Qualitative exploration of barriers to alcohol management in patients with chronic disease in a regional setting

2020 ◽  
Vol 26 (3) ◽  
pp. 265 ◽  
Author(s):  
Julie Mudd ◽  
Robyn Preston ◽  
Sarah Larkins
Keyword(s):  
Chronic Disease ◽  
Alcohol Consumption ◽  
General Practitioners ◽  
Multidisciplinary Care ◽  
Cultural Norms ◽  
Health Practitioners ◽  
General Practices ◽  
Qualitative Exploration ◽  
Regional Australia ◽  
Excess Alcohol Consumption

Chronic diseases are a major contributor to the burden of disease in Australia. Alcohol consumption is similar in people with chronic disease and the general public, and may contribute to management challenges. In regional Australia, there are limited options for the management of excess alcohol consumption, so most of this burden falls to general practitioners. This study explored how staff in general practices are managing alcohol in patients with chronic disease with a view to determining what additional services may be appropriate. Brief interviews were conducted with doctors, nurses and allied health practitioners across three general practices in a regional centre. Interviews were analysed using abductive thematic techniques to elicit broad themes. In all, 18 interviews were conducted. All interviewees found the management of patients with chronic disease who were drinking in excess of guidelines to be challenging. The complexity of patients, in terms of health needs and social circumstances, affected management and self-care. Australian drinking cultural norms also affected patients’ and practitioners’ behaviour. Multidisciplinary care was highlighted by all health professionals; however, there were challenges maintaining staff motivation, a lack of training in alcohol management and a lack of referral or assistance services. Experienced practitioners identified that the patient was the key stakeholder who needed to take ownership of their health. The combined burden of excess alcohol consumption and chronic disease is a common management challenge faced by staff in general practice. Although there was evidence of awareness of the issue and a concerted effort to address the problem, most staff felt they had inadequate training, skills and resources. More undergraduate or postgraduate training in alcohol management and more resources are required to support general practitioners in this area.

scholarly journals Reducing Deaths by Diet: A Call for Public Policy to Prevent Chronic Disease

1970 ◽  
Vol 11 (1) ◽  
Author(s):  
Norm Campbell CM, MD, FRCPC ◽  
Michel Sauvé MD FRCP FACP FCCP MSc
Keyword(s):  
Cardiovascular Disease ◽  
Public Policy ◽  
Risk Factor ◽  
Chronic Disease ◽  
Alcohol Consumption ◽  
Chronic Diseases ◽  
Physical Inactivity ◽  
Unhealthy Eating ◽  
Unhealthy Diet ◽  
Excess Alcohol Consumption

Chronic diseases including cardiovascular disease and cancer are the leading causes of disability and death in Canada.1,2 The majority of chronic diseases are caused by physical inactivity, tobacco use, excess alcohol consumption and unhealthy diet.3-6 In particular, unhealthy diet is the leading risk factor for death and disability in Canada resulting in an estimated 64,000 deaths and over 1 million years of disability (DALYs) in 2010 alone.7 Worldwide, a staggering 11 million deaths and over 200 million DALYs were attributed to unhealthy eating in 2010.

scholarly journals ‘Motivational work’: a qualitative study of preventive health dialogues in general practice

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Marie Broholm-Jørgensen ◽  
Siff Monrad Langkilde ◽  
Tine Tjørnhøj-Thomsen ◽  
Pia Vivian Pedersen
Keyword(s):  
General Practice ◽  
General Practitioners ◽  
Support System ◽  
Preventive Intervention ◽  
Digital Health ◽  
Clinical Encounter ◽  
Preventive Health ◽  
Structured Interviews ◽  
General Practices ◽  
Municipal Health

Abstract Background The aim of this article is to explore preventive health dialogues in general practice in the context of a pilot study of a Danish primary preventive intervention ‘TOF’ (a Danish acronym for ‘Early Detection and Prevention’) carried out in 2016. The intervention consisted of 1) a stratification of patients into one of four groups, 2) a digital support system for both general practitioners and patients, 3) an individual digital health profile for each patient, and 4) targeted preventive services in either general practice or a municipal health center. Methods The empirical material in this study was obtained through 10 observations of preventive health dialogues conducted in general practices and 18 semi-structured interviews with patients and general practitioners. We used the concept of ‘motivational work’ as an analytical lens for understanding preventive health dialogues in general practice from the perspectives of both general practitioners and patients. Results While the health dialogues in TOF sought to reveal patients’ motivations, understandings, and priorities related to health behavior, we find that the dialogues were treatment-oriented and structured around biomedical facts, numeric standards, and risk factor guidance. Overall, we find that numeric standards and quantification of motivation lessens the dialogue and interaction between General Practitioner and patient and that contextual factors relating to the intervention framework, such as a digital support system, the general practitioners’ perceptions of their professional position as well as the patients’ understanding of prevention —in an interplay—diminished the motivational work carried out in the health dialogues. Conclusion The findings show that the influence of different kinds of context adds to the complexity of prevention in the clinical encounter which help to explain why motivational work is difficult in general practice.

scholarly journals Connecting General Practitioners Through a Peer-Facilitated Community of Practice for Chronic Disease Care

2020 ◽  
Vol 18 (2) ◽  
pp. 179-179
Author(s):  
Hyun Jung Song ◽  
Mark Harris ◽  
Fan-Yin Li ◽  
Jennifer Green ◽  
Andrew Knight
Keyword(s):  
Chronic Disease ◽  
Community Of Practice ◽  
General Practitioners ◽  
Chronic Disease Care

scholarly journals Influence of serum iron test results on the diagnosis of iron deficiency in children: a retrospective observational study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e046865
Author(s):  
Gorkem Sezgin ◽  
Ling Li ◽  
Johanna Westbrook ◽  
Elisabeth Wearne ◽  
Denise Azar ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Observational Study ◽  
General Practitioners ◽  
Serum Ferritin ◽  
Serum Iron ◽  
Estimating Equation ◽  
Normal Serum ◽  
Retrospective Observational Study ◽  
Test Results ◽  
General Practices

Background and objectiveSerum iron results are not indicative of iron deficiency yet may be incorrectly used to diagnose iron deficiency instead of serum ferritin results. Our objective was to determine the association between serum iron test results and iron-deficiency diagnosis in children by general practitioners.Design, setting, patients and main outcome measuresA retrospective observational study of 14 187 children aged 1–18 years with serum ferritin and serum iron test results from 137 general practices in Victoria, Australia, between 2008 and 2018. Generalised estimating equation models calculating ORs were used to determine the association between serum iron test results (main exposure measure) and iron-deficiency diagnosis (outcome measure) in the following two population groups: (1) iron-deplete population, defined as having a serum ferritin <12 µg/L if aged <5 years and <15 µg/L if aged ≥5 years and (2) iron-replete population, defined as having a serum ferritin >30 µg/L.Results3484 tests were iron deplete and 15 528 were iron replete. Iron-deplete children were less likely to be diagnosed with iron deficiency if they had normal serum iron levels (adjusted OR (AOR): 0.73; 95% CI 0.57 to 0.96). Iron-replete children had greater odds of an iron-deficiency diagnosis if they had low serum iron results (AOR: 2.59; 95% CI 1.72 to 3.89). Other contributors to an iron-deficiency diagnosis were female sex and having anaemia.ConclusionSerum ferritin alone remains the best means of diagnosing iron deficiency. Reliance on serum iron test results by general practitioners is leading to significant overdiagnosis and underdiagnosis of iron deficiency in children.

scholarly journals Weaved into the cultural fabric: a qualitative exploration of alcohol consumption during pregnancy among tribal women in Odisha, India

2018 ◽  
Vol 13 (1) ◽  
Author(s):  
Sanghamitra Pati ◽  
Abhimanyu Singh Chauhan ◽  
Pranab Mahapatra ◽  
Devraj Hansdah ◽  
Krushna Chandra Sahoo ◽  
...  
Keyword(s):  
Alcohol Consumption ◽  
Tribal Women ◽  
Qualitative Exploration

scholarly journals Acceptability of a vocational advice service for patients consulting in primary care with musculoskeletal pain: A qualitative exploration of the experiences of general practitioners, vocational advisers and patients

2017 ◽  
Vol 47 (1) ◽  
pp. 78-85 ◽  
Author(s):  
Tom Sanders ◽  
Gwenllian Wynne-Jones ◽  
Bie Nio Ong ◽  
Majid Artus ◽  
Nadine Foster
Keyword(s):  
Primary Care ◽  
Controlled Trial ◽  
Comparative Method ◽  
Qualitative Interviews ◽  
Cluster Randomised Controlled Trial ◽  
Key Factors ◽  
Constant Comparative Method ◽  
General Practices ◽  
Randomised Controlled ◽  
Qualitative Exploration

Aims: Using qualitative interviews, this study explored the experiences of GPs, vocational advisers and patients towards a new vocational advice (VA) service in primary care. Methods: This study was nested within the Study of Work and Pain (SWAP) cluster randomised controlled trial. The SWAP trial located a VA service within three general practices in Staffordshire. Interviews took place with 10 GPs 12 months after the introduction of the VA service, four vocational advisers whilst the VA service was running and 20 patients on discharge from the VA service. The data were analysed using the constant comparative method, which is a variation of grounded theory. Results: The key factors determining the acceptability and perceived effectiveness of the VA service from the perspective of the three groups of stakeholders were (1) the timing of referrals to the VA, (2) the perceived lack of patient demand for the service and (3) role uncertainty experienced by VAs. Conclusions: Early vocational intervention may not be appropriate for all musculoskeletal patients with work difficulties. Indeed, many patients felt they did not require the support of a VA, either because they had self-limiting work difficulties and/or already had support mechanisms in place to return to work. Future VA interventions may be better implemented in a targeted way so that appropriate patients are identified with characteristics which can best be addressed by the VA service.

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