scholarly journals Implications of comorbidity for primary care costs in the UK: a retrospective observational study

2013 ◽  
Vol 63 (609) ◽  
pp. e274-e282 ◽  
Author(s):  
Samuel L Brilleman ◽  
Sarah Purdy ◽  
Chris Salisbury ◽  
Frank Windmeijer ◽  
Hugh Gravelle ◽  
...  
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Retrospective Observational Study ◽  
The Uk ◽  
Care Costs

scholarly journals Trends in end digit preference for blood pressure and associations with cardiovascular outcomes in Canadian and UK primary care: a retrospective observational study

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e024970 ◽  
Author(s):  
Michelle Greiver ◽  
Sumeet Kalia ◽  
Teja Voruganti ◽  
Babak Aliarzadeh ◽  
Rahim Moineddin ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Observational Study ◽  
Diastolic Pressure ◽  
Cardiovascular Outcomes ◽  
Retrospective Observational Study ◽  
Digit Preference ◽  
The Mean ◽  
The Uk ◽  
Primary Care Practices

ObjectivesTo study systematic errors in recording blood pressure (BP) as measured by end digit preference (EDP); to determine associations between EDP, uptake of Automated Office BP (AOBP) machines and cardiovascular outcomes.DesignRetrospective observational study using routinely collected electronic medical record data from 2006 to 2015 and a survey on year of AOBP acquisition in Toronto, Canada in 2017.SettingPrimary care practices in Canada and the UK.ParticipantsAdults aged 18 years or more.Main outcome measuresMean rates of EDP and change in rates. Rates of EDP following acquisition of an AOBP machine. Associations between site EDP levels and mean BP. Associations between site EDP levels and frequency of cardiovascular outcomes.Results707 227 patients in Canada and 1 558 471 patients in the UK were included. From 2006 to 2015, the mean rate of BP readings with both systolic and diastolic pressure ending in zero decreased from 26.6% to 15.4% in Canada and from 24.2% to 17.3% in the UK. Systolic BP readings ending in zero decreased from 41.8% to 32.5% in the 3 years following the purchase of an AOBP machine. Sites with high EDP had a mean systolic BP of 2.0 mm Hg in Canada, and 1.7 mm Hg in the UK, lower than sites with no or low EDP. Patients in sites with high levels of EDP had a higher frequency of stroke (standardised morbidity ratio (SMR) 1.15, 95% CI 1.12 to 1.17), myocardial infarction (SMR 1.16, 95% CI 1.14 to 1.19) and angina (SMR 1.25, 95% CI 1.22 to 1.28) than patients in sites with no or low EDP.ConclusionsAcquisition of an AOBP machine was associated with a decrease in EDP levels. Sites with higher rates of EDP had lower mean BPs and a higher frequency of adverse cardiovascular outcomes. The routine use of manual office-based BP measurement should be reconsidered.

Off-label prescribing to children in primary care: retrospective observational study

2004 ◽  
Vol 60 (5) ◽  
Author(s):  
Suzie Ekins-Daukes ◽  
PeterJ. Helms ◽  
ColinR. Simpson ◽  
MichaelW. Taylor ◽  
JamesS. McLay
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Retrospective Observational Study ◽  
Off Label

scholarly journals Primary care chaplaincy: an intervention for complex presentation

2018 ◽  
Vol 20 ◽  
Author(s):  
Gordon W. Macdonald
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Observational Study ◽  
Social Isolation ◽  
Well Being ◽  
Retrospective Observational Study ◽  
Holistic Care ◽  
Presenting Symptoms ◽  
Routinely Collected Data ◽  
Mental Well Being

Abstract Aim To determine the responsiveness of primary care chaplaincy (PCC) to the current variety of presenting symptoms seen in primary care. This was done with a focus on complex and undifferentiated illness. Background Current presentations to primary care are often complex, undifferentiated and display risk factors for social isolation and loneliness. These are frequently associated with loss of well-being and spiritual issues. PCC provides holistic care for such patients but its efficacy is unknown in presentations representative of such issues. There is therefore a need to assess the characteristics of those attending PCC. The effectiveness of PCC relative to the type and number of presenting symptoms should also be analysed whilst evaluating impact on GP workload. Methods This was a retrospective observational study based on routinely collected data. In total, 164 patients attended PCC; 75 were co-prescribed antidepressants (AD) and 89 were not (No-AD). Pre- and post-PCC well-being was assessed by the Warwick–Edinburgh mental well-being score. Presenting issue(s) data were collected on a separate questionnaire. GP appointment utilisation was measured for three months pre- and post-PCC. Findings Those displaying undifferentiated illness and risk factors for social isolation and loneliness accessed PCC. PCC (No-AD) was associated with a clinically meaningful and statistically significant improvement in well-being in all presenting issues. This effect was maintained in those with multiple presenting issues. PCC was associated with a reduction in GP appointment utilisation in those not co-prescribed AD.

scholarly journals Safety netting in routine primary care consultations: an observational study using video-recorded UK consultations

2019 ◽  
Vol 69 (689) ◽  
pp. e878-e886 ◽  
Author(s):  
Peter J Edwards ◽  
Matthew J Ridd ◽  
Emily Sanderson ◽  
Rebecca K Barnes
Keyword(s):  
Primary Care ◽  
Logistic Regression ◽  
Observational Study ◽  
Confidence Interval ◽  
Treatment Planning ◽  
Odds Ratio ◽  
Adult Patients ◽  
Specific Advice ◽  
The Uk ◽  
Safety Netting

BackgroundSafety-netting advice is information shared with a patient or their carer designed to help them identify the need to seek further medical help if their condition fails to improve, changes, or if they have concerns about their health.AimTo assess when and how safety-netting advice is delivered in routine GP consultations.Design and settingThis was an observational study using 318 recorded GP consultations with adult patients in the UK.MethodA safety-netting coding tool was applied to all consultations. Logistic regression for the presence or absence of safety-netting advice was compared between patient, clinician, and problem variables.ResultsA total of 390 episodes of safety-netting advice were observed in 205/318 (64.5%) consultations for 257/555 (46.3%) problems. Most advice was initiated by the GP (94.9%) and delivered in the treatment planning (52.1%) or closing (31.5%) consultation phases. Specific advice was delivered in almost half (47.2%) of episodes. Safety-netting advice was more likely to be present for problems that were acute (odds ratio [OR] 2.18, 95% confidence interval [CI] = 1.30 to 3.64), assessed first in the consultation (OR 2.94, 95% CI = 1.85 to 4.68) or assessed by GPs aged ≤49 years (OR 2.56, 95% CI = 1.45 to 4.51). Safety-netting advice was documented for only 109/242 (45.0%) problems.ConclusionGPs appear to commonly give safety-netting advice, but the contingencies or actions required on the patient’s part may not always be specific or documented. The likelihood of safety-netting advice being delivered may vary according to characteristics of the problem or the GP. How to assess safety-netting outcomes in terms of patient benefits and harms does warrant further exploration.

Observational study of ezetimibe discontinuation in primary care practices in the UK

2013 ◽  
Vol 29 (12) ◽  
pp. 1737-1745
Author(s):  
Gillian C. Hall ◽  
Vian Amber ◽  
Chris O’Regan ◽  
Kevin Jameson
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Care Practices ◽  
The Uk ◽  
Primary Care Practices
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