scholarly journals A Patient-Focused Questionnaire Designed to Support Headache Diagnosis in General Practice

2021 ◽  
Author(s):  
Martin Ruttledge ◽  
Gregor Broessner ◽  
Astrid Gendolla ◽  
Els Hollanders
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Medication Overuse Headache ◽  
Correct Diagnosis ◽  
Unmet Need ◽  
Real Life ◽  
Headache Disorders ◽  
Primary Headache Disorders ◽  
Number Of Patients ◽  
Headache Diagnosis

Abstract Background: There is an unmet need for the correct diagnosis of primary headache disorders, such as migraine, in primary care. Misdiagnosis is associated with suboptimal management of patients, and it is now widely accepted internationally that better diagnostic support is needed for general practitioners (GPs). In this study, we describe the development of a short, patient-directed questionnaire and supporting documents that aim to help with the diagnosis of headache disorders in primary care. We have also prepared patient feedback material and collected preliminary input from patients, but the main aim of this report is to invite comment and debate on the use of the questionnaire in real-life clinical practice.Methods: This questionnaire was developed over 18 months using the clinical experience of the authors, current literature review and the International Classification of Headache Disorders (ICHD), 3rd edition, for migraine, tension-type headache, cluster headache and medication-overuse headache. The questionnaire and two supporting documents will hopefully assist the GP to make a correct diagnosis. A patient survey was used to gather feedback from a small number of patients, and based on these comments, the questionnaire and the supporting documents were modified and updated.Results: Feedback gathering was attempted in Austria, Germany, Switzerland, Ireland and Spain, but was only possible in Austria due to the COVID-19 pandemic restrictions. From the 18 patients who participated, 17 responded about how easy or difficult the questionnaire was to complete, with 14/17 (82%) being able to complete the questionnaire easily on their own. Overall, the patients found the questionnaire averagely helpful in reminding them of and communicating their headache triggers, symptoms and behaviour changes; on a scale of 1–5, with 1 being very helpful and 5 being not helpful at all, the mean scores were 2.8 and 2.7 (n=18), respectively. Conclusions: This questionnaire and associated documents were developed with a view to helping GPs to make an accurate headache diagnosis quickly in primary care. Following feedback from patients, updates have been made, including changes to reduce the time it takes to complete the questionnaire. Next steps include wider validation and feedback from primary care physicians.

Electronic cigarettes: How confident and effective are allergists, pulmonologists, and primary care physicians in their practice behavior?

2020 ◽  
Vol 41 (3) ◽  
pp. 192-197
Author(s):  
Sherry S. Zhou ◽  
Alan P. Baptist
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Electronic Cigarettes ◽  
The United States ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Knowledge And Beliefs ◽  
Tobacco Cigarette ◽  
Number Of Patients ◽  
Personal Use

Background: There has been a striking increase in electronic cigarette (EC) use in the United States. The beliefs and practices toward ECs among physicians are unknown. Objective: The purpose of this study was to investigate EC practice patterns among allergists, pulmonologists, and primary care physicians. Methods: An anonymous survey was sent to physicians. The survey contained 32 questions and addressed issues related to demographics, cessation counseling behaviors, personal use, and knowledge and beliefs about ECs. Statistical analysis was performed by using analysis of variance, the Pearson χ2 test, Fisher exact test, and logistic regression. Results: A total of 291 physicians completed the survey (222 primary care physicians, 33 pulmonologists, and 36 allergists) for a response rate of 46%. The allergists asked about tobacco cigarette use as frequently as did the pulmonologists and more than the primary care physicians (p < 0.001), but they rarely asked about EC use. The pulmonologists scored highest on self-reported knowledge on ECs, although all the groups answered <40% of the questions correctly. The allergists did not feel as comfortable about providing EC cessation counseling as did the pulmonologists and primary care physicians (p < 0.001). All three groups were equally unlikely to recommend ECs as a cessation tool for tobacco cigarette users. Conclusion: Allergists lacked knowledge and confidence in providing education and cessation counseling for EC users. As the number of patients who use these products continues to increase, there is an urgent need for all physicians to be comfortable and knowledgeable with counseling about ECs.

A Comparative ID Migraine™ Screener Study in Ophthalmology, ENT and Neurology Out-Patient Clinics

Cephalalgia ◽  
2009 ◽  
Vol 29 (1) ◽  
pp. 68-75 ◽  
Author(s):  
M Ertaş ◽  
B Baykan ◽  
D Tuncel ◽  
M Gökçe ◽  
F Gökçay ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Screening Instrument ◽  
Headache Diagnosis ◽  
Id Migraine ◽  
Study Sites ◽  
Sensitivity Specificity ◽  
Test Result ◽  
Simple Screening ◽  
Nose And Throat

Migraine is more likely to be misdiagnosed in patients with comorbid diseases. Not only primary care physicians, but also specialists might misdiagnose it due to the lack of diagnostic criteria awareness. The ID migraine test is a reliable screening instrument that may facilitate and accelerate migraine recognition. This study aimed to compare the prevalence and characteristics of migraine in a large sample of patients admitted to clinics of ophthalmology (OC), ear, nose and throat diseases (ENTC) and neurology (NC), as well as to validate the use of the ID migraine test in OC and ENTC settings. This was a multicentre (11 cites) study of out-patients admitting either to NC, ENTC or OC of the study sites during five consecutive working days within 1 week. From each of the clinics, 100 patients were planned to be recruited. All recruited patients were interviewed and those having a headache complaint received an ID migraine test and were examined for headache diagnosis by a neurologist, blinded to the ID migraine test result. A total of 2625 subjects were recruited. Only 1.3% of OC patients and 5.4% of ENTC patients have been admitted with a primary complaint of headache, whereas the percentage of NC patients suffering from headache was 37.6%. Whereas 138 patients (19.3%) in OC, 154 (17.3%) in ENTC and 347 (34%) in NC were found to be ID migraine test positive, 149 patients (20.8%) in OC, 142 (16%) in ENTC and 338 (33.1%) in NC were diagnosed with migraine. The sensitivity, specificity, and positive and negative predictive ratios of the ID migraine test were found to be similar in all clinics. An important fraction of the patients admitted to NC, as well as to OC and ENTC, for headache and/or other complaints were found out to have migraine by means of a simple screening test. This study validated the ID migraine test as a sensitive and specific tool in OC and ENTC, encouraging its use as a screening instrument.

scholarly journals Medical Cannabis for the Primary Care Physician

2019 ◽  
Vol 10 ◽  
pp. 215013271988483 ◽  
Author(s):  
Deepika Slawek ◽  
Senthil Raj Meenrajan ◽  
Marika Rose Alois ◽  
Paige Comstock Barker ◽  
Irene Mison Estores ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physician ◽  
Primary Care Physicians ◽  
The United States ◽  
Care Physician ◽  
Chronic Health Conditions ◽  
Health Conditions ◽  
Efficacy And Safety ◽  
Medical Cannabis ◽  
Number Of Patients

Medical cannabis use is common in the United States and increasingly more socially acceptable. As more patients seek out and acquire medical cannabis, primary care physicians will be faced with a growing number of patients seeking information on the indications, efficacy, and safety of medical cannabis. We present a case of a patient with several chronic health conditions who asks her primary care provider whether she should try medical cannabis. We provide a review of the pharmacology of medical cannabis, the state of evidence regarding the efficacy of medical cannabis, variations in the types of medical cannabis, and safety monitoring considerations for the primary care physician.

scholarly journals General practitioners’ challenges and strategies in dealing with Internet-related health anxieties—results of a qualitative study among primary care physicians in Germany

2020 ◽  
Vol 170 (13-14) ◽  
pp. 329-339
Author(s):  
Julian Wangler ◽  
Michael Jansky
Keyword(s):  
Primary Care ◽  
Content Analysis ◽  
General Practitioners ◽  
Primary Care Physicians ◽  
Qualitative Approach ◽  
The Internet ◽  
State Of Health ◽  
Medical Practices ◽  
Number Of Patients ◽  
Consultation Time

Summary Time and again, it is discussed that in medical practices, the number of patients who develop health anxieties due to extensive health information searches on the Internet is increasing. The objective of this study is to explore and describe general practitioners’ experiences and attitudes towards cyberchondria patients as well as strategies to stabilize affected patients. Following a qualitative approach, oral personal semi-standardized interviews with general practitioners (N = 38) in Rhineland-Palatinate, Germany, were conducted in 2019. In the course of a content analysis, one can see that most interviewees see the emergence of Internet-related health anxieties as an increasing problem in everyday care. Affected patients not only show marked levels of doubt and nervousness as well as hypersensitivity to their own state of health, but also low confidence in the physician. In addition to compliance-related difficulties, the high need for advice and the demand for further diagnostics are regarded as major problems. Various approaches were identified by which general practitioners respond to unsettled patients (more consultation time, recommendation of reputable websites, information double-checking, expanded history questionnaire, additional psychosocial training).

scholarly journals Betahistine in the Treatment of Peripheral Vestibular Vertigo: Results of a Real-Life Study in Primary Care

2019 ◽  
Vol 99 (6) ◽  
pp. 356-360
Author(s):  
Guillermo Sanchez-Vanegas ◽  
Carlos Castro-Moreno ◽  
Diana Buitrago
Keyword(s):  
Primary Care ◽  
Incidence Rate ◽  
Cumulative Incidence ◽  
Primary Care Physicians ◽  
Real Life ◽  
Global Improvement ◽  
Life Study ◽  
Observational Prospective Cohort Study ◽  
Vestibular Vertigo

The present research was carried out with the objective to establish the clinical effect and safety of betahistine (48 mg daily), for the management of peripheral vestibular vertigo, in patients treated by primary care physicians in Colombia. An observational prospective cohort study was conducted including patients older than 15 years with clinical diagnosis of peripheral vestibular vertigo who were candidates to be treated with betahistine (48 mg daily). A sample size of 150 individuals was calculated, and weekly follow-ups were planned for 12 weeks. Rotatory movement sensation, loss of balance, and global improvement scale from 0 to 100 points were evaluated. Complete improvement was defined when the patient reached a level of 100 points. We calculated average weekly improvement, cumulative incidence of complete improvement, incidence rate of complete improvement, and the probability of complete improvement as a function of time. After the first week, the average improvement was 56.6 points (95% confidence interval [CI]: 50.4-62.7). At the end of week 12, it was 89.3 points (95% CI: 86.5-92.2). Sixty-one percent of the patients had achieved complete improvement at the end of the second week. After the sixth week, the percentage of cumulative improvement was 72%, and after 12 weeks of follow-up, the cumulative incidence of complete improvement was 73% (95% CI: 65%-80%). Based on the follow-up times, a complete improvement incidence rate of 16 cases per 100 people/week was calculated (95% CI: 13-19). We concluded that Betahistine (48 mg daily) has a positive effect, controlling the symptoms associated with benign paroxysmal vertigo, with an adequate safety profile.

scholarly journals General practitioner attitudes and confidence to deprescribing for elderly patients

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Pier Riccardo Rossi ◽  
Sarah E. Hegarty ◽  
Vittorio Maio ◽  
Marco Lombardi ◽  
Andrea Pizzini ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Real Life ◽  
Care Physician ◽  
Local Health Authority ◽  
Local Health ◽  
Cross Sectional Survey ◽  
Patient Centered ◽  
Cross Sectional ◽  
Factors Affecting

Deprescribing is a patient-centered process of medication withdrawal intended to achieve improved health outcomes through discontinuation of one or more medications that are either potentially harmful or no longer required. The objective of this study was to assess the perceptions of primary care physicians on deprescribing and potential barriers to deprescribing in the Local Health Authority (LHA) of Turin, Piedmont, Italy. Secondary objective was to evaluate educational needs of primary care physician. Cross sectional survey of primary care physicians working in the LHA of Turin, Piedmont, Italy. 439 GPs (71.3% of the total number of primary care physicians) attended an educational session related to deprescribing and were asked to anonymously answer a paper survey. Participants were asked to complete a previously published questionnaire about deprescribing and potential factors affecting the deprescribing process. A correlation coefficient was calculated to assess the association between physicians’ confidence in deprescribing and attitudes or barriers associated with deprescribing. Many GPs (71%) reported general confidence in their ability to deprescribe. Most respondents (83%) reported they were comfortable deprescribing preventive medications, however almost half expressed doubts regarding deprescribing when medication was initially prescribed by a colleague (45%) or when patient and/or caregiver supported the opportunity to continue the assumption (49%). Around a third of doctors maintain that the absence of strong evidence supporting deprescribing prevents them from considering it (38%), that they do not have the necessary time to effectively go through the process of deprescribing (29%), and that fear of possible effects due on withdrawal prevents them from deprescribing (31%). There was no strong correlation between physicians’ confidence and attitudes or barriers associated with deprescribing. The present study confirms that general practitioners sense the importance of deprescribing and feel prepared to face it managing communication with patients and caregivers, but find barriers when enacting the practice in a real-life context.

scholarly journals Early detection of asthma and chronic obstructive pulmonary disease in primary care patients

2013 ◽  
Vol 66 (1-2) ◽  
pp. 46-52 ◽  
Author(s):  
Marija Vukoja ◽  
Predrag Rebic ◽  
Zorica Lazic ◽  
Marija Mitic-Milikic ◽  
Branislava Milenkovic ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Primary Care ◽  
Pulmonary Disease ◽  
General Practitioners ◽  
Primary Care Physicians ◽  
Smoking History ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Number Of Patients ◽  
Primary Care Patients

Introduction. Asthma and chronic obstructive pulmonary disease are often unrecognized and undertreated. The aim of this study was to describe the frequency of chronic obstructive pulmonary disease and asthma in primary care patients in Serbia, and to examine the agreement between general practitioners and pulmonologists on the diagnosis of chronic obstructive pulmonary disease and asthma. Material and Methods. In this multicenter observational study, the general practitioners identified eligible patients from October 2009 to June 2010. The study included all adult patients with respiratory symptoms and/or smoking history based on structured interview. The patients were referred to a pulmonologist and underwent a diagnostic work-up, including spirometry. Results. There were 2074 patients, 38.4% men, their mean age being 54?15.5 years. The patients were mostly current (40.3%) or ex-smokers (27.4%). The common symptoms included shortness of breath (84.9%), cough (79.1%) and wheezing (64.3%). The diagnosis of chronic obstructive pulmonary disease was confirmed by pulmonologists in 454 (21.9%) and asthma in 455 (21.9%) patients. The chronic obstructive pulmonary disease was newly diagnosed in 226 (10.9%) and asthma in 269 (13%) of the cases. There was a moderate agreement between the pulmonologists and general practitioners on the diagnosis of chronic obstructive pulmonary disease (kappa 0.41, 95%CI 0.36-0.46) and asthma (kappa 0.42, 95% CI 0.37-0.465). Conclusion. A significant number of patients seen in the general practitioner?s office were diagnosed with chronic obstructive pulmonary disease or asthma and half of them represent new cases. A substantial proportion of patients referred to a pulmonologist by primary care physicians have been misdiagnosed.

scholarly journals The prevalence and burden of primary headache disorders among adults in rural villages of Bangalore District, South India: A community-based study

2022 ◽  
Vol 7 (4) ◽  
pp. 322-325
Author(s):  
Thomas Mathew ◽  
Shweta Ajay ◽  
B Ramakrishna Goud ◽  
Deepthi Narayan Shanbhag ◽  
Charles J Pallan ◽  
...  
Keyword(s):  
Rural Communities ◽  
Rural Community ◽  
Primary Care Physicians ◽  
South India ◽  
Health Centre ◽  
Community Setting ◽  
Primary Headache ◽  
Headache Disorders ◽  
Rural Villages ◽  
Primary Headache Disorders

The prevalence of primary headache disorders (PHDs) and their burden has been seldom studied in the rural community setting of a developing country. To study the prevalence of primary headache disorders and their burden in the rural community A door to door survey was done in seven rural villages under Mugalur sub centre area, Sarjapura Primary Health Centre and Anekal taluk, Bangalore district, Karnataka State, south India, for finding the prevalence and burden of PHDs. During the study period of three months, a total of 1255 people were screened in the seven villages. 13.1% (165/1255) of people suffered from PHDs. The population prevalence of migraine without aura was 8.84% (111/1255), tension type headache was 2.86% (36/1255) and chronic migraine was 1.43%(18/1255). The mean number of headache days for all the PHDs was 4.26 (±1.64) days. 66.1% of persons with headache reported minimal or infrequent impact of headache. Among various demographic variables, headache was significantly associated with the female gender and marital status. PHDs are prevalent in the rural communities of developing countries and need urgent attention of primary care physicians, community health departments, governmental agencies and policy makers.

scholarly journals Barriers to End-of-life Discussions in the Primary Care Setting

2020 ◽  
pp. 12-15
Author(s):  
Devon Boydstun ◽  
Shandra Basil ◽  
JIll Porter ◽  
Anand Gupta
Keyword(s):  
Primary Care ◽  
End Of Life ◽  
Primary Care Physicians ◽  
Care Setting ◽  
Primary Care Setting ◽  
Age Difference ◽  
Advanced Directives ◽  
Healthcare Facilities ◽  
Number Of Patients ◽  
Study Population

Background: The Patient Self Determination Act was passed in 1991 and requires healthcare facilities to present patients with information regarding advanced directives. Since that time, there has been no improvement in the number of patients reported to have had such discussions. Numerous barriers to these discussions exist both on the patient and provider side. This study aims to identify barriers to end of life discussions among providers in the primary care setting. Methods: The study population included practicing primary care physicians in the OhioHealth system. They were administered an anonymous questionnaire addressing demographic information and questions specific to end of life discussions and what barriers exist. Results: A majority of primary care physicians reported engaging in end of life discussions with their patients. A majority of physicians cited lack of time as a barrier to having these discussions. There was a statistically significant age difference among primary care physicians who reported they have end of life discussions with their patients and among these physicians there was a statistically significant increase in their level of comfort having these discussions. Conclusion: Primary care physicians further into their career reported having end of life discussions more frequently and felt more comfortable doing so. Additionally, physicians cite lack of time as the most common barrier to holding end of life discussions.

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