Jamie Brown, R. West, C. Angus, E. Beard, A. Brennan, C. Drummond, M. Hickman, J. Holmes, E. Kaner, S. Michie
Background Brief interventions have a modest but meaningful effect on promoting smoking cessation and reducing excessive alcohol consumption. Guidelines recommend offering such advice opportunistically and regularly but incentives vary between the two behaviours. Aim To use representative data from the perspective of patients to compare the prevalence and characteristics of people who smoke or drink excessively and who receive a brief intervention. Design and setting Data was from a representative sample of 15 252 adults from household surveys in England. Method Recall of brief interventions on smoking and alcohol use, sociodemographic information, and smoking and alcohol consumption patterns were assessed among smokers and those who drink excessively (AUDIT score of ≥8), who visited their GP surgery in the previous year. Results Of 1775 smokers, 50.4% recalled receiving brief advice on smoking in the previous year. Smokers receiving advice compared with those who did not were more likely to be older (odds ratio [OR] 17-year increments 1.19, 95% confidence interval [CI] =1.06 to 1.34), female (OR 1.35, 95% CI =1.10 to 1.65), have a disability (OR 1.44, 95% CI = 1.11 to 1.88), have made more quit attempts in the previous year (compared with no attempts: one attempt, OR 1.65, 95% CI = 1.32 to 2.08; ≥2 attempts, OR 2.02, 95% CI =1.49 to 2.74), and have greater nicotine dependence (OR 1.17, 95% CI =1.05 to 1.31) but were less likely to have no post-16 qualifications (OR 0.81, 95% CI = 0.66 to 1.00). Of 1110 people drinking excessively, 6.5% recalled receiving advice in their GP surgery on their alcohol consumption in the previous year. Those receiving advice compared with those who did not had higher AUDIT scores (OR 1.17, 95% CI =1.12 to 1.23) and were less likely to be female (OR 0.44, 95% CI = 0.23 to 0.87). Conclusion Whereas approximately half of smokers in England visiting their GP in the past year report having received advice on cessation, <10% of those who drink excessively report having received advice on their alcohol consumption.
背景:简短的干预措施在促进戒烟和减少过度饮酒方面具有适度但有意义的作用。指导方针建议有机会地、定期地提供此类建议，但两种行为的激励机制各不相同。目的从患者的角度，利用具有代表性的数据，比较过度吸烟或饮酒人群与接受短暂干预人群的患病率和特征。设计和设置数据来自英格兰家庭调查中15252名成年人的代表性样本。方法对上一年就诊全科医生的吸烟者和过度饮酒者(审计评分≥8分)进行吸烟和酒精使用、社会人口统计信息、吸烟和酒精消费模式的简短干预回顾评估。结果在1775名吸烟者中，50.4%的人回忆在前一年接受过简短的吸烟建议。与未接受建议的吸烟者相比，接受建议的吸烟者更有可能是老年人(比值比[OR] 17年递增1.19,95%可信区间[CI] =1.06至1.34)、女性(比值比[OR] 1.35, 95% CI =1.10至1.65)、有残疾(比值比[OR] 1.44, 95% CI = 1.11至1.88)、在前一年有更多的戒烟尝试(与未尝试的吸烟者相比:1次尝试，比值比[OR] 1.65, 95% CI = 1.32至2.08;≥2次尝试，OR 2.02, 95% CI =1.49 ~ 2.74)，并且有较大的尼古丁依赖性(OR 1.17, 95% CI =1.05 ~ 1.31)，但较少可能没有16后资格证书(OR 0.81, 95% CI = 0.66 ~ 1.00)。在1110名过度饮酒的人中，6.5%的人回忆说，他们在前一年的全科医生手术中接受过关于他们饮酒的建议。与那些没有接受建议的人相比，接受建议的人审计得分更高(OR 1.17, 95% CI =1.12至1.23)，女性的可能性更低(OR 0.44, 95% CI = 0.23至0.87)。结论:在过去的一年中，英国约有一半的吸烟者接受了戒烟建议，而过度饮酒者中只有不到10%的人接受了关于饮酒的建议。
{"title":"Comparison of brief interventions in primary care on smoking and excessive alcohol consumption: a population survey in England","authors":"Jamie Brown, R. West, C. Angus, E. Beard, A. Brennan, C. Drummond, M. Hickman, J. Holmes, E. Kaner, S. Michie","doi":"10.3399/bjgp16X683149","DOIUrl":"https://doi.org/10.3399/bjgp16X683149","url":null,"abstract":"Background Brief interventions have a modest but meaningful effect on promoting smoking cessation and reducing excessive alcohol consumption. Guidelines recommend offering such advice opportunistically and regularly but incentives vary between the two behaviours. Aim To use representative data from the perspective of patients to compare the prevalence and characteristics of people who smoke or drink excessively and who receive a brief intervention. Design and setting Data was from a representative sample of 15 252 adults from household surveys in England. Method Recall of brief interventions on smoking and alcohol use, sociodemographic information, and smoking and alcohol consumption patterns were assessed among smokers and those who drink excessively (AUDIT score of ≥8), who visited their GP surgery in the previous year. Results Of 1775 smokers, 50.4% recalled receiving brief advice on smoking in the previous year. Smokers receiving advice compared with those who did not were more likely to be older (odds ratio [OR] 17-year increments 1.19, 95% confidence interval [CI] =1.06 to 1.34), female (OR 1.35, 95% CI =1.10 to 1.65), have a disability (OR 1.44, 95% CI = 1.11 to 1.88), have made more quit attempts in the previous year (compared with no attempts: one attempt, OR 1.65, 95% CI = 1.32 to 2.08; ≥2 attempts, OR 2.02, 95% CI =1.49 to 2.74), and have greater nicotine dependence (OR 1.17, 95% CI =1.05 to 1.31) but were less likely to have no post-16 qualifications (OR 0.81, 95% CI = 0.66 to 1.00). Of 1110 people drinking excessively, 6.5% recalled receiving advice in their GP surgery on their alcohol consumption in the previous year. Those receiving advice compared with those who did not had higher AUDIT scores (OR 1.17, 95% CI =1.12 to 1.23) and were less likely to be female (OR 0.44, 95% CI = 0.23 to 0.87). Conclusion Whereas approximately half of smokers in England visiting their GP in the past year report having received advice on cessation, <10% of those who drink excessively report having received advice on their alcohol consumption.","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":"60 1","pages":"e1 - e9"},"PeriodicalIF":0.0,"publicationDate":"2015-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90459654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Williams, A. Edwards, P. Hibbert, P. Rees, Huw Prosser Evans, S. Panesar, B. Carter, G. Parry, M. Makeham, Aled Jones, A. Avery, A. Sheikh, L. Donaldson, A. Carson-Stevens
Background Discharge from hospital presents significant risks to patient safety, with up to one in five patients experiencing adverse events within 3 weeks of leaving hospital. Aim To describe the frequency and types of patient safety incidents associated with discharge from secondary to primary care, and commonly described contributory factors to identify recommendations for practice. Design and setting A mixed methods analysis of 598 patient safety incident reports in England and Wales related to ‘Discharge’ from the National Reporting and Learning System. Method Detailed data coding (with 20% double-coding), data summaries generated using descriptive statistical analysis, and thematic analysis of special-case sample of reports. Incident type, contributory factors, type, and level of harm were described, informing recommendations for future practice. Results A total of 598 eligible reports were analysed. The four main themes were: errors in discharge communication (n = 151; 54% causing harm); errors in referrals to community care (n = 136; 73% causing harm); errors in medication (n = 97; 87% causing harm); and lack of provision of care adjuncts such as dressings (n = 62; 94% causing harm). Common contributory factors were staff factors (not following referral protocols); and organisational factors (lack of clear guidelines or inefficient processes). Improvement opportunities include developing and testing electronic discharge methods with agreed minimum information requirements and unified referrals systems to community care providers; and promoting a safety culture with ‘safe discharge’ checklists, discharge coordinators, and family involvement. Conclusion Significant harm was evident due to deficits in the discharge process. Interventions in this area need to be evaluated and learning shared widely.
{"title":"Harms from discharge to primary care: mixed methods analysis of incident reports","authors":"H. Williams, A. Edwards, P. Hibbert, P. Rees, Huw Prosser Evans, S. Panesar, B. Carter, G. Parry, M. Makeham, Aled Jones, A. Avery, A. Sheikh, L. Donaldson, A. Carson-Stevens","doi":"10.3399/bjgp15X687877","DOIUrl":"https://doi.org/10.3399/bjgp15X687877","url":null,"abstract":"Background Discharge from hospital presents significant risks to patient safety, with up to one in five patients experiencing adverse events within 3 weeks of leaving hospital. Aim To describe the frequency and types of patient safety incidents associated with discharge from secondary to primary care, and commonly described contributory factors to identify recommendations for practice. Design and setting A mixed methods analysis of 598 patient safety incident reports in England and Wales related to ‘Discharge’ from the National Reporting and Learning System. Method Detailed data coding (with 20% double-coding), data summaries generated using descriptive statistical analysis, and thematic analysis of special-case sample of reports. Incident type, contributory factors, type, and level of harm were described, informing recommendations for future practice. Results A total of 598 eligible reports were analysed. The four main themes were: errors in discharge communication (n = 151; 54% causing harm); errors in referrals to community care (n = 136; 73% causing harm); errors in medication (n = 97; 87% causing harm); and lack of provision of care adjuncts such as dressings (n = 62; 94% causing harm). Common contributory factors were staff factors (not following referral protocols); and organisational factors (lack of clear guidelines or inefficient processes). Improvement opportunities include developing and testing electronic discharge methods with agreed minimum information requirements and unified referrals systems to community care providers; and promoting a safety culture with ‘safe discharge’ checklists, discharge coordinators, and family involvement. Conclusion Significant harm was evident due to deficits in the discharge process. Interventions in this area need to be evaluated and learning shared widely.","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":"30 1","pages":"e829 - e837"},"PeriodicalIF":0.0,"publicationDate":"2015-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81672987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Rates of prostate specific antigen (PSA) test ordering vary among GPs. Aim To examine whether GPs’ risk attitude, level of empathy, and burnout status are associated with PSA testing. Design and setting Register and questionnaire study including 129 solo GPs (active in the Central Denmark Region) and 76 672 of their adult male patients with no history of or current prostate cancer diagnosis. Method PSA tests from 2012 were retrieved from a register and classified as incident (that is, the first PSA test within 24 months), repeated normal, or repeated raised tests. This was merged with information on GPs’ risk attitudes, empathy, and burnout status from a 2012 survey. Results Patients registered with a GP with a high score on anxiety caused by uncertainty (odds ratio [OR] 1.03, 95% confidence interval [CI] = 1.00 to 1.06, P = 0.025) or concern about bad outcomes (OR 1.04; 95% CI = 1.00 to 1.08, P = 0.034) were more likely to have an incident PSA test, whereas those registered with a GP with increased tolerance for ambiguity were less likely (OR 0.98, 95% CI = 0.96 to 1.00, P = 0.025). Patients registered with a GP reporting high tolerance for ambiguity (OR 0.96, 95% CI = 0.94 to 0.99, P = 0.009) or high propensity to risk-taking (OR 0.97, 95% CI = 0.93 to 1.00, P = 0.047) were less likely to have a repeated normal PSA test. Conclusion Various aspects of GPs’ risk-taking attitudes were associated with patients’ probability of having an incident and a repeated normal PSA test. The probability of having a repeated raised PSA test was not influenced by any of the psychological factors. Burnout and empathy were not associated with PSA testing.
背景前列腺特异性抗原(PSA)检测顺序在全科医生中有所不同。目的探讨全科医生的风险态度、共情水平和职业倦怠状态是否与PSA检测相关。设计和设置登记和问卷研究包括129名全科医生(活跃在丹麦中部地区)和76 672名没有前列腺癌病史或目前诊断的成年男性患者。方法从注册表中检索2012年的PSA测试，并将其分类为事件(即24个月内的首次PSA测试)、重复正常测试或重复升高测试。这与2012年的一项调查中关于全科医生风险态度、同理心和倦怠状态的信息相结合。结果在全科医生处登记的患者因不确定性(优势比[OR] 1.03, 95%可信区间[CI] = 1.00 ~ 1.06, P = 0.025)或担心不良结局(OR 1.04;95% CI = 1.00至1.08,P = 0.034)更有可能进行偶发性PSA检测，而GP患者对模糊容忍度增加的可能性较小(OR 0.98, 95% CI = 0.96至1.00,P = 0.025)。注册的全科医生报告对模棱两可的高耐受性(OR 0.96, 95% CI = 0.94至0.99,P = 0.009)或高风险倾向(OR 0.97, 95% CI = 0.93至1.00,P = 0.047)的患者不太可能重复进行正常的PSA检测。结论全科医生的冒险态度的各个方面与患者发生事故和重复正常PSA测试的可能性有关。PSA反复升高的概率不受任何心理因素的影响。倦怠和同理心与PSA检测无关。
{"title":"Association of GPs’ risk attitudes, level of empathy, and burnout status with PSA testing in primary care","authors":"A. Pedersen, A. H. Carlsen, P. Vedsted","doi":"10.3399/bjgp15X687649","DOIUrl":"https://doi.org/10.3399/bjgp15X687649","url":null,"abstract":"Background Rates of prostate specific antigen (PSA) test ordering vary among GPs. Aim To examine whether GPs’ risk attitude, level of empathy, and burnout status are associated with PSA testing. Design and setting Register and questionnaire study including 129 solo GPs (active in the Central Denmark Region) and 76 672 of their adult male patients with no history of or current prostate cancer diagnosis. Method PSA tests from 2012 were retrieved from a register and classified as incident (that is, the first PSA test within 24 months), repeated normal, or repeated raised tests. This was merged with information on GPs’ risk attitudes, empathy, and burnout status from a 2012 survey. Results Patients registered with a GP with a high score on anxiety caused by uncertainty (odds ratio [OR] 1.03, 95% confidence interval [CI] = 1.00 to 1.06, P = 0.025) or concern about bad outcomes (OR 1.04; 95% CI = 1.00 to 1.08, P = 0.034) were more likely to have an incident PSA test, whereas those registered with a GP with increased tolerance for ambiguity were less likely (OR 0.98, 95% CI = 0.96 to 1.00, P = 0.025). Patients registered with a GP reporting high tolerance for ambiguity (OR 0.96, 95% CI = 0.94 to 0.99, P = 0.009) or high propensity to risk-taking (OR 0.97, 95% CI = 0.93 to 1.00, P = 0.047) were less likely to have a repeated normal PSA test. Conclusion Various aspects of GPs’ risk-taking attitudes were associated with patients’ probability of having an incident and a repeated normal PSA test. The probability of having a repeated raised PSA test was not influenced by any of the psychological factors. Burnout and empathy were not associated with PSA testing.","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":"34 1","pages":"e845 - e851"},"PeriodicalIF":0.0,"publicationDate":"2015-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91395107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Burt, C. Lloyd, John Campbell, M. Roland, G. Abel
Background Doctor–patient communication is a key driver of overall satisfaction with primary care. Patients from minority ethnic backgrounds consistently report more negative experiences of doctor–patient communication. However, it is currently unknown whether these ethnic differences are concentrated in one gender or in particular age groups. Aim To determine how reported GP–patient communication varies between patients from different ethnic groups, stratified by age and gender. Design and setting Analysis of data from the English GP Patient Survey from 2012–2013 and 2013–2014, including 1 599 801 responders. Method A composite score was created for doctor–patient communication from five survey items concerned with interpersonal aspects of care. Mixed-effect linear regression models were used to estimate age- and gender-specific differences between white British patients and patients of the same age and gender from each other ethnic group. Results There was strong evidence (P<0.001 for age by gender by ethnicity three-way interaction term) that the effect of ethnicity on reported GP–patient communication varied by both age and gender. The difference in scores between white British and other responders on doctor–patient communication items was largest for older, female Pakistani and Bangladeshi responders, and for younger responders who described their ethnicity as ‘Any other white’. Conclusion The identification of groups with particularly marked differences in experience of GP–patient communication — older, female, Asian patients and younger ‘Any other white’ patients — underlines the need for a renewed focus on quality of care for these groups.
{"title":"Variations in GP–patient communication by ethnicity, age, and gender: evidence from a national primary care patient survey","authors":"J. Burt, C. Lloyd, John Campbell, M. Roland, G. Abel","doi":"10.3399/bjgp15X687637","DOIUrl":"https://doi.org/10.3399/bjgp15X687637","url":null,"abstract":"Background Doctor–patient communication is a key driver of overall satisfaction with primary care. Patients from minority ethnic backgrounds consistently report more negative experiences of doctor–patient communication. However, it is currently unknown whether these ethnic differences are concentrated in one gender or in particular age groups. Aim To determine how reported GP–patient communication varies between patients from different ethnic groups, stratified by age and gender. Design and setting Analysis of data from the English GP Patient Survey from 2012–2013 and 2013–2014, including 1 599 801 responders. Method A composite score was created for doctor–patient communication from five survey items concerned with interpersonal aspects of care. Mixed-effect linear regression models were used to estimate age- and gender-specific differences between white British patients and patients of the same age and gender from each other ethnic group. Results There was strong evidence (P<0.001 for age by gender by ethnicity three-way interaction term) that the effect of ethnicity on reported GP–patient communication varied by both age and gender. The difference in scores between white British and other responders on doctor–patient communication items was largest for older, female Pakistani and Bangladeshi responders, and for younger responders who described their ethnicity as ‘Any other white’. Conclusion The identification of groups with particularly marked differences in experience of GP–patient communication — older, female, Asian patients and younger ‘Any other white’ patients — underlines the need for a renewed focus on quality of care for these groups.","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":"41 1","pages":"e47 - e52"},"PeriodicalIF":0.0,"publicationDate":"2015-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90637815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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