scholarly journals GPs’ experiences and perceptions of early detection of liver disease: a qualitative study in primary care

2018 ◽  
Vol 68 (676) ◽  
pp. e743-e749 ◽  
Author(s):  
Holly C Standing ◽  
Helen Jarvis ◽  
James Orr ◽  
Catherine Exley ◽  
Mark Hudson ◽  
...  
Keyword(s):  
Primary Care ◽  
Liver Disease ◽  
Qualitative Study ◽  
Early Detection ◽  
Liver Function Tests ◽  
Comparative Approach ◽  
Structured Interviews ◽  
Alcoholic Fatty Liver ◽  
Study Sites ◽  
The Uk

BackgroundThe incidence of liver disease is increasing in the UK and primary care is a key setting where improvement in the detection and management of liver disease is required. Little is known about GPs’ understanding and confidence in detecting liver disease.AimTo explore GPs’ experiences of liver disease with a focus on early detection and interpretation of liver function tests (LFTs).Design and settingA qualitative study employing semi-structured interviews of a purposive sample of GPs from five UK primary care study sites.MethodTelephone and face-to-face interviews of GPs were undertaken. Data were analysed thematically, using a constant comparative approach.ResultsFrom a total of 25 GP interviews (N = 25), four themes were identified from the data: test-requesting behaviour, confidence and challenges in diagnosing disease, access to specialist tests, and guidance and education. Participants’ descriptions of how they request and interpret LFTs varied widely. Concern over missing diagnoses was a common reason for requesting blood tests; patients with mildly abnormal LFTs and those at risk of non-alcoholic fatty liver disease (NAFLD) were a particular cause of concern. GPs saw themselves as generalists, with a reluctance to take on specialist investigations. Guidelines promoted confidence for some clinicians, but others felt that liver disease was too complex to be amenable to simple instructions. Most felt that they did not have access to relevant, focused education on liver disease.ConclusionLiver disease is not perceived as a priority in primary care. If GPs are to take on a greater role in identification and management of liver disease, support is needed to promote awareness, knowledge, and confidence.

Abnormal liver function tests

2019 ◽  
Vol 12 (9) ◽  
pp. 507-515
Author(s):  
Ceen-Ming Tang
Keyword(s):  
Primary Care ◽  
Liver Disease ◽  
Liver Function ◽  
Liver Function Tests ◽  
Alcoholic Fatty Liver ◽  
Premature Deaths ◽  
Function Tests ◽  
Medication Reviews ◽  
Related Liver Disease ◽  
The Uk

Liver disease is a clinical priority area identified by the RCGP, due to increasing levels of morbidity and mortality. Liver disease causes an estimated 8500 premature deaths in the UK annually, predominantly from a rise in non-alcoholic fatty liver disease, alcohol-related liver disease, and viral hepatitis. There has been a corresponding increase in liver function tests (LFTs) ordered from primary care, often as part of medication reviews or monitoring of chronic disease. GPs will therefore encounter an increasing number of abnormal LFTs in patients asymptomatic of liver disease. This article outlines a framework for investigating abnormal LFTs in primary care.

scholarly journals Experiences of support from primary care and perceived needs of parents bereaved by suicide: a qualitative study

2020 ◽  
Vol 70 (691) ◽  
pp. e102-e110 ◽  
Author(s):  
Verity Wainwright ◽  
Lis Cordingley ◽  
Carolyn A Chew-Graham ◽  
Nav Kapur ◽  
Jenny Shaw ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Qualitative Study ◽  
Support Needs ◽  
Structured Interviews ◽  
Perceived Needs ◽  
The North ◽  
Suicide Bereavement ◽  
Additional Support ◽  
The Uk

BackgroundPeople bereaved by suicide are a vulnerable group, also at risk of dying by suicide. The importance of postvention support (intervention after suicide) has recently been highlighted; however, little is known about the support needs of parents bereaved by suicide in the UK, and the role played by general practice.AimTo explore the perspectives, experiences, and support needs of parents bereaved by suicide.Design and settingThis was a qualitative study, with semi-structured interviews conducted between 2012 and 2014 in the north of England and the Midlands, with parents bereaved by their son or daughter’s suicide.MethodInterviews explored parents’ experiences of suicide bereavement following the death of their son or daughter, with a focus on their experiences of support from primary care. Interviews were analysed thematically using constant comparison.ResultsTwenty-three interviews were conducted. Three themes were identified from the data: the importance of not feeling alone; perceived barriers to accessing support; and the need for signposting for additional support. Some parents reported having experienced good support from their general practice; others described a number of barriers to accessing help, including triage processes. Primary care was considered to be an important avenue of support but GPs were often perceived as uncertain how to respond. The need for information, signposting to avenues of support, and the helpfulness of group support were also highlighted.ConclusionParents believed it was important that people working in general practice have an awareness of suicide bereavement and understanding of their needs, including knowledge of where to direct people for further support.

Detecting chronic liver disease: are liver function tests the solution?

2020 ◽  
Vol 81 (2) ◽  
pp. 1-8
Author(s):  
Prarthana Thiagarajan ◽  
Jane Chalmers ◽  
Indra N Guha ◽  
Martin W James
Keyword(s):  
Liver Disease ◽  
Liver Function ◽  
Chronic Liver Disease ◽  
Liver Function Tests ◽  
Chronic Liver ◽  
Alcoholic Fatty Liver ◽  
Non Invasive ◽  
Function Tests ◽  
Life Years ◽  
The Uk

By 2020, chronic liver disease will have eclipsed ischaemic heart disease as the leading cause of working life years lost in the UK. As mortality from chronic liver disease continues to rise, the landscape of aetiology has shifted from infectious to non-communicable causes. In parallel with the growing prevalence of obesity and type 2 diabetes, non-alcoholic fatty liver disease is estimated to affect 25% of the UK adult population. Simultaneously, escalating alcohol consumption has fuelled public health and economic concerns regarding its widespread impact on working-age adults. Given that chronic liver disease remains clinically silent until its advanced stages, there is an urgent unmet need to identify affected individuals earlier in the disease process, enabling targeted intervention strategies which may improve prognosis. Robust epidemiological data have shown that liver fibrosis is the strongest predictor of clinically meaningful outcomes, including decompensation, liver cancer and overall mortality. Detecting fibrosis among at-risk individuals, in a manner that is reproducible, non-invasive, safe and cost effective, has become a major challenge of our time. This article addresses the pitfalls of the standard panel of liver function tests, discusses other non-invasive biomarkers and reviews imaging technologies which may revolutionise community-based diagnosis and stratification of chronic liver disease.

scholarly journals Patient and practitioner views on cancer risk discussions in primary care: a qualitative study

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0108
Author(s):  
David N Blane ◽  
Sara MacDonald ◽  
Catherine A O'Donnell
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Qualitative Study ◽  
Cancer Risk ◽  
Lifestyle Modification ◽  
Structured Interviews ◽  
It Use ◽  
Practice Nurses ◽  
Primary Care Practitioners ◽  
The Uk

BackgroundIt is estimated that nearly 600,000 cancer cases in the UK could have been avoided in the last five years if people had healthier lifestyles, with the principle modifiable risk factors being smoking, obesity, alcohol consumption and inactivity. There is growing interest in the use of cancer risk information in general practice to encourage lifestyle modification.AimTo explore the views and experiences of patients and practitioners in relation to cancer prevention and cancer risk discussions in general practice.Design & settingQualitative study among patient and practitioners in general practices in Glasgow, UK.MethodSemi-structured interviews were conducted with nine practitioners (5 GPs and four practice nurses, recruited purposively from practices based on list size and deprivation status) and 13 patients (aged 30–60, with two or more specified co-morbidities).ResultsCurrently, cancer risk discussions focus on smoking and cancer, with links between alcohol/obesity and cancer rarely made. There was support for the use of the personalised cancer risk tool as an additional resource in primary care. Practitioners felt practice nurses were best placed to use it. Use in planned appointments (eg, chronic disease reviews) was preferred over opportunistic use. Concerns were expressed, however, about generating anxiety, time constraints, and widening inequalities.ConclusionsHealth behaviour change is complex and the provision of information alone is unlikely to have significant effects. Personalised risk tools may have a role, but important concerns about their use – particularly in areas of socio-economic disadvantage – remain.

scholarly journals GPs’ experiences of diagnosing and managing childhood eczema: a qualitative study in primary care

2018 ◽  
Vol 68 (667) ◽  
pp. e73-e80 ◽  
Author(s):  
Emma Le Roux ◽  
Kingsley Powell ◽  
Jonathan P Banks ◽  
Mathew J Ridd
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Disease Control ◽  
Medication Use ◽  
Self Care ◽  
Trial And Error ◽  
Structured Interviews ◽  
Common Cause ◽  
Topical Treatments ◽  
The Uk

BackgroundEczema is common among children, and in the UK the majority are managed by GPs. The most common cause of poor disease control is incorrect use of topical treatments. There is a lack of research into the challenges faced by GPs in diagnosing and managing this condition.AimTo explore the experiences of GPs in assessing and managing children with eczema.Design and settingQualitative study in primary care in England.MethodSemi-structured interviews with 15 GPs were audiorecorded, transcribed verbatim, and analysed thematically using the framework method.ResultsGPs described a paucity of dermatology training. Although most GPs were confident diagnosing uncomplicated eczema, they reported using a trial-and-error approach to prescribing emollients, and were uncertain about quantities of topical treatments to issue. Mild and moderate potency topical corticosteroids (TCS) were commonly used, but most GPs lacked confidence in recommending potent TCS, and viewed parents or carers to be fearful of using all strengths of TCS. GPs perceived adherence to treatments to be low, but provision of information to support self-care was variable. Routine review of medication use or disease control was uncommon, which GPs attributed to service constraints. Participants’ views on the causes and management of eczema were perceived to be at odds with parents and carers, who were said to be overly focused on an underlying cause, such as allergy.ConclusionGP uncertainty in managing eczema, lack of routine information and review, and perceived dissonance with parents around causation and management may be contributing to low concordance with treatments.

Optimising referral pathways for patients with non-alcoholic fatty liver disease in the UK

2021 ◽  
Vol 27 (3) ◽  
pp. 62-70
Author(s):  
Alexander Boyd ◽  
Ankur Srivastava ◽  
William Rosenberg ◽  
Philip N Newsome ◽  
Matthew J Armstrong
Keyword(s):  
Primary Care ◽  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Clinical Pathways ◽  
Lessons Learned ◽  
Alcoholic Fatty Liver ◽  
Non Invasive ◽  
The Uk ◽  
Alcoholic Fatty Liver Disease

The increasing burden of non-alcoholic fatty liver disease means that robust clinical pathways need to be established in primary care to identify patients with advanced fibrosis who may benefit from specialist management. This article summarises the current landscape of non-invasive liver fibrosis tests and discusses the outcomes and lessons learned from non-alcoholic fatty liver disease pathways that have been instigated around the UK. The inherent challenges of implementing such pathways are explored, along with developing technologies, such as artificial intelligence blood testing, which will likely play an important role in helping to identify and risk-stratify more patients with non-alcoholic fatty liver disease in primary care in the future.

Non-alcoholic fatty liver disease: a survey of involvement of primary care physicians

2020 ◽  
Vol 65 (4) ◽  
Author(s):  
Amir Mari ◽  
Sohaib Omari ◽  
Fadi Abu Baker ◽  
Saif Abu Much ◽  
Helal Said Ahmad ◽  
...  
Keyword(s):  
Primary Care ◽  
Liver Disease ◽  
Fatty Liver ◽  
Primary Care Physicians ◽  
Fatty Liver Disease ◽  
Alcoholic Fatty Liver ◽  
Alcoholic Fatty Liver Disease

scholarly journals Drivers of Broad-Spectrum Antibiotic Overuse across Diverse Hospital Contexts—A Qualitative Study of Prescribers in the UK, Sri Lanka and South Africa

Antibiotics ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 94
Author(s):  
Carolyn Tarrant ◽  
Andrew M. Colman ◽  
David R. Jenkins ◽  
Edmund Chattoe-Brown ◽  
Nelun Perera ◽  
...  
Keyword(s):  
South Africa ◽  
Sri Lanka ◽  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Low Income ◽  
System Level ◽  
Comparative Approach ◽  
Structured Interviews ◽  
Public And Private ◽  
The Uk

Antimicrobial stewardship programs focus on reducing overuse of broad-spectrum antibiotics (BSAs), primarily through interventions to change prescribing behavior. This study aims to identify multi-level influences on BSA overuse across diverse high and low income, and public and private, healthcare contexts. Semi-structured interviews were conducted with 46 prescribers from hospitals in the UK, Sri Lanka, and South Africa, including public and private providers. Interviews explored decision making about prescribing BSAs, drivers of the use of BSAs, and benefits of BSAs to various stakeholders, and were analyzed using a constant comparative approach. Analysis identified drivers of BSA overuse at the individual, social and structural levels. Structural drivers of overuse varied significantly across contexts and included: system-level factors generating tensions with stewardship goals; limited material resources within hospitals; and patient poverty, lack of infrastructure and resources in local communities. Antimicrobial stewardship needs to encompass efforts to reduce the reliance on BSAs as a solution to context-specific structural conditions.

scholarly journals Identifying Risk Factors Affecting the Usage of Digital and Social Media: A Preliminary Qualitative Study in the Dental Profession and Dental Education

2021 ◽  
Vol 9 (5) ◽  
pp. 53
Author(s):  
Rayan Sharka ◽  
Jonathan P. San Diego ◽  
Melanie Nasseripour ◽  
Avijit Banerjee
Keyword(s):  
Risk Factors ◽  
Qualitative Study ◽  
Perceived Risk ◽  
Dental Education ◽  
Dental Students ◽  
General Context ◽  
Structured Interviews ◽  
Factors Affecting ◽  
The Uk ◽  
Dental Professionals

Aims: This study aimed to identify the risk factors of using DSM to provide an insight into the inherent implications this has on dental professionals in practice and trainee professionals’ education. Materials and methods: Twenty-one participants (10 dental professionals and 11 undergraduate and postgraduate dental students) participated in this qualitative study using semi-structured interviews in a dental school in the UK. The interviews were analysed and categorised into themes, some of which were identified from previous literature (e.g., privacy and psychological risks) and others emerged from the data (e.g., deceptive and misleading information). Results: The thematic analysis of interview transcripts identified nine perceived risk themes. Three themes were associated with the use of DSM in the general context, and six themes were related to the use of DSM in professional and education context. Conclusions: This study provided evidence to understand the risk factors of using DSM in dental education and the profession, but the magnitude of these risks on the uptake and usefulness of DSM needs to be assessed.

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