Management of chest pain: a prospective study from Norwegian out-of-hours primary care

Abstract Background Chronic diseases are responsible for over 70% of all deaths globally. While some self-management programs have been shown to be efficacious in preventing or altering trajectories for some chronic conditions, scaling-up and sustaining such programs beyond tightly-controlled study conditions remain a major challenge. CISSS-Laval partnered with the Cardiovascular Health Awareness Program team to co-develop Cible-santé/prévention and evaluate the first cohort of participants enrolled in the program, in order to better understand the program’s implementation and scope. The objective of the current study was to describe the profile of attendees and the level of engagement of participants in a new, region-wide cardiometabolic disease self-management program offered in Laval, Canada. Methods This was a prospective study with no comparison group. Potential participants were identified and referred to the program from April to December 2015 by their primary care health professional practicing in one of the city’s interdisciplinary primary care clinics. They had their blood pressure, waist circumference and body mass index measured by trained volunteers, and completed a questionnaire on health habits, level of activation and the risk of developing prediabetes and type 2 diabetes over the next 10 years. Results A descriptive analysis of the first cohort of 141 Cible-Santé/prévention participants showed very low attendance. Furthermore, only 1 in 10 of enrolled participants completed the full program. The program typically attracted adults with some risk factors associated with their conditions (high waist circumference, obesity), but with an already high level of knowledge, skills and confidence to participate in self-management activities. Conclusion This study provides a portrait of new participants to a self-management cardiometabolic disease program, which highlights the potential of supporting patients ready to make changes but also exposes the difficulty of attracting a larger number and diversity of participants and in encouraging completion of the program.

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A prospective study of patient satisfaction with communication regarding chronic pain in the primary care setting: Do opioid prescriptions matter?

Journal of Pain ◽

10.1016/j.jpain.2017.12.135 ◽

2018 ◽

Vol 19 (3) ◽

pp. S55

Author(s):

J. Gewandter ◽

S. Northwood ◽

M. Frazier ◽

J. DelVecchio ◽

S. Judge ◽

...

Keyword(s):

Primary Care ◽

Chronic Pain ◽

Patient Satisfaction ◽

Prospective Study ◽

Care Setting ◽

Primary Care Setting ◽

A Prospective Study

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Rationale and design of a cohort study evaluating triage of acute chest pain in out-of-hours primary care in the Netherlands (TRACE)

Primary Health Care Research & Development ◽

10.1017/s1463423620000122 ◽

2020 ◽

Vol 21 ◽

Author(s):

Amy Manten ◽

Cuny J.J. Cuijpers ◽

Remco Rietveld ◽

Emma Groot ◽

Freek van de Graaf ◽

...

Keyword(s):

Primary Care ◽

Cohort Study ◽

Chest Pain ◽

The Netherlands ◽

Clinical Outcomes ◽

Acute Chest Pain ◽

Urgent Care ◽

Triage System ◽

Out Of Hours ◽

Coronary Syndrome

Abstract The aims of this study are (1) to evaluate the performance of current triage for chest pain; (2) to describe the case mix of patients undergoing triage for chest pain; and (3) to identify opportunities to improve performance of current Dutch triage system for chest pain. Chest pain is a common symptom, and identifying patients with chest pain that require urgent care can be quite challenging. Making the correct assessment is even harder during telephone triage. Temporal trends show that the referral threshold has lowered over time, resulting in overcrowding of first responders and emergency services. While various stakeholders advocate for a more efficient triage system, careful evaluation of the performance of the current triage in primary care is lacking. TRiage of Acute Chest pain Evaluation in primary care (TRACE) is a large cohort study designed to describe the current Dutch triage system for chest pain and subsequently evaluate triage performance in regard to clinical outcomes. The study consists of consecutive patients who contacted the out-of-hours primary care facility with chest pain in the region of Alkmaar, the Netherlands, in 2017, with follow-up for clinical outcomes out to August 2019. The primary outcome of interest is ‘major event’, which is defined as the occurrence of death from any cause, acute coronary syndrome, urgent coronary revascularization, or other high-risk diagnoses in which delay is inadmissible and hospitalization is necessary. We will evaluate the performance of the triage system by assessing the ability of the triage system to correctly classify patients regarding urgency (accuracy), the proportion of safe actions following triage (safety) as well as rightfully deployed ambulances (efficacy). TRACE is designed to describe the current Dutch triage system for chest pain in primary care and to subsequently evaluate triage performance in regard to clinical outcomes.

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Non-melancholic depressive symptoms increase risk for incident cardiovascular disease: A prospective study in a primary care population at risk for cardiovascular disease and type 2 diabetes

Journal of Psychosomatic Research ◽

10.1016/j.jpsychores.2019.109887 ◽

2020 ◽

Vol 129 ◽

pp. 109887 ◽

Cited By ~ 2

Author(s):

Ansa Talvikki Rantanen ◽

Jyrki Jaakko Antero Korkeila ◽

Hannu Kautiainen ◽

Päivi Elina Korhonen

Keyword(s):

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Primary Care ◽

Depressive Symptoms ◽

Prospective Study ◽

Primary Care Population ◽

Increase Risk ◽

A Prospective Study ◽

Incident Cardiovascular Disease

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The clinical course of herpes zoster: A prospective study in primary care

European Journal of General Practice ◽

10.3109/13814789609161651 ◽

1996 ◽

Vol 2 (1) ◽

pp. 12-16 ◽

Cited By ~ 44

Author(s):

Sigurdur Helgason ◽

Johann A Sigurdsson ◽

Sigurdur Gudmundsson

Keyword(s):

Primary Care ◽

Herpes Zoster ◽

Prospective Study ◽

Clinical Course ◽

A Prospective Study

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Prospective analysis of phoned potassium results and what general practitioners do with them: a pilot study

Annals of Clinical Biochemistry International Journal of Laboratory Medicine ◽

10.1177/0004563218790298 ◽

2018 ◽

Vol 55 (6) ◽

pp. 710-712

Author(s):

Jennifer S Johnstone ◽

Michael J Murphy

Keyword(s):

Primary Care ◽

General Practice ◽

Pilot Study ◽

Information Management ◽

Laboratory Information Management System ◽

Information Management System ◽

Prospective Analysis ◽

Out Of Hours ◽

A Prospective Study ◽

Laboratory Information Management

Background Communicating abnormal results to requesting clinicians is an essential part of clinical authorisation. Guidance from the Royal College of Pathologists on communication of critical/unexpected results is issued as ‘advice to pathologists’. The 2017 guidelines advise rapid communication of serum potassium results ≤2.5 mmol/L and ≥6.5 mmol/L. Little is known about what happens after the results have been communicated. We wished to establish answers to the following questions: Are phoned results acted on? If so, when? What is the outcome of any action taken? Methods A prospective study of primary care potassium results authorised out of hours was undertaken. Potassium requests from primary care were retrieved from the laboratory information management system. The potassium result was recorded, along with other data. Data were analysed for potassium results that were validated out of hours (18:00 h–08:00 h). Results Over six months, 220 potassium results <3.1 mmol/L and >5.9 mmol/L from primary care were validated out of hours. A subset of these (27) were phoned to the general practice out of hours ‘hub’, and 16 patients referred to hospital out of hours, on account of the potassium results. The remaining potassium results phoned out of hours were acted on subsequently. Conclusions Critical potassium results were phoned urgently and are acted on, although not always out of hours. For potassium results phoned out of hours, the most frequent action was to refer to hospital out of hours. Different actions occurred for similar potassium results, reflecting the fact that actions taken and their urgency depend on the patient, the clinician and the practice policy for handling results.

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Pain scores and recovery post tonsillectomy: intracapsular versus extracapsular coblation

The Journal of Laryngology & Otology ◽

10.1017/s0022215119001610 ◽

2019 ◽

Vol 133 (09) ◽

pp. 775-781 ◽

Cited By ~ 3

Author(s):

M Junaid ◽

S Sood ◽

H Walijee ◽

J Dorgham ◽

S De

Keyword(s):

Primary Care ◽

General Practitioner ◽

Visual Analogue Scale ◽

Prospective Study ◽

Analogue Scale ◽

Normal Fluid ◽

Pain Scores ◽

Average Pain ◽

A Prospective Study ◽

Intracapsular Tonsillectomy

AbstractObjectiveThis study compared post-tonsillectomy pain scores and recovery using the coblation-only technique, comparing extracapsular versus intracapsular approaches.MethodsA prospective study was performed in our paediatric ENT department. Pain scores were recorded on days 0, 2, 4 and 8, using a visual analogue scale ranging from 0 (no pain) to 10 (extreme pain). Information was also collected on: return to normal fluid and solid intake, and any post-operative visits to primary care.ResultsIn total, 101 patients were included in the analysis. Average pain scores were statistically lower on days 2, 4 and 8 in the intracapsular group compared to the extracapsular cohort. The intracapsular cohort also returned sooner to normal fluid and solids intake. The extracapsular group were more likely to visit the general practitioner post-operatively.ConclusionIntracapsular tonsillectomy appears to result in reduced morbidity overall and should be considered as a viable alternative in relevant cases.

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