◽

2016 ◽

Vol 51 (1) ◽

pp. 75-82 ◽

Cited By ~ 5

Author(s):

Adrian H Heald ◽

Julie L Martin ◽

Tony Payton ◽

Luma Khalid ◽

Simon G Anderson ◽

...

Keyword(s):

Body Mass Index ◽

Mental Illness ◽

General Practice ◽

Blood Glucose ◽

Severe Mental Illness ◽

Body Mass ◽

Odds Ratio ◽

Retrospective Cohort ◽

Fasting Blood Glucose ◽

Over Time

Background: Diabetes, obesity and metabolic syndrome are highly prevalent in patients with severe mental illness and can impose a major physical health burden. Objective: To determine how anthropometric and metabolic features changed over time in a retrospective cohort of people with Severe Mental Illness living in Cheshire, UK. Methods: In all, 1307 individuals on the severe mental illness Register were followed up between 2002 and 2012 in UK general practice. Subjects were identified through a pseudanonymised search of general practice registers. Results: Baseline body mass index was 28.6 kg/m2 increasing to 31.0 at 10-year follow-up ( r2 = 0.84; p = 0.0002). There was a significant increase in fasting blood glucose from 5.72 to 6.79 mmol/L ( r2 = 0.48; p = 0.026). Correspondingly, there was a strong positive univariate relation between increase in body mass index and fasting blood glucose ( r2 = 0.54; p < 0.0001) taking into account all measurements. Fasting blood glucose also increased slightly with age ( p = 0.028). With increasing use of statins, total cholesterol fell from 4.5 to 3.9 mmol/L ( r2 = 0.88; p = 0.0001), as did low-density lipoprotein cholesterol from 3.43 to 2.35 mmol/L ( r2 = 0.94; p = 0.0001). In multivariate models, adjusting for age, gender, smoking and blood pressure, each unit increase in body mass index (odds ratio = 1.07 [1.01, 1.13]; p = 0.031) and triglycerides (odds ratio = 1.28 (1.06, 1.55); p = 0.009) was independently associated with an increased risk of having type 2 diabetes. Conclusion: Increasing body mass index relates to increasing rates of dysglycaemia over time. Measures to encourage weight reduction should be key strategies to reduce dysglycaemia rates in severe mental illness. Prescribing statins may have been effective in improving the lipid profile in this group.

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Variation in formulary adherence in general practice over time (2003-2007)

Family Practice ◽

10.1093/fampra/cmr043 ◽

2011 ◽

Vol 28 (6) ◽

pp. 624-631 ◽

Cited By ~ 11

Author(s):

L. van Dijk ◽

J. D. de Jong ◽

G. P. Westert ◽

D. H. de Bakker

Keyword(s):

General Practice ◽

Over Time

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