The History of Primary Care Counselling

2018 ◽  
pp. 7-30
Author(s):  
Joan Foster
Keyword(s):  
Primary Care ◽  
History Of ◽  
Care Counselling

scholarly journals The contribution of depressive ‘disorder characteristics’ to determinations of prognosis for adults with depression: an individual patient data meta-analysis

2021 ◽  
pp. 1-14
Author(s):  
Joshua E. J. Buckman ◽  
Rob Saunders ◽  
Zachary D. Cohen ◽  
Phoebe Barnett ◽  
Katherine Clarke ◽  
...  
Keyword(s):  
Primary Care ◽  
Depressive Symptoms ◽  
Depressive Symptom ◽  
Panic Disorder ◽  
Symptom Severity ◽  
Individual Patient Data ◽  
Antidepressant Treatment ◽  
Patient Data ◽  
History Of ◽  
Depressive Symptom Severity

Abstract Background This study aimed to investigate general factors associated with prognosis regardless of the type of treatment received, for adults with depression in primary care. Methods We searched Medline, Embase, PsycINFO and Cochrane Central (inception to 12/01/2020) for RCTs that included the most commonly used comprehensive measure of depressive and anxiety disorder symptoms and diagnoses, in primary care depression RCTs (the Revised Clinical Interview Schedule: CIS-R). Two-stage random-effects meta-analyses were conducted. Results Twelve (n = 6024) of thirteen eligible studies (n = 6175) provided individual patient data. There was a 31% (95%CI: 25 to 37) difference in depressive symptoms at 3–4 months per standard deviation increase in baseline depressive symptoms. Four additional factors: the duration of anxiety; duration of depression; comorbid panic disorder; and a history of antidepressant treatment were also independently associated with poorer prognosis. There was evidence that the difference in prognosis when these factors were combined could be of clinical importance. Adding these variables improved the amount of variance explained in 3–4 month depressive symptoms from 16% using depressive symptom severity alone to 27%. Risk of bias (assessed with QUIPS) was low in all studies and quality (assessed with GRADE) was high. Sensitivity analyses did not alter our conclusions. Conclusions When adults seek treatment for depression clinicians should routinely assess for the duration of anxiety, duration of depression, comorbid panic disorder, and a history of antidepressant treatment alongside depressive symptom severity. This could provide clinicians and patients with useful and desired information to elucidate prognosis and aid the clinical management of depression.

scholarly journals Improving the management of people with a family history of breast cancer in primary care: before and after study of audit-based education

2013 ◽  
Vol 14 (1) ◽  
Author(s):  
Imran Rafi ◽  
Susmita Chowdhury ◽  
Tom Chan ◽  
Ibrahim Jubber ◽  
Mohammad Tahir ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Family History ◽  
Before And After ◽  
History Of ◽  
Before And After Study

scholarly journals Blood pressure and cholesterol measurements in primary care: cross-sectional analyses in a dynamic cohort

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0131
Author(s):  
Annemarijn de Boer ◽  
Monika Hollander ◽  
Ineke van Dis ◽  
Frank L.J. Visseren ◽  
Michiel L Bots ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Cardiovascular Risk ◽  
Mixed Model ◽  
Time Window ◽  
Guideline Implementation ◽  
Cross Sectional ◽  
Menopausal Women ◽  
History Of ◽  
Post Menopausal

BackgroundGuidelines on cardiovascular risk management (CVRM) recommend blood pressure (BP) and cholesterol measurements every five years in men ≥40 and (post-menopausal) women ≥50 years.AimEvaluate CVRM guideline implementation.Design & settingCross-sectional analyses in a dynamic cohort using primary care electronic health record (EHR) data from the Julius General Practitioners’ Network (n=388,929).MethodWe assessed trends (2008–2018) in the proportion of patients with at least one measurement (BP and cholesterol) every one, two, and five years, in those with a history of (1) cardiovascular disease (CVD) and diabetes, (2) diabetes only, (3) CVD only, (4) cardiovascular risk assessment (CRA) indication based on other medical history, or (5) no CRA indication. We evaluated trends over time using logistic regression mixed model analyses.ResultsTrends in annual BP and cholesterol measurement increased for patients with a history of CVD from 37.0% to 48.4% (P<0.001) and 25.8% to 40.2% (P<0.001). In the five-year window 2014–2018, BP and cholesterol measurements were performed in respectively 78.5% and 74.1% of all men ≥40 years and 82.2% and 78.5% in all women ≥50 years. Least measured were patients without a CRA indication: men 60.2% and 62.4%; women 55.5% and 59.3%.ConclusionThe fairly high frequency of CVRM measurements available in the EHR of patients in primary care suggests an adequate implementation of the CVRM guideline. As nearly all individuals visit the general practitioner once within a five-year time window, improvement of CVRM remains very well possible, especially in those without a CRA indication.

scholarly journals Screening for Atrial Fibrillation in American Indian Adults in a Tribal Primary Care Clinic

2021 ◽  
Author(s):  
Stavros Stavrakis ◽  
Khaled Elkholey ◽  
Marty M. Lofgren ◽  
Zain U. A. Asad ◽  
Lancer D. Stephens ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
American Indian ◽  
Primary Care Clinic ◽  
Care Physician ◽  
Racial Groups ◽  
Unique Identifier ◽  
Care Clinic ◽  
Time Period ◽  
History Of

Background American Indian adults have a higher risk of atrial fibrillation (AF) compared with other racial groups. We implemented opportunistic screening to detect silent AF in American Indian adults attending a tribal health system using a mobile, single‐lead ECG device. Methods and Results American Indian patients aged ≥50 years followed in a tribal primary care clinic with no history of AF underwent a 30‐second ECG. A cardiologist overread all tracings to confirm the diagnosis of AF. After AF was confirmed, patients were referred to their primary care physician for initiation of anticoagulation. Patients seen over the same time period, who were not undergoing screening, served as controls. A total of 1019 patients received AF screening (mean age, 61.5±8.9 years, 62% women). Age and sex distribution of those screened was similar to the overall clinic population. New AF was diagnosed in 15 of 1019 (1.5%) patients screened versus 4 of 1267 (0.3%) patients who were not screened (mean difference, 1.2%; 95% CI, 0.3%–2.2%, P =0.002). Eight of 15 with new screen‐detected AF were aged <65 years. Those with screen‐detected AF were slightly older and had a higher CHA 2 DS 2 ‐VASc score than those without AF. Fourteen of 15 patients diagnosed with new AF had a CHA 2 DS 2 ‐VASc score ≥1 and initiated anticoagulation. Conclusions Opportunistic, mobile single‐lead ECG screening for AF is feasible in tribal clinics, and detects more AF than usual care, leading to appropriate initiation of anticoagulation. AF develops at a younger age in American Indian adults who would likely benefit from earlier AF screening. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03740477.

scholarly journals 1109. Factors Impacting the Decision to Order Stool Diagnostic Testing in Patients With Acute Gastroenteritis Among Primary Care Providers

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S332-S333
Author(s):  
Sean O’Leary ◽  
Mandy Allison ◽  
Cristina V Cardemil ◽  
Laura Hurley ◽  
Lori Crane ◽  
...  
Keyword(s):  
Primary Care ◽  
Acute Gastroenteritis ◽  
Pathogen Detection ◽  
Immunocompromised Patient ◽  
Diagnostic Testing ◽  
Primary Care Providers ◽  
Care Providers ◽  
Risk Area ◽  
High Risk Area ◽  
History Of

Abstract Background Diagnostic options for stool pathogens are evolving and expanding rapidly. The majority of acute gastroenteritis (AGE) patients seeking medical care are seen by primary care providers (PCPs), and stool testing may not be performed as AGE is generally self-limited. Little is known about how PCPs decide for which patients to order testing. Our objective was to describe among PCPs factors affecting the decision of whether to order stool diagnostic testing for pathogen detection in patients with AGE symptoms in the outpatient setting. Methods A national survey was conducted from January to March 2018 among primary care pediatricians (Peds), family physicians (FP), and internists (GIM). Results The response rate was 50% (689/1,383; Peds 59% [275/466], FP 49% [226/461], GIM 41% [188/456]). Factors most often reported as greatly increasing the likelihood of testing that did not differ significantly between specialties included patient history of travel to a high-risk area (75% Peds, 71% FP, 72% GIM), immunocompromised patient (Peds 67%, FP 60%, GIM 69%), and clinical suspicion of a pathogen that can be treated with antibiotics or antiparasitics (Peds 63%, FP 56%, GIM 65%). Factors with significant differences between specialties that were most often reported as greatly increasing likelihood of testing included presence of blood in stool (Peds 76%, FP 58%, GIM 48%, P &lt; 0.0001), history of recent antibiotic use (Peds 31%, FP 66%, GIM 72%, P &lt; 0.0001), history of recent hospitalization (Peds 29%, FP 61%, GIM 64%, P &lt; 0.0001), consideration of inpatient admission (Peds 36%, FP 57%, GIM 56%, P &lt; 0.0001), and fever ≥38.5 C (Peds 13%, FP 27%, GIM 40%, P &lt; 0.0001). Factors most often reported as greatly decreasing the likelihood of testing included presence of vomiting without diarrhea (Peds 49%, FP 43%, GIM 50%) and presence of vomiting and diarrhea together (Peds 12%, FP 7%, GIM 9%). Conclusion Physicians rely on a variety of factors when considering diagnostic testing for stool pathogens in AGE, with recent travel, caring for an immunocompromised patient, and antibiotic/antiparasitic treatment decisions often reported as increasing the likelihood of testing. Consideration of the clinical presentation and most common AGE pathogens by age group may be driving some of the differences between specialties. Disclosures All authors: No reported disclosures.

scholarly journals When should a rare inherited connective tissue disorder be suspected in bicuspid aortic valve by primary-care internists and cardiologists? Proposal of a score

2020 ◽  
Author(s):  
Guglielmina Pepe ◽  
Betti Giusti ◽  
Stefania Colonna ◽  
Maria Pia Fugazzaro ◽  
Elena Sticchi ◽  
...  
Keyword(s):  
Primary Care ◽  
Aortic Valve ◽  
Connective Tissue ◽  
Bicuspid Aortic Valve ◽  
Aortic Surgery ◽  
Connective Tissue Disorder ◽  
Tertiary Center ◽  
History Of ◽  
Selected Traits ◽  
Size Threshold

Abstract Size threshold for aortic surgery in bicuspid aortic valve (BAV) is debated. Connective tissue disorders (CTDs) are claimed as a clinical turning point, suggesting early surgery in BAV patients with CTD. Thus, we aimed at developing a score to detect high risk of carrying CTDs in consecutive BAVs from primary care. Ninety-eight BAVs without ectopia lentis or personal/family history of aortic dissection were studied at the Marfan syndrome Tuscany Referral Center. Findings were compared with those detected in 84 Marfan patients matched for sex and age. We selected traits with high statistical difference between MFS and BAV easily obtainable by cardiologists and primary-care internists: mitral valve prolapse, myopia ≥ 3DO, pectus carenatum, pes planus, wrist and thumb signs, and difference between aortic size at root and ascending aorta ≥ 4 mm. Clustering of ≥ 3 of these manifestations were more frequent in Marfan patients than in BAVs (71.4% vs 6.1%, p < 0.0001) resulting into an Odds Ratio to be affected by MFS of 38.3 (95% confidence intervals 14.8–99.3, p < 0.0001). We propose a score assembling simple clinical and echocardiographic variables resulting in an appropriate referral pattern of BAVs from a primary-care setting to a tertiary center to evaluate the presence of a potential, major CTD.

scholarly journals Bronchodilators, Antibiotics, and Oral Corticosteroids Use in Primary Care for Children With Cough

2019 ◽  
Vol 6 ◽  
pp. 2333794X1983129
Author(s):  
Sankaran Krishnan ◽  
Vicki Ianotti ◽  
John Welter ◽  
Meighan Maye Gallagher ◽  
Tatiana Ndjatou ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Practice ◽  
Past History ◽  
Nasal Congestion ◽  
Care Practice ◽  
Acute Cough ◽  
Pediatric Practice ◽  
Oral Corticosteroids ◽  
History Of ◽  
Neurological Conditions

Real-world management decisions for acute cough in children in primary care practice are not well understood. This study is an analysis of 560 encounters for children with cough, 19 days to 18 years of age, seen in a predominantly suburban academic pediatric practice, over 1 year. Past history, cough duration, and cough characteristics significantly affected treatment decisions. Children with cough frequently had a history of preterm birth, allergies, asthma, and neurological conditions. Most common therapies were bronchodilators, antibiotics, and oral corticosteroids. Children prescribed antibiotics were older, more likely to have a wet or productive cough, history of sinusitis, pneumonia or dysphagia, and longer cough duration. Children prescribed oral corticosteroids were younger, less likely to be wet or productive and more likely to have history of asthma or dysphagia. Children prescribed bronchodilators were more likely to have fever, nasal congestion, and wheezing and history of previous asthma, pneumonia, or dysphagia.

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