The Frequency and Content of Discussions About Alcohol Use in Primary Care and Application of the Chief Medical Officer’s Low-Risk Drinking Guidelines: A Cross-Sectional Survey of General Practitioners and Practice Nurses in the UK

Abstract Aims To examine how often general practitioners (GPs) and practice nurses (PNs) working in primary care discuss alcohol with patients, what factors prompt discussions, how they approach patient discussions and whether the Chief Medical Officers’ (CMO) revised low-risk drinking guidelines are appropriately advised. Methods Cross-sectional survey with GPs and PNs working in primary care in the UK, conducted January–March 2017 (n = 2020). A vignette exercise examined what factors would prompt a discussion about alcohol, whether they would discuss before or after a patient reported exceeded the revised CMO guidelines (14 units per week) and whether the CMO drinking guidelines were appropriately advised. For all patients, participants were asked how often they discussed alcohol and how they approached the discussion (e.g. used screening tool). Results The most common prompts to discuss alcohol in the vignette exercise were physical cues (44.7% of participants) or alcohol-related symptoms (23.8%). Most practitioners (70.1%) said they would wait until a patient was exceeding CMO guidelines before instigating discussion. Two-fifths (38.1%) appropriately advised the CMO guidelines in the vignette exercise, with PNs less likely to do so than GPs (odds ratio [OR] = 0.77, P = 0.03). Less than half (44.7%) reportedly asked about alcohol always/often with all patients, with PNs more likely to ask always/often than GPs (OR = 2.22, P < 0.001). Almost three-quarters said they would enquire by asking about units (70.3%), compared to using screening tools. Conclusion Further research is required to identify mechanisms to increase the frequency of discussions about alcohol and appropriate recommendation of the CMO drinking guidelines to patients.

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Weight assessment and the provision of weight management advice in primary care: a cross-sectional survey of self-reported practice among general practitioners and practice nurses in the United Kingdom

BMC Family Practice ◽

10.1186/s12875-020-01184-z ◽

2020 ◽

Vol 21 (1) ◽

Cited By ~ 1

Author(s):

Nathan Critchlow ◽

Gillian Rosenberg ◽

Harriet Rumgay ◽

Robert Petty ◽

Jyotsna Vohra

Keyword(s):

Primary Care ◽

United Kingdom ◽

Weight Management ◽

General Practitioners ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Practice Nurses ◽

The United Kingdom ◽

Management Advice

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General practitioners’ views on use of patient reported outcome measures in primary care: a cross-sectional survey and qualitative study

10.21203/rs.2.13219/v1 ◽

2019 ◽

Author(s):

Grace M Turner ◽

Ian Litchfield ◽

Sam Finnikin ◽

Olalekan Lee Aiyegbusi ◽

Melanie Calvert

Keyword(s):

Primary Care ◽

General Practitioners ◽

Outcome Measures ◽

Qualitative Interviews ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Patient Reported ◽

Clinical Systems

Abstract Background Patient reported outcome measures (PROMs) are increasingly used to assess impact of disease and treatment on quality of life and symptoms; however, their use in primary care is fragmented. We aimed to understand the current use of PROMs in primary care, barriers and facilitators, and how their use might be optimised. Methods Cross-sectional survey and semi-structured interviews among general practitioners (GPs) in England. GPs’ opinions were explored using an electronic, self-completed questionnaire disseminated to 100 GPs via an online doctors’ community and semi-structured qualitative interviews with 25 GPs. Results Most GPs surveyed (77/100; 77%) reported using one or more PROM, primarily to aid clinical management (n=66) or as screening/diagnostic tools (n=62). Qualitative interviews highlighted challenges in identifying and selecting PROMs; however, some GPs valued PROMs for shared decision making and to direct patient discussions. The interviews identified key barriers to PROM use including: time constraints; insufficient knowledge; lack of integration into clinical systems; and PROMs being mandated without consultation or explanation. Evidence of the benefit of PROMs is required to promote uptake and use of PROMs in primary care. Conclusion Implementation of PROMs in primary care requires integration with clinical systems, a bottom-up approach to PROM selection and system design involving meaningful consultation with patients and primary care clinicians and training/support for use.

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General practitioners’ views on use of patient reported outcome measures in primary care: a cross-sectional survey and qualitative study

BMC Family Practice ◽

10.1186/s12875-019-1077-6 ◽

2020 ◽

Vol 21 (1) ◽

Cited By ~ 1

Author(s):

Grace M. Turner ◽

Ian Litchfield ◽

Sam Finnikin ◽

Olalekan Lee Aiyegbusi ◽

Melanie Calvert

Keyword(s):

Primary Care ◽

Qualitative Study ◽

General Practitioners ◽

Outcome Measures ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Patient Reported

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General practitioners’ views on use of patient reported outcome measures in primary care: a cross-sectional survey and qualitative study

10.21203/rs.2.13219/v2 ◽

2019 ◽

Author(s):

Grace M Turner(Former Corresponding Author) ◽

Ian Litchfield(New Corresponding Author) ◽

Sam Finnikin ◽

Olalekan Lee Aiyegbusi ◽

Melanie Calvert

Keyword(s):

Primary Care ◽

General Practitioners ◽

Outcome Measures ◽

Qualitative Interviews ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Patient Reported ◽

Clinical Systems

Abstract Background Patient reported outcome measures (PROMs) are increasingly used to assess impact of disease and treatment on quality of life and symptoms; however, their use in primary care is fragmented. We aimed to understand how PROMs are currently being used in primary care, the barriers and facilitators of this use and if appropriate how it might be optimised.Methods Cross-sectional survey and semi-structured interviews among general practitioners (GPs) in England. GPs’ opinions were explored using an electronic, self-completed questionnaire disseminated to 100 GPs via an online doctors’ community and semi-structured qualitative interviews with 25 GPs.Results Most GPs surveyed (77/100; 77%) reported using one or more PROM, primarily to aid clinical management (n=66) or as screening/diagnostic tools (n=62). Qualitative interviews highlighted challenges in identifying and selecting PROMs; however, some GPs valued PROMs for shared decision making and to direct patient discussions. The interviews identified key barriers to PROM use including: time constraints; insufficient knowledge; lack of integration into clinical systems; and PROMs being mandated without consultation or explanation. Evidence of the benefit of PROMs is required to promote uptake and use of PROMs in primary care.Conclusion Implementation of PROMs in primary care requires integration with clinical systems, a bottom-up approach to PROM selection and system design involving meaningful consultation with patients and primary care clinicians and training/support for use.

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Task shifting from general practitioners to practice assistants and nurses in primary care: a cross-sectional survey in 34 countries

Primary Health Care Research & Development ◽

10.1017/s1463423621000657 ◽

2021 ◽

Vol 22 ◽

Author(s):

Peter P. Groenewegen ◽

Wienke G. W. Boerma ◽

Peter Spreeuwenberg ◽

Bohumil Seifert ◽

Willemijn Schäfer ◽

...

Keyword(s):

Primary Care ◽

General Practitioners ◽

Professional Training ◽

Institutional Development ◽

Task Shifting ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Independent Variables ◽

Nurse Prescribing ◽

Number Of Patients

Abstract Aim: To describe variation in task shifting from general practitioners (GPs) to practice assistants/nurses in 34 countries, and to explain differences by analysing associations with characteristics of the GPs, their practices and features of the health care systems. Background: Redistribution of tasks and responsibilities in primary care are driven by changes in demand for care, such as the growing number of patients with chronic conditions, and workforce developments, including staff shortage. The need to manage an expanding range of services has led to adaptations in the skill mix of primary care teams. However, these developments are hampered by barriers between professional domains, which can be rigid as a result of strict regulation, traditional attitudes and lack of trust. Methods: Data were collected between 2011 and 2013 through a cross-sectional survey among approximately 7200 GPs in 34 countries. The dependent variable ‘task shifting’ is measured through a composite score of GPs’ self-reported shifting of tasks. Independent variables at GP and practice level are: innovativeness; part-time working; availability of staff; location and population of the practice. Country-level independent variables are: institutional development of primary care; demand for and supply of care; nurse prescribing as an indicator for professional boundaries; professionalisation of practice assistants/nurses (indicated by professional training, professional associations and journals). Multilevel analysis is used to account for the clustering of GPs in countries. Findings: Countries vary in the degree of task shifting by GPs. Regarding GP and practice characteristics, use of electronic health record applications (as an indicator for innovativeness) and age of the GPs are significantly related to task shifting. These variables explain only little variance at the level of GPs. Two country variables are positively related to task shifting: nurse prescribing and professionalisation of primary care nursing. Professionalisation has the strongest relationship, explaining 21% of the country variation.

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Dentists’ preferences for diagnosis, management and referral of chronic oro-facial pain: Results from a national survey

Health Education Journal ◽

10.1177/0017896911419350 ◽

2011 ◽

Vol 71 (6) ◽

pp. 662-669 ◽

Cited By ~ 10

Author(s):

Vishal R Aggarwal ◽

Amy Joughin ◽

Joanna Zakrzewska ◽

Priscilla Appelbe ◽

Martin Tickle

Keyword(s):

Primary Care ◽

Facial Pain ◽

Temporomandibular Disorder ◽

Postal Questionnaire ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Specialist Services ◽

Primary Care Practitioners ◽

Pain Symptoms ◽

The Uk

Aim: To explore the diagnosis, treatment and referral patterns of chronic oro-facial pain patients by generalist primary care dentists (GDPs) in the UK. Methods: A cross-sectional survey was conducted using a non-stratified random sample of 500 GDPs who were selected from the General Dental Council register. A self-complete postal questionnaire with four hypothetical clinical case scenarios describing sub-types of chronic oro-facial pain (COFP) was used to investigate diagnosis, treatment and referral options of GDPs. Results: Two hundred and twenty (44%) GDPs responded. The majority correctly diagnosed temporomandibular disorder (TMD; 88%) and burning mouth syndrome (BMS; 92%). There was more variation in the diagnosis of the other cases related to persistent oro-facial pain. For TMD there was a clear preference for treatment with occlusal splint therapy, and referral to a temporomandibular joint (TMJ) specialist. The BMS scenario showed drug therapy and referral to an oral medicine specialist to be most popular. The chronic oro-facial pain cases had greater variation in management and choice of psychotherapy was related to duration of pain symptoms. Conclusions: The greater variation in responses to scenarios based on patients with chronic oro-facial pain may reflect the difficulty clinicians face in diagnosing and treating this condition. Management appears to follow a biomedical model and most clinicians chose to refer patients for treatment. There are few specialist services to cater for such referrals, indicating a need to train primary care practitioners in management of chronic COFP, along with the establishment of evidence-based guidelines.

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Patient-Reported Use of the After Visit Summary in a Primary Care Internal Medicine Practice

Journal of Patient Experience ◽

10.1177/2374373519879286 ◽

2019 ◽

Vol 7 (5) ◽

pp. 703-707

Author(s):

Sarita Pathak ◽

Gregory Summerville ◽

Celia P Kaplan ◽

Sarah S Nouri ◽

Leah S Karliner

Keyword(s):

Primary Care ◽

Multivariable Analysis ◽

Free Text ◽

Primary Care Visit ◽

Communication Tool ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Care Visit ◽

Patient Reported ◽

Communication Errors

Participants completed a cross-sectional survey about their use of the after visit summary (AVS) at a previous primary care visit. Of 355 participants, 294 (82.8%) recalled receiving it, 67.4% consulted it, 45.9% consulted it more than once, and 31.6% shared the AVS. In multivariable analysis, higher education and older age were associated with AVS consultation. Among the subset of 133 patients recalling personalized free-text instructions, 96% found them easy to understand and 94.4% found them useful. Our findings suggest that the AVS is a useful communication tool and improvement efforts should emphasize clarity for those most vulnerable to communication errors.

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A cross-sectional survey of awareness of human papillomavirus-associated oropharyngeal cancers among general practitioners in the UK

BMJ Open ◽

10.1136/bmjopen-2018-023339 ◽

2018 ◽

Vol 8 (7) ◽

pp. e023339 ◽

Cited By ~ 8

Author(s):

Matt Lechner ◽

Claire Vassie ◽

Cemal Kavasogullari ◽

Oliver Jones ◽

James Howard ◽

...

Keyword(s):

Risk Factor ◽

Human Papillomavirus ◽

General Practitioners ◽

Further Education ◽

Secondary Outcome ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Chewing Tobacco ◽

The Uk ◽

Epidemiological Trends

ObjectivesTo examine the level of awareness of the link between human papillomavirus (HPV) and oropharyngeal cancer (OPC) and epidemiological trends in HPV-related OPC among general practitioners (GPs) in the UK.DesignCross-sectional survey.Participants384 GPs from England, Scotland, Wales and Northern Ireland.SettingThe survey was administered at GP training courses and via email to lists of training course attendees.Primary and secondary outcome measuresProportion of respondents aware of the link between HPV and OPC; respondents’ self-rated knowledge of OPC; proportion of participants aware of the epidemiological trends in HPV-associated OPC.Results384 questionnaires were completed with an overall response rate of 72.9%. 74.0% of participants recognised HPV as a risk factor for OPC, which was lower than knowledge about the role of smoking, chewing tobacco and alcohol consumption (all >90% recognition). Overall, 19.4% rated their knowledge of OPC as very good or good, 62.7% as average and 17.7% as poor or very poor. The majority (71.9%) were aware that rates of HPV-associated OPC have increased over the last two decades. Fewer than half (41.5%) of the participants correctly identified being male as a risk factor of HPV-associated OPC, while 58.8% were aware that patients with HPV-associated OPC tend to be younger than those with non-HPV-associated disease.ConclusionsThe association of HPV infection with OPC is a relatively recent discovery. Although the level of awareness of HPV and OPC among GPs was high, the characteristics of HPV-associated OPC were less well recognised, indicating the need for further education.

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