An algorithmic approach to diagnosing asthma in older patients in general practice

Abstract Background Depression is highly prevalent, but knowledge is scarce as to whether increased public awareness and strengthened government focus on mental health have changed how general practitioners (GPs) help their depressed patients. This study aimed to examine national time trends in GP depression care and whether trends varied regarding patient gender, age, and comorbidity. Methods Nationwide registry-based cohort study, Norway. The study population comprised all residents aged 20 years or older with new depression diagnoses recorded in general practice, 2009–2015. We linked reimbursement claims data from all consultations in general practice for depression with information on demographics and antidepressant medication. The outcome was type(s) of GP depression care during 12 months from the date of diagnosis: (long) consultation, talking therapy, antidepressant drug treatment, sickness absence certification, and referral to secondary mental health care. Covariates were patient gender, age, and comorbidity. The data are presented as frequencies and tested with generalized linear models. Results We included 365,947 new depression diagnoses. Mean patient age was 44 years (SD = 16), 61.9 % were women, 41.2 % had comorbidity. From 2009 to 2015, proportions of patients receiving talking therapy (42.3–63.4 %), long consultations (56.4–71.8 %), and referral to secondary care (16.6–21.6 %) increased, while those receiving drug treatment (31.3–25.9 %) and sick-listing (58.1–50 %) decreased. The trends were different for gender (women had a greater increase in talking therapy and a smaller decrease in sick-listing, compared to men), age (working-aged patients had a smaller increase in talking therapy, a greater increase in long consultations, and a smaller decrease in antidepressant drug use, compared to older patients) and comorbidity (patients with mental comorbidity had a smaller increase in talking therapy and a greater increase in long consultations, compared to those with no comorbidity and somatic comorbidity). Conclusions The observed time trends in GP depression care towards increased provision of psychological treatment and less drug treatment and sick-listing were in the desired direction according to Norwegian health care policy. However, the large and persistent differences in treatment rates between working-aged and older patients needs further investigation.

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Real-life implementation of guidelines on the hospital-to-home transition for older patients: a cohort study in general practice

Age and Ageing ◽

10.1093/ageing/afz143 ◽

2019 ◽

Vol 49 (1) ◽

pp. 46-51

Author(s):

Aline Hurtaud ◽

François Lallier ◽

Matthieu Heidet ◽

Charline Arnoult ◽

Moustapha Dramé ◽

...

Keyword(s):

Primary Care ◽

General Practice ◽

Cohort Study ◽

Hospital Discharge ◽

Older Patients ◽

Real Life ◽

Discharge Summary ◽

Life Assessment ◽

Hospital To Home ◽

Discharge Summaries

Abstract Background hospital discharge is a critical event for older patients. The French guidelines recommended the swift transmission of a discharge summary to the general practitioner (GP) and a primary care consultation within 7 days. The relevance and feasibility of these guidelines have not previously been assessed. Objective to perform a real-life assessment of compliance with French guidelines on the transmission of discharge summaries and post-discharge medical reviews and to examine these factors’ association with 30-day readmissions. Design a prospective multicentre cohort study. Setting primary care (general practice) in France. Subjects a sample of GPs and the same number of patients aged 75 or over having consulted within 30 days of hospital discharge. Methods the main endpoints were the proportion of discharge summaries available and the proportion of patients consulting their GP within 7 days. The 30-day readmission rate was also measured. Factors associated with these endpoints were assessed in univariate and multivariate analyses. Results seventy-one GPs (mean ± standard deviation age: 49 ± 11; males: 62%) and 71 patients (mean age: 84 ± 5; males: 52%; living at home: 94%; cognitive disorders: 22%) were included. Forty-six patients (65%, [95% confidence interval [CI]]: 53–76) consulted their GP within 7 days of hospital discharge. At the time of the consultation, 27 GPs (38% [95% CI]: 27–50) had not received the corresponding hospital discharge summary. Discharge summary availability was associated with a lower risk of 30-day readmission (adjusted odds ratio [95% CI] = 0.25 [0.07–0.91]). Conclusions compliance with the French guidelines on hospital-to-home transitions is insufficient.

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Oral Medicine Considerations for Older Patients

Primary Dental Journal ◽

10.1177/2050168420943975 ◽

2020 ◽

Vol 9 (3) ◽

pp. 45-53

Author(s):

Jayne Patterson ◽

Amanda Willis

Keyword(s):

General Practice ◽

Oral Cavity ◽

Older Patients ◽

Facial Pain ◽

Healthcare Professionals ◽

Significant Problem ◽

Oral Medicine ◽

Mucosal Disease ◽

Older Populations

With the projected increase to 1.3 billion people aged 65 years or older by 2040, healthcare professionals are faced with significant challenges in managing this population of patients. In the oral cavity, oral mucosal disease is a signiﬁcant problem found in older populations. Several facial pain conditions are more likely to be seen in this cohort of patients. Although management of this group of patients may not always be appropriate in general practice, an awareness of the range of oral medicine conditions that may be encountered in older patients is essential to allow prompt referral and treatment.

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Older patients' consultations in an apprenticeship model-based general practice training program: A cross-sectional study

Australasian Journal on Ageing ◽

10.1111/ajag.12364 ◽

2016 ◽

Vol 36 (1) ◽

pp. E1-E7 ◽

Cited By ~ 3

Author(s):

Andrew Bonney ◽

Simon Morgan ◽

Amanda Tapley ◽

Kim Henderson ◽

Elizabeth Holliday ◽

...

Keyword(s):

General Practice ◽

Training Program ◽

Older Patients ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Model Based ◽

Apprenticeship Model ◽

General Practice Training

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PROGNOSTIC SIGNIFICANCE OF BLOOD PRESSURE MEASURED IN THE OFFICE, AT HOME, AND DURING AMBULATORY MONITORING IN OLDER PATIENTS IN ONE GENERAL PRACTICE

Journal of Hypertension ◽

10.1097/00004872-200406002-00995 ◽

2004 ◽

Vol 22 (Suppl. 2) ◽

pp. S287 ◽

Cited By ~ 1

Author(s):

R. H. Fagard ◽

P. Decort ◽

C. Van Den Broeke

Keyword(s):

Blood Pressure ◽

General Practice ◽

Older Patients ◽

Prognostic Significance ◽

Ambulatory Monitoring ◽

At Home

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Complex health care decisions with older patients in general practice: Patient-centeredness and prioritization in consultations following a geriatric assessment

Patient Education and Counseling ◽

10.1016/j.pec.2012.07.015 ◽

2013 ◽

Vol 90 (1) ◽

pp. 54-60 ◽

Cited By ~ 14

Author(s):

Jennifer Wrede ◽

Isabel Voigt ◽

Jutta Bleidorn ◽

Eva Hummers-Pradier ◽

Marie-Luise Dierks ◽

...

Keyword(s):

Health Care ◽

General Practice ◽

Geriatric Assessment ◽

Older Patients ◽

Patient Centeredness ◽

Health Care Decisions ◽

Practice Patient

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Emergency department utilisation by older people in metropolitan Melbourne, 2008–12: findings from the Reducing Older Patient’s Avoidable Presentations for Emergency Care Treatment (REDIRECT) study

Australian Health Review ◽

10.1071/ah16191 ◽

2018 ◽

Vol 42 (2) ◽

pp. 181 ◽

Cited By ~ 4

Author(s):

Danielle Mazza ◽

Christopher Pearce ◽

Angela Joe ◽

Lyle R. Turner ◽

Bianca Brijnath ◽

...

Keyword(s):

General Practice ◽

General Practitioner ◽

Older People ◽

Older Patients ◽

Medical Officer ◽

Public Hospitals ◽

Out Of Hours ◽

Gp Services ◽

Emergency Department Utilisation ◽

Lost Opportunity

Objective Older patients are over-represented in emergency departments (ED), with many presenting for conditions that could potentially be managed in general practice. The aims of the present study were to examine the characteristics of ED presentations by older patients and to identify patient factors contributing to potentially avoidable general practitioner (PAGP)-type presentations. Methods A retrospective analysis was performed of routinely collected data comprising ED presentations by patients aged ≥70 years at public hospitals across metropolitan Melbourne from January 2008 to December 2012. Presentations were classified according to the National Healthcare Agreement definition for PAGP-type presentations. Presentations were characterised according to patient demographic and clinical factors and were compared across PAGP-type and non-PAGP-type groups. Results There were 744 519 presentations to the ED by older people, of which 103 471 (13.9%) were classified as PAGP-type presentations. The volume of such presentations declined over the study period from 20 893 (14.9%) in 2008 to 20 346 (12.8%) in 2012. External injuries were the most common diagnoses (13 761; 13.3%) associated with PAGP-type presentations. Sixty-one per cent of PAGP-type presentations did not involve either an investigation or a procedure. Patients were referred back to a medical officer (including a general practitioner (GP)) in 58.7% of cases. Conclusion Older people made a significant number of PAGP-type presentations to the ED during the period 2008–12. A low rate of referral back to the primary care setting implies a potential lost opportunity to redirect older patients from ED services back to their GPs for ongoing care. What is known about the topic? Older patients are increasingly attending EDs, with a proportion attending for problems that could potentially be managed in the general practice setting (termed PAGP-type presentations). What does this paper add? This study found that PAGP-type presentations, although declining, remain an important component of ED demand. Patients presented for a wide array of conditions and during periods that may indicate difficulty accessing a GP. What are the implications for practitioners? Strategies to redirect PAGP-type presentations to the GP setting are required at both the primary and acute care levels. These include increasing out-of-hours GP services, better triaging and appointment management in GP clinics and improved communication between ED clinicians and patients’ GPs. Although some strategies have been implemented, further examination is required to assess their ongoing effectiveness.

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