The Edinburgh Primary Care Depression Study: Personality Disorder and Outcome

1995 ◽  
Vol 167 (3) ◽  
pp. 324-330 ◽  
Author(s):  
Douglas A. Patience ◽  
Ralph J. McGuire ◽  
Allan I. F. Scott ◽  
Christopher P. L. Freeman
Keyword(s):  
Primary Care ◽  
Personality Disorder ◽  
Social Functioning ◽  
Depressive Illness ◽  
Substantial Improvement ◽  
Personality Pathology ◽  
Major Depressive ◽  
Maximum Improvement ◽  
The Uk ◽  
The Impact

BackgroundLittle is known about the impact of personality pathology on the treatment outcome of major depressive illness in primary care in the UK.MethodPatients meeting criteria for DSM–III major depressive disorder were randomly allocated to one of four treatments each lasting 16 weeks, then followed up for 18 months. Assessments were made of depressive symptoms, personality and social functioning. Personality was assessed at maximum improvement or 16 weeks.ResultsThe prevalence of personality disorder (PD) in the sample of 113 patients was 26%. Patients with a PD were significantly younger and rated more depressed at entry than patients with no personality disorder (NoPD). On completion of treatment patients with a PD were significantly more depressed and had poorer social functioning than the NoPD group. After 18 months there were no differences in ratings of depression or social functioning between the groups.ConclusionsThere was substantial improvement in both the PD and NoPD groups. The presence of personality pathology delays recovery from major depressive illness.

scholarly journals Understanding the impact of the COVID-19 pandemic on a socially deprived UK coastal town: a preliminary exploratory analysis of health and socioeconomic data

2021 ◽  
Author(s):  
Maddy French ◽  
Mark Spencer ◽  
Mike Walker ◽  
Afzal Patel ◽  
Neil Clarke ◽  
...  
Keyword(s):  
Primary Care ◽  
Hospital Admissions ◽  
Exploratory Analysis ◽  
Social Outcomes ◽  
Socioeconomic Outcomes ◽  
Chi Squared ◽  
Service Activity ◽  
Indirect Impacts ◽  
The Uk ◽  
The Impact

Introduction In addition to the direct impact of COVID-19 infections on health and mortality, a growing body of literature indicates there are wide-ranging indirect impacts of the COVID-19 pandemic and associated public health measures on population health and wellbeing. Exploring these indirect impacts in the context of a socially deprived UK coastal town will help identify priority areas to focus COVID-19 recovery efforts on. Methods Data on primary care diagnosis, hospital admissions, and several socioeconomic outcomes between 2016 and Spring 2021 in the UK town of Fleetwood were collected and analysed in an exploratory analysis looking at pre- and post- COVID-19 patterns in health and social outcomes. Weekly and monthly trends were plotted by time and differences between periods examined using Chi-squared and t-tests. Results Initial falls in hospital admissions and diagnoses of conditions in primary care in March 2020 were followed by sustained changes to health service activity for specific diagnostic and demographic groups, including for chronic kidney disease and young people. Increases in the number of people receiving Universal Credit and children eligible for free school meals appear to be greater for those in the least deprived areas of the town. Discussion These exploratory findings provide initial evidence of the sustained impact of the pandemic across several health and social outcomes. Examining these trends in multivariate analyses will further test these associations and establish the strength of the medium term impact of the pandemic on the population of this coastal town. Advanced modelling of this data is ongoing and will be published shortly.

The Impact of Dementia on Oral Health and Dental Care, Part 1: Setting the Scene for Dental Care Provision

2020 ◽  
Vol 9 (2) ◽  
pp. 24-30 ◽  
Author(s):  
Kathryn Kerr ◽  
Charlotte Curl ◽  
Andrew Geddis-Regan
Keyword(s):  
Primary Care ◽  
Oral Health ◽  
Dental Care ◽  
Care Provision ◽  
Care Environment ◽  
Oral Pain ◽  
Key Issues ◽  
Definition Of ◽  
The Uk ◽  
The Impact

There are over 850,000 people living with dementia in the UK and this figure is expected to rise to over a million by 2021. Increasingly, oral healthcare professionals in primary care will see more patients affected by dementia at varying stages of the disease, and it is therefore crucial that they have a basic understanding of the disease and how these patients can be managed in a primary care environment. The first article in this series of two provides a definition of dementia and describes the symptoms of the disease along with the key issues related to oral health, such as oral pain. Oral pain can have far reaching consequences, but identifying it can be problematic, particularly in the latter stages of the disease. This article will therefore cover how to diagnose pain in patients with dementia. Information is also provided about how to make dental surgeries more ‘dementia friendly’.

scholarly journals Cross-sectional observation study to investigate the impact of risk-based stratification on care pathways for patients with chronic kidney disease: protocol paper

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e027315 ◽  
Author(s):  
Harjeet Kaur Bhachu ◽  
Paul Cockwell ◽  
Anuradhaa Subramanian ◽  
Krishnarajah Nirantharakumar ◽  
Derek Kyte ◽  
...  
Keyword(s):  
Primary Care ◽  
Kidney Disease ◽  
Secondary Care ◽  
Health Improvement ◽  
Cross Sectional ◽  
Risk Equation ◽  
Failure Risk ◽  
The Health Improvement Network ◽  
The Uk ◽  
The Impact

IntroductionChronic kidney disease (CKD) management in the UK is usually primary care based, with National Institute for Health and Care Excellence (NICE) guidelines defining criteria for referral to secondary care nephrology services. Estimated glomerular filtration rate (eGFR) is commonly used to guide timing of referrals and preparation of patients approaching renal replacement therapy. However, eGFR lacks sensitivity for progression to end-stage renal failure; as a consequence, the international guideline group, Kidney Disease: Improving Global Outcomes has recommended the use of a risk calculator. The validated Kidney Failure Risk Equation may enable increased precision for the management of patients with CKD; however, there is little evidence to date for the implication of its use in routine clinical practice. This study will aim to determine the impact of the Kidney Failure Risk Equation on the redesignation of patients with CKD in the UK for referral to secondary care, compared with NICE CKD guidance.Method and analysisThis is a cross-sectional population-based observational study using The Health Improvement Network database to identify the impact of risk-based designation for referral into secondary care for patients with CKD in the UK. Adult patients registered in primary care and active in the database within the period 1 January 2016 to 31 March 2017 with confirmed CKD will be analysed. The proportion of patients who meet defined risk thresholds will be cross-referenced with the current NICE guideline recommendations for referral into secondary care along with an evaluation of urinary albumin–creatinine ratio monitoring.Ethics and disseminationApproval was granted by The Health Improvement Network Scientific Review Committee (Reference number: 18THIN061). Study outcomes will inform national and international guidelines including the next version of the NICE CKD guideline. Dissemination of findings will also be through publication in a peer-reviewed journal, presentation at conferences and inclusion in the core resources of the Think Kidneys programme.

scholarly journals Primary care consultations in the UK between 2006 and 2015: An analysis of electronic health records

2017 ◽  
Author(s):  
Benjamin Eaton
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Medical Science ◽  
Care Provision ◽  
Health Records ◽  
Healthcare Needs ◽  
Economic Recessions ◽  
The 2008 Financial Crisis ◽  
The Uk ◽  
The Impact

Primary care accounts for the majority of patient contact within the NHS. Over time medical science and healthcare needs change, which may lead to differences in how patients are treated in primary care for good or ill. In this study over 700 million consultations were analysed over a 10 year period between 2006 and 2015 inclusively to examine the trends in how people access primary care. The number of consultations per person per year initially increased in the first two years from 5.81 to 5.92, an increase of 0.11(0.10 to 0.12 95% CI) before declining to 3.7 by 2015, a decrease of 2.21 from the peak in 2008(2.20 to 2.23 95% CI). Consultations were increasingly handled by health care assistants instead of Nurses and GPs, and increased slightly in duration for all types of staff. This reduction in number of consultations is theorized to be a consequence of the 2008 financial crisis and its aftermath, further research is recommended on the impact of economic recessions and austerity policies on health care provision.

scholarly journals Primary care clinical management following self-harm during the first wave of COVID-19 in the UK

2021 ◽  
Author(s):  
Sarah Steeg ◽  
Matthew J Carr ◽  
Laszlo Trefan ◽  
Darren M Ashcroft ◽  
Nav Kapur ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Services ◽  
Health Services ◽  
Psychotropic Medication ◽  
Clinical Management ◽  
Practice Nurse ◽  
Self Harm ◽  
The Uk ◽  
The Impact

AbstractBackgroundA substantial reduction in GP-recorded self-harm occurred during the first wave of COVID-19 but effects on primary care management of self-harm are unknown.AimTo examine the impact of COVID-19 on clinical management within three months of an episode of self-harm.Design and settingProspective cohort study using data from the UK Clinical Practice Research Datalink.MethodWe compared cohorts of patients with an index self-harm episode recorded during a pre-pandemic period (10th March-10th June, 2010-2019) versus the COVID-19 first-wave period (10th March-10th June 2020). Patients were followed up for three months to capture psychotropic medication prescribing, GP/practice nurse consultation and referral to mental health services.Results48,739 episodes of self-harm were recorded during the pre-pandemic period and 4,238 during the first-wave COVID-19 period. Similar proportions were prescribed psychotropic medication within 3 months in the pre-pandemic (54.0%) and COVID-19 first-wave (54.9%) cohorts. Likelihood of having at least one GP/practice nurse consultation was broadly similar (83.2% vs. 80.3% in the COVID-19 cohort). The proportion of patients referred to mental health services in the COVID-19 cohort (3.4%) was around half of that in the pre-pandemic cohort (6.5%).ConclusionDespite the challenges experienced by primary healthcare teams during the initial COVID-19 wave, prescribing and consultation patterns following self-harm were broadly similar to pre-pandemic levels. However, the reduced likelihood of referral to mental health services warrants attention. Accessible outpatient and community services for people who have self-harmed are required as the COVID-19 crisis recedes and the population faces new challenges to mental health.

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