scholarly journals Evaluation of winter pressures on general practice in Manchester: a cross-sectional analysis of nine GP practices

BJGP Open ◽  
2020 ◽  
pp. bjgpopen20X101138
Author(s):  
Sinead Millwood ◽  
Peter Tomlinson ◽  
Jon Hopwood
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Seasonal Variation ◽  
Secondary Care ◽  
Hospital Admissions ◽  
Respiratory Illness ◽  
Cross Sectional ◽  
Support Unit ◽  
The North ◽  
Sectional Analysis

Background: The Nuffield Trust’s report on NHS winter pressure highlights a lack of data for primary care, with a consequential focus on secondary care. Aim: To quantify seasonal variation in workload in primary and secondary care. Design and Setting: Analysis of data for nine GP practices in Greater Manchester with a patient population of 75,421. Method: Descriptive and comparative analyses were performed for winter and summer periods in 2018-19. Data were obtained from the North of England Clinical Support Unit (NECSU) via the Rapid Actionable Insight Driving Reform (RAIDR) toolkit, and EMIS Enterprise clinical audit tools. Results: Accident & Emergency (A&E) attendances increased by 4% (p= 0.035) during winter with no difference in the number of hospital admissions (p=0.668). The number of problems seen in General practice increased by 61% (p<0.001), as did the number of GP consultations 61% (p<0.001). Respiratory diagnoses saw the greatest seasonal variation accounting for 10% in winter, 4% in summer (p<0.001). Self-referral accounted for 70% of A&E attendance in winter, 63% in summer (p<0.001). GP referral accounted for 7% in winter, 6% in summer (p=0.002). Conclusion: General practice observed a greater seasonal increase in presenting patients compared to secondary care. We recommend any winter pressures strategy target both respiratory illness and patients who self-refer to A&E. Transferring 50% of self-referrals in Manchester to GP appointments would achieve a £2.3 million cost saving. Increasing provision in primary care requires funding and increased appointments, but more importantly improved patient opportunities to easily access timely advice and assistance.

scholarly journals Emergency hospital admissions for asthma and access to primary care: cross-sectional analysis

2016 ◽  
Vol 66 (650) ◽  
pp. e640-e646 ◽  
Author(s):  
Robert Fleetcroft ◽  
Michael Noble ◽  
Aidan Martin ◽  
Emma Coombes ◽  
John Ford ◽  
...  
Keyword(s):  
Primary Care ◽  
Hospital Admissions ◽  
Cross Sectional ◽  
Emergency Hospital ◽  
Emergency Hospital Admissions ◽  
Cross Sectional Analysis ◽  
Access To Primary Care ◽  
Sectional Analysis

scholarly journals Management of depression in primary care - A cross-sectional study in the North-East of England, UK

2021 ◽  
Vol 19 (2) ◽  
Author(s):  
Reshma Hegde ◽  
Prinul Gunputh ◽  
Baxi Sinha
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Secondary Care ◽  
Cross Sectional Study ◽  
Free Text ◽  
Sectional Study ◽  
Cross Sectional ◽  
North East ◽  
The North

Background: Depression is a common and serious disorder that impairs quality of life. Since general practitioners (GP) are considered gatekeepers to secondary care, the choice of interventions offered in primary care can have a significant impact not only on patients’ quality of life, but also on health service demands. Objective: To evaluate the confidence of GPs in diagnosing and managing depression; and, to assess the factors influencing their strategy in treating depression. Methods: A cross-sectional study was carried out among GPs working in the North-East of England, UK. The survey questionnaire consisted of mostly close-ended questions with some allowing for free-text comments (see Appendix 1). The responses obtained were analysed using Microsoft Excel. Results: Among the total of 63 respondents, most GPs were comfortable diagnosing depression. Most would consider combining talking therapies with antidepressants (68.3%) at presentation, followed by referral to talking therapies alone (41.2%). In only 14.3% of cases would antidepressant therapy alone be considered. For those patients non-responsive to initial treatment, 25.4% considered offering a different antidepressant or adjunct medication (such as a sedative, anxiolytic, or beta-blocker), and another 25.4% of GPs considered a combination with another antidepressant. 46.0% of participants were not comfortable prescribing dual antidepressants due to concerns about side effects, lack of experience, paucity of guidelines, and lack of timely access and guidance from the local mental team. Nearly all (98.4%) GP participants would agree to prescribe dual antidepressants on advice of the mental health team with telephone advice being the preferred means of communication in 65.1% of cases. Conclusion: The results of this study can help to develop closer co-operation between primary and secondary care by not only upskilling GPs through various means (educational events, training posts, etc.), but by also creating better communication channels at the interface between those two services. Key words: antidepressants, combination therapy, depression, primary care, primary-secondary care interface

scholarly journals “Inappropriate Prescriptions of Direct Oral Anticoagulants among Patients with Atrial Fibrillation in General Practice: a Cross-sectional Analysis of the French CACAO Cohort Study”

2020 ◽  
pp. bjgp20X714005
Author(s):  
Emilie Ferrat ◽  
Julie Fabre ◽  
Philippe Galletout ◽  
Emmanuelle Boutin ◽  
Julien Le Breton ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
General Practice ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Logistic Models ◽  
Nonvalvular Atrial Fibrillation ◽  
Cross Sectional ◽  
Sectional Analysis ◽  
Inappropriate Prescriptions

Abstract Background: Direct oral anticoagulants (DOACs) account for an increasing proportion of prescriptions in patients with nonvalvular atrial fibrillation (NVAF) in primary care. Inappropriate dosing of DOACs (especially under-dosing) is the most common problem. However, conflicting results have been reported with regard to the factors independently associated with inappropriate dosing. Aim: The present study’s objectives were to describe inappropriate prescriptions of DOACs in the Comparison of Accidents and Circumstances with Oral Anticoagulants” (CACAO) French nationwide general practice cohort, and to identify factors independently associated with inappropriate DOAC doses. Design and setting: We performed an ancillary cross-sectional baseline analysis of the CACAO French national multicentre prospective cohort of adult patients in primary care receiving an oral anticoagulant and recruited from April to October 2014. We selected the set of CACAO patients having taken a DOAC for NVAF on inclusion (n=1111). Method: We described inappropriate prescriptions of DOACs (inappropriate dosage, contraindications, non-indications, interactions, and precautions for use) and then used multivariate logistic models to investigate factors associated with inappropriate DOAC dosing (under-dosing and over-dosing). Results: Overall, 438 patients (39.4%) received at least one inappropriate DOAC prescription – mainly an inappropriate dosage (33.7%), and especially under-dosing (31.3%). In a multivariate analysis, the factors independently associated with under-dosing were older age (odds ratio [95% confidence interval] =1.03[1.02-1.05]), prescription of apixaban (3.93[2.29-6.74]) or dabigatran (1.55[1.17-2.06]), and a CHA2DS2-VASc score ≥2 (2.39[0.92-6.18]) vs. a score=1 (0.73[0.23-2.34]). Conclusion: The appropriateness of DOAC prescribing for NVAF can be improved, especially in older patients, those with kidney failure, a higher risk for ischemic stroke and/or a higher risk for bleeding.

scholarly journals Cross sectional study estimating prevalence of heart failure and left ventricular systolic dysfunction in community patients at risk

Heart ◽  
2001 ◽  
Vol 86 (2) ◽  
pp. 172-178 ◽  
Author(s):  
O W Nielsen ◽  
J Hilden ◽  
C T Larsen ◽  
J F Hansen
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
General Practice ◽  
Heart Disease ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Systolic Dysfunction ◽  
Cross Sectional ◽  
General Practices

OBJECTIVETo examine a general practice population to measure the prevalence of signs and symptoms of heart failure (SSHF) and left ventricular systolic dysfunction (LVSD).DESIGNCross sectional screening study in three general practices followed by echocardiography.SETTING AND PATIENTSAll patients ⩾ 50 years in two general practices and ⩾ 40 years in one general practice were screened by case record reviews and questionnaires (n = 2158), to identify subjects with some evidence of heart disease. Among these, subjects were sought who had SSHF (n = 115). Of 357 subjects with evidence of heart disease, 252 were eligible for examination, and 126 underwent further cardiological assessment, including 43 with SSHF.MAIN OUTCOME MEASURESPrevalence of SSHF as defined by a modified Boston index, LVSD defined as an indirectly measured left ventricular ejection fraction ⩽ 0.45, and numbers of subjects needing an echocardiogram to detect one case with LVSD.RESULTSSSHF afflicted 0.5% of quadragenarians and rose to 11.7% of octogenarians. Two thirds were handled in primary care only. At ⩾ 50 years of age 6.4% had SSHF, 2.9% had LVSD, and 1.9% (95% confidence interval 1.3% to 2.5%) had both. To detect one case with LVSD in primary care, 14 patients with evidence of heart disease without SSHF and 5.5 patients with SSHF had to be examined.CONCLUSIONSSHF is extremely prevalent in the community, especially in primary care, but more than two thirds do not have LVSD. The number of subjects with some evidence of heart disease needing an echocardiogram to detect one case of LVSD is 14.

General practice registrars’ clinical exposure to dermatological procedures during general practice training: a cross-sectional analysis

2018 ◽  
Vol 29 (6) ◽  
pp. 357-366 ◽  
Author(s):  
Er Tsing Vivian Tng ◽  
Amanda Tapley ◽  
Andrew Davey ◽  
Sally De Zwaan ◽  
Simon Morgan ◽  
...  
Keyword(s):  
General Practice ◽  
Cross Sectional ◽  
Clinical Exposure ◽  
Cross Sectional Analysis ◽  
Sectional Analysis ◽  
General Practice Training

scholarly journals Interprofessional collaboration among care professionals in obstetrical care: are perceptions aligned?

2017 ◽  
Vol 27 (4) ◽  
pp. 279-286 ◽  
Author(s):  
Anita Romijn ◽  
Pim W Teunissen ◽  
Martine C de Bruijne ◽  
Cordula Wagner ◽  
Christianne J M de Groot
Keyword(s):  
Primary Care ◽  
The Netherlands ◽  
Interprofessional Collaboration ◽  
Cross Sectional Study ◽  
Measurement Scale ◽  
Cross Sectional ◽  
Communication Accommodation ◽  
Obstetrical Care ◽  
The North ◽  
Ensure Patient Safety

BackgroundIn an obstetrical team, obstetricians, midwives and nurses work together in a dynamic and complex care setting. Different professional cultures can be a barrier for effective interprofessional collaboration. Although the different professional cultures in obstetrical care are well known, little is understood about discrepancies in mutual perceptions of collaboration. Similar perceptions of collaboration are important to ensure patient safety. We aimed to understand how different care professionals in an obstetrical team assess interprofessional collaboration in order to gain insight into the extent to which their perceptions are aligned.MethodsThis cross-sectional study was performed in the north-western region of the Netherlands. Care professionals from five hospitals and surrounding primary-care midwifery practices were surveyed. The respondents consisted of four groups of care professionals: obstetricians (n=74), hospital-based midwives known as clinical midwives (n=42), nurses (n=154) and primary-care midwives (n=109). The overall response rate was 80.8%. We used the Interprofessional Collaboration Measurement Scale (IPCMS) to assess perceived interprofessional collaboration. The IPCMS distinguishes three subscales: communication, accommodation and isolation. Data were analysed using non-parametrical tests.ResultsOverall, ratings of interprofessional collaboration were good. Obstetricians rated their collaboration with clinical midwives, nurses and primary-care midwives more positively than these three groups rated the collaboration with obstetricians. Discrepancies in mutual perceptions were most apparent in the isolation subscale, which is about sharing opinions, discussing new practices and respecting each other.ConclusionWe found relevant discrepancies in mutual perceptions of collaboration in obstetrical care in the Netherlands. Obstetrical care is currently being reorganised to enable more integrated care, which will have consequences for interprofessional collaboration. The findings of this study indicate opportunities for improvement especially in terms of perceived isolation.

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