Family practice最新文献

Background: Musculoskeletal (MSK) pain is known to influence health-related quality of life (HRQoL), but the role of co-occurring chronic diseases in HRQoL in a MSK pain population has been less studied. This study aimed to evaluate (i) whether chronic disease clusters are related to HRQoL and (ii) whether these relationships differ in magnitude from those between the number of chronic diseases and HRQoL among people with MSK pain.

Material and methods: The Northern Finland Birth Cohort 1966 and its 46-year data collection point were used. The chronic disease clusters for individuals reporting any MSK pain within the past year were previously formulated using latent class analysis and consisted of: Psychiatric (co-existing mental health disorder, substance use disorder, and asthma), Metabolic (referring to the burden of metabolic diseases), and Relatively healthy. HRQoL was measured with a 15-dimension questionnaire. General linear regression model was used.

Results: Among 4490 participants, both the Psychiatric and Metabolic clusters associated with clinically significantly reduced HRQoL, when contrasted with the Relatively healthy cluster, but the association was stronger for the Psychiatric cluster. Similarly, the adjusted mean difference in HRQoL was higher for the Psychiatric cluster than for the multimorbidity (two or more diseases) category when compared with the reference categories (Relatively healthy cluster and no chronic diseases, respectively).

Conclusions: The present findings imply the clinical relevance of the previously identified chronic disease clusters and suggest that pure counts of chronic diseases may not be enough to describe the role of chronic diseases in HRQoL in MSK pain.

Background: Multimorbidity guidelines recommend tailoring care to patients' priorities. The Supporting Prescribing in Multimorbidity in Primary Care (SPPiRE) trial focused on optimizing medicines use in older adults with significant polypharmacy and tailoring prescribing and deprescribing to individual priorities. This study aimed to compare self-reported and general practitioner (GP)-recorded patient priorities and examine the impact of prioritizing pain on analgesic prescribing.

Methods: This secondary cohort analysis of the SPPIRE trial and process evaluation assessed baseline participant-identified priorities and intervention group GP-recorded priorities during medication reviews with agreement assessed using Cohen's kappa. Analgesic prescribing patterns and daily morphine milligram equivalents changes during the study period were summarized. The impact of pain (self-reported, GP-recorded, and severe or extreme pain on the baseline EQ5D) on opioid intensification was analysed using multi-level models accounting for GP practice clustering and intervention effects.

Results: A total of 403 patients (mean age 76.5 years) were included; 178 (44.2%) reported pain as a priority at baseline. Agreement between self-reported and GP-recorded pain was poor (kappa 0.118, P = 0.05). Most analgesic prescriptions decreased during the study, except for potent opioids, which increased in both trial arms. All three pain variables were associated with increased odds of opioid intensification at follow-up.

Conclusion: In this older population of patients with significant polypharmacy, identifying pain as a priority was associated with an increased likelihood of opioid intensification, despite guidelines advising against their use for chronic pain. This study highlights the challenges faced by GPs treating pain in older adults with multimorbidity.

Primary care researchers and clinicians are facing an ever-growing evidence base, more options to access research evidence, and increasingly limited time. Incorporating search filters into primary care systematic reviews can significantly improve the efficiency and confidence of the search process. Search filters, or hedges, are predeveloped search strategies that combine controlled vocabulary and free text terms using Boolean operators (words like "AND," "OR"). Search filters help to manage the diverse terminology in the literature, such as the various synonyms for primary care, and can be tailored to the specific needs of the review, whether it aims to be exhaustive or more focussed. Resources such as specialized librarians, databases such as PubMed, and repositories such as the InterTASC Information Specialists Sub-Group provide access to these valuable tools. However, as primary care terminology continues to evolve, regular updates to these filters are necessary to maintain their relevance and effectiveness. This method brief presents search filters and highlights their value for finding research literature in primary care.

Background: Mapping general practitioners' antibiotic prescribing practices is essential to optimize antibiotic use in primary care and mitigate antibiotic resistance.

Objectives: The objective of this study was to examine the adherence of Dutch general practitioners to prescribing guidelines for ear and respiratory tract symptoms and conditions.

Methods: A cross-sectional study was conducted on Dutch electronic health records from 2018 to 2021. Antibiotic prescribing frequency and type were examined for ear and respiratory tract symptoms and conditions based on professional prescribing guidelines. Descriptive statistics and multilevel logistic regression analyses were applied.

Results: Patient records from up to 384 general practices were analysed for 15 ear and 27 respiratory tract conditions. For 11 of the 15 (73%) ear and 17 of the 27 (63%) respiratory tract conditions, more than 95% of patients were treated according to the prescribing guidelines. Most potential non-adherence to antibiotic prescribing guidelines occurred for acute otitis media (31%-34%), acute bronchitis/bronchiolitis (26%-39%), and acute sinusitis (25%-34%). Several other respiratory tract conditions showed non-indicated prescribing rates above 10%. For otitis externa, many broad-spectrum antibiotics were prescribed, which rarely happened for respiratory conditions. High variation in prescribing frequency and type between general practices occurred.

Conclusions: For most conditions, Dutch general practitioners adhere well to antibiotic prescribing guidelines. There are conditions for which there is a high potential for inappropriate prescribing. High variation between practices suggests room for improvement. Stricter implementation of prescribing guidelines may help improve prescribing practice. Alternatively, a practice-specific approach could be effective. The Dutch setting may be exemplary for international antibiotic prescribing practice.

Background: The Brain Care Score (BCS) was developed in partnership with patients and practitioners to convey actionable knowledge to individuals everywhere that can motivate change in health-related behaviors and thereby reduce the risk of dementia, stroke, and late-life depression (LLD). Because diseases outside the brain share modifiable risk factors with dementia, stroke, and LLD, we investigated the associations of the BCS with other common age-related diseases, including cardiovascular disease (CVD) and cancer.

Methods: Among all UK Biobank (UKB) participants with complete BCS data, we performed Cox proportional hazard regression analyses between the BCS at baseline and incident CVD (ischemic heart disease, stroke, and heart failure) and the three most common cancer types (lung, colorectal, and breast cancer), adjusted for sex and stratified by age.

Results: Among 416 370 UKB participants (mean age: 57 years; 54% female), 33 944 cases of CVD (8.8%) and 16 090 cases of cancer (4.0%) were identified over a median follow-up of 12.5 years. A 5-point higher BCS at baseline was associated with a lower incidence of CVD (hazard ratio [HR]: 0.57 [95% confidence interval {95% CI}: 0.55-0.59]) and lower incidence of the three most common cancer types (HR: 0.69 [95% CI: 0.66-0.72]).

Conclusions: A higher BCS at baseline is associated with a lower incidence of CVD and three cancer types. Although developed specifically as an actionable tool to guide individuals in reducing their risk of common age-related brain diseases, we show that it may also offer ancillary benefits, providing a single place to start for guiding individuals toward improving their chances of healthy aging more generally.

Introduction: General practitioner (GP) confidence in management and diagnosis across the range of dermatological conditions has not been well-explored.

Objectives: This study aimed to document Australian GPs' confidence and its associations in diagnosing and managing dermatological presentations.

Methods: A cross-sectional questionnaire-based study of Australian GPs. Recruitment was through the restricted Facebook group ('GPs Down Under') and 2022 Royal Australian College of General Practice conference attendees. Items elicited practitioner and practice demographics, dermatology educational experience, and confidence levels in diagnosing and managing 28 dermatological curriculum areas.

Results: Respondents (n = 278) were most confident in managing eczema, bacterial skin infections, acne, contact dermatitis, and fungal skin diseases. They reported lower confidence for nail disease, connective tissue diseases, vasculitis, vascular tumours and malformations, and cutaneous manifestations of internal diseases. GPs reported greater confidence in managing, as opposed to diagnosing, melanoma and melanocytic lesions, premalignant and malignant keratinocyte skin cancers, sexually transmitted infections, and the skin and viral exanthems. Melanoma and melanocytic lesions, premalignant and malignant keratinocyte skin cancers were perceived as the greatest learning priorities.

Conclusions: While Australian GPs report high confidence in diagnosing and managing common dermatological conditions, confidence declines for rarer, more complex presentations. Notably, GPs feel more confident in managing skin cancers than diagnosing them, indicating a need for enhanced training in diagnostic skills, particularly dermoscopy. These findings have implications for education delivery.

Background: In France, 90.1% of the population was registered with a preferred doctor in 2019.

Objectives: To explore the risk factors and healthcare utilization associated with not being registered with a preferred doctor.

Design and setting: Population-based cross-sectional study conducted among insured individuals aged 16 years or above in the Lyon metropolitan area.

Methods: Data was extracted from the French health insurance information system for the year 2019. Univariate and multivariate models were used to analyse the risk factors and healthcare utilization associated with not being registered with a preferred doctor.

Results: Among 878 030 individuals, 12.2% were not registered with a preferred doctor. In multivariate analysis, individuals not registered with a preferred doctor were younger (OR up to 18.2 between 16 and 30 years, compared to those aged ≥ 75 years), more often male (OR = 1.13), lived more often in a high medical accessibility area (OR up to 1.13 in the fourth quartile, compared to the first quartile), had less often a low income (OR = 0.64) or a long-term condition status (OR = 0.30), than those registered. Individuals without a preferred doctor had fewer visits to a GP (OR = 0.09), to a specialist (OR = 0.15), and to an emergency department (OR = 0.35), fewer hospitalizations (OR for no hospitalization = 4.54), and fewer selected prevention procedures (OR as low as 0.06 for breast cancer screening).

Conclusions: Not having a preferred doctor may limit access to primary and secondary care. Strategies to enhance registration should be considered, particularly for individuals with a long-term condition and those living in medically underserved areas.

Background: Tobacco use among healthcare workers compromises their role as cessation advocates. This study focuses on nicotine dependence, quit intentions, and cessation efforts among daily tobacco-using healthcare students, professionals, and staff in Eastern India.

Methods: A multicentric cross-sectional study using a structured questionnaire was conducted in 24 healthcare institutions across Bihar and Jharkhand during July-August 2023, analysing data from 729 daily tobacco users among a total of 7619 participants.

Results: The mean nicotine dependence score was 4.6 ± 2.3, with 49.2% showing moderate dependence, 38.4% low, and 12.3% high. Among daily users, 63.1% expressed quit intentions. Two-thirds (67.9%) attempted to quit in the past year, with 36.6% using nicotine replacement therapy and 62.0% trying unaided. Participants without quit intentions had higher odds of moderate dependence [adjusted odds ratio (AOR) = 9.36] and high dependence (AOR = 28.8). Receiving no cessation advice increased the odds of moderate (AOR = 5.30) and high dependence (AOR = 16.15). Quit intentions were associated with lower nicotine dependence (AOR = 29.9 for low and 4.04 for moderate), receiving quit advice (AOR = 2.03), and awareness of tobacco control laws (AOR = 1.08 per unit). Quit attempts were influenced by quit intentions (AOR = 13.03), lower nicotine dependence (AOR = 2.68 for moderate), and receiving cessation advice (AOR = 2.82).

Conclusions: The study population showed moderate nicotine dependence and substantial quit intentions, emphasizing the need for stronger healthcare-led cessation efforts to enhance success and empower healthcare workers as tobacco control advocates.

Background: Refeeding syndrome (RFS) is a complex phenomenon associated with increased mortality. However, the prevalence of risk factors for RFS has never been assessed in primary care. Our aim was to assess the prevalence of risk for developing RFS in primary care.

Methods: A retrospective observational study was conducted in a general practitioner (GP) surgery in June 2022. The study included older adult patients (aged ≥75 years) or adult patients with chronic disease (aged 18-74 years), living at home and receiving care at home or at the GP's surgery between January 1 and June 30, 2021. Patients at high risk of developing RFS were identified using the National Institute for Health and Clinical Excellence (NICE) criteria. The risk of RFS was also assessed in patients aged ≥70 years using an adaptation of the NICE criterion for body mass index based on the Global Leadership Initiative on Malnutrition guidelines.

Results: The prevalence of patients at risk for RFS was 2.8% (95% CI: 1.5%-4.1%) in the full population of 611 patients and 8.8% (95% CI: 6.1%-6.4%) in the subset of patients aged ≥70 years assessed using the adapted NICE criterion. The prevalence of patients at risk for RFS increased with age and chronic conditions. More severe comorbidity and home care were factors associated with higher risk of RFS.

Conclusion: The risk of developing RFS in primary care settings is not negligible. GPs should consider this risk in their practice to develop a more comprehensive care programme.