High rates of general practice attendance by former prisoners: a prospective cohort study

BackgroundClinical judgement is intrinsic to diagnostic strategies in general practice; however, empirical evidence for its validity is sparse.AimTo ascertain whether a GP’s global clinical judgement of future cognitive status has an added value for predicting a patient’s likelihood of experiencing dementia.Design and settingMulticentre prospective cohort study among patients in German general practice that took place from January 2003 to October 2016.MethodPatients without baseline dementia were assessed with neuropsychological interviews over 12 years; 138 GPs rated the future cognitive decline of their participating patients. Associations of baseline predictors with follow-up incident dementia were analysed with mixed-effects logistic and Cox regression.ResultsA total of 3201 patients were analysed over the study period (mean age = 79.6 years, 65.3% females, 6.7% incident dementia in 3 years, 22.1% incident dementia in 12 years). Descriptive analyses and comparison with other cohorts identified the participants as having frequent and long-lasting doctor–patient relationships and being well known to their GPs. The GP baseline rating of future cognitive decline had significant value for 3-year dementia prediction, independent of cognitive test scores and patient’s memory complaints (GP ratings of very mild (odds ratio [OR] 1.97, 95% confidence intervals [95% CI] = 1.28 to 3.04); mild (OR 3.00, 95% CI = 1.90 to 4.76); and moderate/severe decline (OR 5.66, 95% CI = 3.29 to 9.73)). GPs’ baseline judgements were significantly associated with patients’ 12-year dementia-free survival rates (Mantel–Cox log rank test P<0.001).ConclusionIn this sample of patients in familiar doctor–patient relationships, the GP’s clinical judgement holds additional value for predicting dementia, complementing test performance and patients’ self-reports. Existing and emerging primary care-based dementia risk models should consider the GP’s judgement as one predictor. Results underline the importance of the GP-patient relationship.

Download Full-text

Costs of treatment of Swiss patients with HIV on antiretroviral therapy in hospital-based and general practice-based care: a prospective cohort study

AIDS Care ◽

10.1080/09540120412331336689 ◽

2005 ◽

Vol 17 (6) ◽

pp. 698-710 ◽

Cited By ~ 9

Author(s):

A. Lowy ◽

J. Page ◽

R. Jaccard ◽

B. Ledergerber ◽

B. Somaini ◽

...

Keyword(s):

General Practice ◽

Cohort Study ◽

Antiretroviral Therapy ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Costs Of Treatment

Download Full-text

Is immunising all patients with chronic lung disease in the community against influenza cost effective? Evidence from a general practice based clinical prospective cohort study in Utrecht, The Netherlands

Journal of Epidemiology & Community Health ◽

10.1136/jech.52.2.120 ◽

1998 ◽

Vol 52 (2) ◽

pp. 120-125 ◽

Cited By ~ 44

Author(s):

E. Hak ◽

G. A. van Essen ◽

E. Buskens ◽

W. Stalman ◽

R. A. de Melker

Keyword(s):

General Practice ◽

Cohort Study ◽

The Netherlands ◽

Lung Disease ◽

Prospective Cohort Study ◽

Chronic Lung Disease ◽

Prospective Cohort ◽

Cost Effective

Download Full-text

Six-year course and prognosis of nontraumatic knee symptoms in adults in general practice: A prospective cohort study

Arthritis Care & Research ◽

10.1002/acr.20522 ◽

2011 ◽

Vol 63 (9) ◽

pp. 1287-1294 ◽

Cited By ~ 14

Author(s):

Marlous Kastelein ◽

Pim A. J. Luijsterburg ◽

Janneke N. Belo ◽

Jan A. N. Verhaar ◽

Bart W. Koes ◽

...

Keyword(s):

General Practice ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort

Download Full-text

Active vaccine safety surveillance of seasonal influenza vaccination via a scalable, integrated system in Western Australian pharmacies: a prospective cohort study

BMJ Open ◽

10.1136/bmjopen-2020-048109 ◽

2021 ◽

Vol 11 (6) ◽

pp. e048109

Author(s):

Sandra Salter ◽

Gurkamal Singh ◽

Lisa Nissen ◽

Kevin Trentino ◽

Kevin Murray ◽

...

Keyword(s):

General Practice ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Surveillance System ◽

Vaccine Safety ◽

Integrated System ◽

Safety Surveillance ◽

Message Service ◽

Outcome Differences

ObjectivesWe integrated an established participant-centred active vaccine safety surveillance system with a cloud-based pharmacy immunisation-recording program in order to measure adverse events following immunisation (AEFI) reported via the new surveillance system in pharmacies, compared with AEFI reported via an existing surveillance system in non-pharmacy sites (general practice and other clinics).DesignA prospective cohort study.Participants and settingIndividuals >10 years receiving influenza immunisations from 22 pharmacies and 90 non-pharmacy (general practice and other clinic) sites between March and October 2020 in Western Australia. Active vaccine safety surveillance was conducted using short message service and smartphone technology, via an opt-out system.Outcome measuresMultivariable logistic regression was used to assess the primary outcome: differences in proportions of AEFI between participants immunised in pharmacies compared with non-pharmacy sites, adjusting for confounders of age, sex and influenza vaccine brand. A subgroup analysis of participants over 65 years was also performed.ResultsOf 101 440 participants (6992 from pharmacies; 94 448 from non-pharmacy sites), 77 498 (76.4%) responded; 96.1% (n=74 448) within 24 hours. Overall, 4.8% (n=247) pharmacy participants reported any AEFI, compared with 6% (n=4356) non-pharmacy participants (adjusted OR: 0.87; 95% CI: 0.76 to 0.99; p=0.039). Similar proportions of AEFIs were reported in pharmacy (5.8%; n=31) and non-pharmacy participants (6; n=1617) aged over 65 years (adjusted OR: 0.94; 95% CI: 0.65 to 1.35; p=0.725). The most common AEFIs in pharmacy were: pain (2%; n=104), tiredness (1.9%; n=95) and headache (1.7%; n=88); and in non-pharmacy sites: pain (2.3%; n=1660), tiredness (1.9%; n=1362) and swelling (1.5%; n=1121).ConclusionsHigh and rapid response rates demonstrate good participant engagement with active surveillance in both pharmacy and non-pharmacy participants. Significantly fewer AEFIs reported after pharmacist immunisations compared with non-pharmacy immunisations, with no difference in older adults, may suggest different cohorts attend pharmacy versus non-pharmacy immunisers. The integrated pharmacy system is rapidly scalable across Australia with global potential.

Download Full-text