scholarly journals ‘The Doctor doesn’t need to see you now’: reduction in general practice appointments following group pain management

2018 ◽  
Vol 13 (2) ◽  
pp. 121-129
Author(s):  
Ajay Clare ◽  
Sarah MacNeil ◽  
Tamzin Bunton ◽  
Stephanie Jarrett
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Pain Management ◽  
Clinical Effectiveness ◽  
Self Management ◽  
Future Research ◽  
Before And After ◽  
Gp Services ◽  
Management Techniques ◽  
Pain Patients

Background: Patients living with chronic, non-malignant, musculoskeletal pain are frequent visitors to general practice (GP) services, placing a large burden on resources. Pain management programmes (PMPs) are recommended for chronic pain patients and aim to teach self-management techniques. While there is evidence for their clinical effectiveness, few studies have explored whether there is a reduction in primary care healthcare use after attending a PMP. Aim: This study sought to address this by gathering data on pain-related primary care appointments before and after attending a PMP. Design and setting: Medical records of 50 patients attending a group outpatient PMP were obtained to determine whether the number of pain-related GP appointments differed 1 year after attending the programme compared with the year beforehand. Robust data were obtained from GP appointment systems and a retrospective observational design was utilised. Results: The results indicated a 43.9% decrease in the number of GP appointments in the year following a PMP, a change that was statistically significant. Conclusion: The findings of the study show that there are fewer pain-related appointments in primary care in the year following a group outpatient PMP compared with the preceding year. It is possible that the self-management techniques taught on the programme lead to a reduction in patient’s need to consult their GP as frequently about their pain. However, limitations in the current research mean that the reduction in appointments cannot be definitively attributed to PMP attendance and suggestions for future research are discussed.

Dermatology in primary care: an audit of the proportion of patients who present to general practice with a dermatological problem that could be self-managed

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711053
Author(s):  
Luamar Dolfini ◽  
Yogesh Patel
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Acne Vulgaris ◽  
Clinical Information ◽  
Electronic Record ◽  
Self Management ◽  
Considerable Proportion ◽  
Dry Skin ◽  
Record System ◽  
Common Skin

BackgroundA considerable proportion of GPs’ workload is dermatological. It is important to investigate what common skin conditions encountered in primary care can be self-managed, in an effort to alleviate the burden on primary care.AimThe purpose of the audit was to identify the proportion of consultations that are dermatological in nature and analyse potential for self-management by patients.MethodData was collected using the patient electronic record system (EMIS) in general practice. A search was made for all consultations from the 17 April to 15 May 2019, which included all new presenting complaints that were dermatological in nature. The criteria for self-management included advising over the counter (OTC) medication or reassurance. On the other hand, a case was deemed not self-manageable if prescription only medication (POM) was prescribed or if a referral to dermatology was made.ResultsThere were a total of 2175 consultations, where 246 (11.31%) cases were dermatological. Of the 246, 80 cases (32.5%) could be self-managed. There were 46 different dermatological presenting complaints of which the 5 most common included: rash (51 cases), dermatitis (44 cases), acne vulgaris (13 cases), moles (12 cases), dry skin (11 cases). None of the acne or moles cases could be self-managed, whereas 23%, 68.2%, 72.7% of rashes, dermatitis, and dry skin cases, respectively, could be self-managed.ConclusionCertain dermatological conditions have more potential for self-management than others. Research into teledermatology as a means of addressing patient concern and providing clinical information is important in order to reduce unnecessary consultations.

scholarly journals The incidence, prevalence, and management of plantar heel pain in Dutch general practice

2019 ◽  
Vol 69 (suppl 1) ◽  
pp. bjgp19X703217
Author(s):  
Nadine Rasenberg ◽  
Sita MA Bierma-Zeinstra ◽  
Patrick Bindels ◽  
Johan van der Lei ◽  
Marienke Van Middelkoop
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Medical Records ◽  
Search Algorithm ◽  
Heel Pain ◽  
Future Research ◽  
Healthcare Database ◽  
Plantar Heel Pain ◽  
Wait And See ◽  
Multiple Interventions

BackgroundPlantar heel pain (PHP) is a common cause of foot complaints, but information on the occurrence in primary care is scarce.AimThe objective of this study was to determine the incidence and prevalence of PHP and to gain insight in types of treatments provided to patients with PHP in primary care.MethodA cohort study was conducted in a healthcare database containing the electronic general practice medical records of approximately 1.9 million patients throughout the Netherlands. A search algorithm was defined and used to identify cases of PHP in the years 2013–2016. Descriptive statistics were used to obtain the incidence and prevalence of PHP. Data on the management of PHP was extracted in a random sample of 1000 patients.ResultsThe overall incidence of PHP was 3.81 (95% confidence [CI] = 3.75 to 3.87) per 1000 patient years and the overall prevalence of PHP was 0.4374% (95% CI = 0.4369 to 0.4378). Incidence of PHP peaked in the last quarter of every calendar year. The GP applied a wait-and-see policy at the first consultation for PHP in 18.0% of patients. The most commonly applied interventions included prescription for NSAID (19.9%), referral to a paramedical podiatric specialist (19.7%), and advice to wear insoles (16.4%): 34.0% of patients received multiple interventions (range 2–11) and 30.9% had multiple consultations for PHP (range 2–8).ConclusionPHP appears to be common in primary care. Despite a lack of evidence for most treatments, multiple interventions are applied. This urges the need for future research on effectiveness of treatments.

Do GPs use motivational interviewing skills in routine consultations with patients living with mental-physical multimorbidity? An observational study of primary care in Scotland

2018 ◽  
pp. 174239531881596
Author(s):  
Kylie J McKenzie ◽  
David Pierce ◽  
Stewart W Mercer ◽  
Jane M Gunn
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Observational Study ◽  
Motivational Interviewing ◽  
Secondary Analysis ◽  
Future Research ◽  
Global Rating ◽  
Coding System ◽  
Interviewing Skills ◽  
Multimorbid Patients

Objectives To examine whether motivational interviewing is used by GPs in consultations with patients living with mental-physical multimorbidity. Methods Secondary analysis of selected videos from an existing database of routine general practice consultations with adult patients in Glasgow, Scotland. Consultations involving patients with mental-physical multimorbidity were selected and coded using the Motivational Interviewing Treatment Integrity (MITI) coding system. Results Sixty consultations were coded involving 32 GPs across 16 practices. Mean consultation length was 9.9 min. On average GPs asked 1.7 questions per minute and offered 1.2 pieces of information per minute. Using the MITI, five GPs met beginner proficiency for the relational global qualities of partnership and empathy; however, none of the GPs met beginner proficiency for the technical global rating of efforts made to encourage patients to discuss behaviour change. Simple reflections were observed in 67% of consultations and complex reflections in 28% of consultations. Confrontation, a technique inconsistent with motivational interviewing, was observed in 18% of consultations. Discussion MI was not evident in these consultations with patients living with mental-physical multimorbidity. This study provides information about the baseline motivational interviewing-consistent skills of GPs working with multimorbid patients and may be helpful in informing motivational interviewing training efforts and future research.

scholarly journals The feasibility of assessing the Flinders Programme of Patient Self-Management in New Zealand primary care settings

2010 ◽  
Vol 2 (4) ◽  
pp. 294 ◽  
Author(s):  
Margaret Horsburgh ◽  
Janine Bycroft ◽  
Faith Mahony ◽  
Dianne Roy ◽  
Denise Miller ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
New Zealand ◽  
Self Management ◽  
Participant Recruitment ◽  
Practice Nurses ◽  
Management Capacity ◽  
Term Trial

INTRODUCTION: The Flinders ProgramTM has been adopted in New Zealand as a useful and appropriate approach for self-management with primary care clients who have chronic conditions. The Flinders ProgramTM has not been evaluated in New Zealand settings. AIM: To assess the feasibility of undertaking a substantive long-term trial to gauge the effectiveness of primary care nurses using the Flinders ProgramTM to improve health outcomes for New Zealand populations. METHODS: A pilot study was undertaken considering four components of feasibility of conducting a long-term trial: practice recruitment, participant recruitment, delivery of the intervention and outcome measures. This included comparing 27 intervention and 30 control patients with long-term health conditions with respect to change in self-management capacity—Partners in Health (PIH) scale—quality of care using the Patient Assessment of Chronic Illness Care (PACIC) scale and self-efficacy across six months. Intervention participants received care planning with practice nurses using the Flinders ProgramTM in general practices, while control participants received usual care in comparable practices. RESULTS: General practice and participant recruitment was challenging, together with a lack of organisational capacity and resources in general practice for the Flinders ProgramTM. The measures of self-management capacity (PIH), quality of care (PACIC) and self-efficacy were useful and valuable primary outcome measures. DISCUSSION: The overall findings do not support a substantive trial of the Flinders ProgramTM in primary care. Difficulties associated with participant recruitment and ability of practice nurses to undertake the Flinders ProgramTM within general practice need to be resolved. KEYWORDS: Self-management; long-term conditions; chronic conditions; chronic illness; primary care; nurses

scholarly journals Teknik Self Management untuk mengurangi perilaku terlambat datang di Sekolah

2020 ◽  
Vol 10 (1) ◽  
pp. 54
Author(s):  
Anita Dewi Astuti ◽  
Sri Dwi Lestari
Keyword(s):  
Student Behavior ◽  
Self Management ◽  
Research Subjects ◽  
Data Presentation ◽  
Purposive Sampling ◽  
Late Arrival ◽  
Before And After ◽  
Management Techniques ◽  
Three Stages ◽  
Collection Methods

<p>Penelitian ini bertujuan untuk mengetahui keefektifan teknik <em>self management </em>untuk mengurangi perilaku terlambat datang di sekolah. Penelitian ini menggunakan pendekatan kualitatif dengan fokus penelitian perilaku terlambat datang di sekolah. Subjek penelitiannya adalah siswa kelas X SMK Negeri I Panjatan yang ditentukan menggunakan teknik <em>purposive sampling</em>. Ada 3 siswa sebagai subjek penelitian yang ditentukan berdasarkan frekuensi keterlambatan siswa datang di sekolah. Metode pengumpulan data yang digunakan adalah observasi, wawancara dan dokumentasi, sedangkan analisis datanya menggunakan tiga tahapan yaitu: (1) reduksi data, (2) penyajian data, (3) verifikasi atau penarikan kesimpulan. Berdasarkan hasil penelitian dapat disimpulkan bahwa ada perubahan perilaku yang ditandai dengan menurunnya perilaku terlambat siswa antara sebelum dan sesudah diberikan layanan teknik <em>self management. </em></p><p> </p><em><strong><em>Abstract</em></strong>: This research aims to find out the effectiveness of self management techniques to reduce late arrival behavior at school. This study uses a qualitative approach with a focus on late-arrival behavior research in school. The research subjects were class X student of SMK Negeri I Panjatan who were determined using purposive sampling techniques. There are 3 students as research subjects that are determined based on the frequency of late students coming to school. Data collection methods used are observation, interviews and documentation, while the data analysis use three stages, namely: (1) data reduction, (2) data presentation, (3) verification or drawing conclusions. Based on the results of the study it can be concluded that there is a change in behavior marked by a decrease in late student behavior between before and after self management techniques are provided</em>

scholarly journals Effectiveness of group counseling services using self management techniques on aggressive student behavior

2021 ◽  
Vol 2 (2) ◽  
pp. 140-146
Author(s):  
Rita Novita ◽  
Neviyarni Neviyarni
Keyword(s):  
Aggressive Behavior ◽  
Group Counseling ◽  
Self Management ◽  
Special Treatment ◽  
Control Group ◽  
Counseling Services ◽  
Significant Difference ◽  
Before And After ◽  
Management Techniques ◽  
Experimental Group

Aggressive behavior is behavior that aims to hurt and injure others physically and psychologically. The factors that influence the occurrence of aggressive behavior are the influence of the student's environment and violent broadcasts on television and social media (Facebook, Instagram, WhatsApp, Telegram and so on). So that efforts are needed to reduce aggressive behavior in students. The aggressive behavior that occurs is physical aggressive behavior, verbal aggressive behavior, excessive angry excessive hostile behavior and behavior. One of the efforts made to reduce students' aggressive behavior at school is to carry out group counseling services with self-management techniques, where the sample in this study was 15 people divided into an experimental group of 8 students and 7 students in the control group. using a non-test instrument, namely a questionnaire. this study aims to test the effectiveness of group counseling services using self-management techniques to reduce aggressive behavior. The findings of this study are: (1) there is a significant difference in the aggressive behavior of the experimental group before and after following self-management techniques (2) there is a significant difference in the aggressive behavior of the control group before and after being given group counseling services about aggressive behavior without special treatment, (3) ) There is a difference in the aggressive behavior of the experimental group students who were given group self-management techniques with the control group who were given group counseling services about aggressive behavior without special treatment, this can be seen in the post-test average score of the experimental group falling higher than the average postest score. control group.

scholarly journals General practice in the Nordic countries

2016 ◽  
Vol 4 (1) ◽  
pp. 56-67 ◽  
Author(s):  
Kim Rose Olsen ◽  
Anders Anell ◽  
Unto Häkkinen ◽  
Tor Iversen ◽  
Thorhildur Ólafsdóttir ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Private Practice ◽  
Financial Incentives ◽  
Health Care Systems ◽  
Nordic Countries ◽  
Future Research ◽  
The Future ◽  
Care Systems ◽  
Common Framework

Background: General practice systems in the Nordic countries share certain common features. The sector is based on the Nordic model of a tax-financed supply of services with a political objective of equal access for all. The countries also share the challenges of increased political expectations to deliver primary prevention and increased workload as patients from hospital care are discharged earlier. However, within this common framework, primary care is organized differently. This is particularly in relation to the private-public mix, remuneration systems and the use of financial and non-financial incentives. Objective: The objective of this paper is to compare the differences and similarities in primary care among the Nordic countries, to create a mapping of the future plans and reforms linked to remuneration and incentives schemes, and to discuss the pros and cons for these plans with reference to the literature. An additional objective is to identify gaps in the literature and future research opportunities. Results/Conclusions: Despite the many similarities within the Nordic health care systems, the primary care sectors function under highly different arrangements. Most important are the differences in the gate-keeping function, private versus salaried practices, possibilities for corporate ownership, skill-mix and the organisational structure. Current reforms and political agendas appear to focus on the side effects of the individual countries’ specific systems. For example, countries with salaried systems with geographical responsibility are introducing incentives for private practice and more choices for patients. Countries with systems largely based on private practice are introducing more monitoring and public regulation to control budgets. We also see that new governments tends to bring different views on the future organisation of primary care, which provide considerable political tension but few actual changes. Interestingly, Sweden appears to be the most innovative in relation to introducing new incentive schemes, perhaps because decisions are made at a more decentralised level.Published: April 2016.

Pilot study of eDOL, a new mHealth application and web platform for medical follow-up of chronic pain patients (Preprint)

2021 ◽  
Author(s):  
NICOLAS KERCKHOVE ◽  
Noémie Delage ◽  
Sébastien Cambier ◽  
Nathalie Cantagrel ◽  
Eric Serra ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Real Life ◽  
Basic Research ◽  
High Rate ◽  
Future Research ◽  
Chronic Pain Patients ◽  
Pain Patients

BACKGROUND The pharmacopoeia of analgesics is old, their effectiveness is limited, with undesirable effects and little progress has been made in recent years. Thus, innovation is limited despite prolific basic research. Better characterization of patients could help to identify the predictors of successful treatments through research programs, and therefore enable physicians to carry out better decision-making in the initial choice of treatment and in the follow-up of their patients. Nevertheless, the current assessment of chronic pain patients provides only fragmentary data on their painful daily experiences. Thus, it is essential to modify the temporality in which patients’ sensations are assessed, with real-life monitoring of different parameters, i.e. subjective and objective markers of chronic pain. Consequently, recent studies have highlighted the urgent need to develop self-management and chronic pain management programs through e-health programs, and enhance their therapeutic value. OBJECTIVE We hypothesize that regular patient self-monitoring using an mHealth application would lead physicians to obtain deeper knowledge and a new vision of chronic pain patients, while for patients it would play a positive therapeutic role, as they become active in their own management and benefit from online advice. Such an assessment would not only contribute to better patient characterization and help in the choice of the most appropriate treatment, but could also improve adherence to treatment. To address this issue, we evaluated the feasibility and acceptability, by patients and physicians, of a new mHealth application called eDOL. METHODS An observational study assessing the feasibility and acceptability of the eDOL tool was conducted. Patients completed several questionnaires via eDOL over a period of 2 weeks, and then repeatedly over a period of 3 months. Physicians saw their patients at a follow-up visit that took place at least 3-months after the inclusion visit. The primary endpoint, a composite criterion reflecting the acceptability of eDOL and the feasibility of its use, was assessed using satisfaction questionnaires for both patients and physicians after the completion of study. RESULTS One hundred and thirty-three patients were included of whom 105 were analyzable. Our results showed a rate of adherence of approximately 60% of patients after 3 months of using eDOL, a median acceptability score around 7/10 for both patients and physicians, a high rate of completion of the baseline questionnaires / meters, and a low rate for follow-up questionnaires / meters and forms. We were also able to characterize subgroups of patients and determine a profile of those who adhered to eDOL. CONCLUSIONS This work demonstrates that eDOL is highly feasible and acceptable for both chronic pain patients and their physicians. It also shows that such a tool can integrate many parameters to ensure the detailed characterization of patients for future research works and pain management. CLINICALTRIAL NCT03931694

Evaluating Pain, Opioids, and Delirium in Critically Ill Older Adults

2020 ◽  
pp. 105477382097312
Author(s):  
Kara J. Pavone ◽  
Juliane Jablonski ◽  
Pamela Z. Cacchione ◽  
Rosemary C. Polomano ◽  
Peggy Compton
Keyword(s):  
Pain Management ◽  
Estimating Equation ◽  
Equation Model ◽  
Future Research ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Chi Square ◽  
Opioid Administration ◽  
Management Approaches ◽  
Pain Patients

Untreated pain and pain management with opioids are independent precipitating factors for delirium. This retrospective study evaluated the relationships among pain severity, its management with opioids, and the onset of delirium in older adult patients admitted to the surgical intensive care unit (SICU). Consecutive patients aged 65 or greater admitted to the SICU over a 5-month period were examined ( n = 172). When assessed using a multivariable general estimating equation model, opioids (chi-square [χ2], 12.34, p = .0004), but not pain (χ2, 3.31, p = .0688) were significant in predicting next-day delirium status. Controlling for pain, patients exposed to opioids were 2.5 times more likely to develop delirium than patients not exposed (95% Confidence Interval: 1.44–4.36). Our data shows that opioid administration predicted the onset of next-day delirium. In an effort to prevent delirium, future research should focus on opioid-sparing pain management approaches to mitigate pain and delirium.

Sign in / Sign up

Export Citation Format

Share Document