Abstract:
BACKGROUND:The benefit of a "diagnosis" of pre-diabetes in very elderly patients is debated. How clinicians manage pre-diabetic blood results in these patients is unknown. This study aims to understand how clinicians are "diagnosing" older patients with pre-diabetic blood parameters. METHODS:Semi-structured interviews and focus groups with health care staff (24 total participants) were conducted in the north of England. Interviews and focus groups were recorded, transcribed and analysed thematically. A grounded theory approach was taken with the theory of candidacy being used as a sensitising concept through which questions were framed and results interpreted. RESULTS:There is a complex system of competing pressures that influence a clinician in deciding whether, and in what way, to inform a very elderly patient that they have pre-diabetes. The majority of clinicians adjust their management of pre-diabetes to the age and perceived risk/benefit for the patient. Whilst some clinicians choose not to inform certain patients of their blood results, many clinicians maintain, what could be seen as a somewhat paradoxical approach of labeling all older patients with pre-diabetes but downplaying the significance to the patient. The policy, organisational context, workload and professional constraints under which clinicians work, play a significant role in shaping how they deal with pre-diabetic blood results in the very elderly. CONCLUSION:There has been recent acknowledgement of how policy and organisational context frames decision-making, but there is a lack of evidence on how this influences uncertainty and dilemmas in decision-making in practice. These findings add further weight for the argument that treatment burden should be included in clinical guidelines.
journal_name
BMC Fam Practjournal_title
BMC family practiceauthors
Burch P,Blakeman T,Bower P,Sanders Cdoi
10.1186/s12875-019-0981-0subject
Has Abstractpub_date
2019-06-29 00:00:00pages
90issue
1issn
1471-2296pii
10.1186/s12875-019-0981-0journal_volume
20pub_type
杂志文章abstract:BACKGROUND:Low patient satisfaction with the quality of out-of-hours primary care (OOH-PC) has been linked with several individual and organizational factors. However, findings have been ambiguous and may not apply to the Danish out-of-hours (OOH) setting in which general practitioners (GPs) perform the initial telepho...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-017-0681-6
更新日期:2018-01-11 00:00:00
abstract:BACKGROUND:Attention deficit hyperactivity disorder (ADHD) is underdiagnosed in the UK and the assessment and diagnosis pathway often involves a general practitioner (GP) referral to secondary care services. GPs' levels of knowledge and understanding about ADHD is often a significant barrier in patients accessing care....
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-020-01289-5
更新日期:2020-11-01 00:00:00
abstract:BACKGROUND:The utility of clinical exercise tests depends on their support of treatment decisions. We sought to assess the utility of exercise tests for the selection of primary-care patients for referral to cardiologic care, and to determine whether referral decisions were biased by gender or socioeconomic status. We ...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-014-0182-9
更新日期:2014-11-30 00:00:00
abstract:BACKGROUND:Switzerland is facing a shortage of primary care physicians (PCPs); government organizations therefore suggested a broad variety of interventions to promote primary care. The aim of the study was to prioritize these interventions according to the acceptance and perceived barriers of most relevant groups of p...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-015-0397-4
更新日期:2015-12-15 00:00:00
abstract:BACKGROUND:The increasing number of available point-of-care (POC) tests challenges clinicians regarding decisions on which tests to use, how to efficiently use them, and how to interpret the results. Although POC tests may offer benefits in terms of low turn-around-time, improved patient's satisfaction, and health outc...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-018-0893-4
更新日期:2019-01-10 00:00:00
abstract::Multimorbidity is a growing issue and poses a major challenge to health care systems around the world. Multimorbidity is related to ageing but many studies have now shown that it is also socially patterned, being more common and occurring at an earlier age in areas of high socioeconomic deprivation. There is lack of r...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-015-0344-4
更新日期:2015-10-14 00:00:00
abstract:BACKGROUND:The Patient Participation Program (PPP) was a patient satisfaction survey endorsed by the Royal Australian College of General Practitioners and designed to assist general practitioners in continuous quality improvement (CQI). The survey was been undertaken by 3500 practices and over a million patients betwee...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-10-13
更新日期:2009-02-08 00:00:00
abstract::The editors have retracted this article [1] because it contains extensive overlap with an article published by the same authors in the Journal of Family & Community Medicine [2] and is therefore redundant. ...
journal_title:BMC family practice
pub_type: 杂志文章,撤回出版物
doi:10.1186/s12875-019-1043-3
更新日期:2019-11-05 00:00:00
abstract:BACKGROUND:In many countries, the referral-consultation process faces a number of challenges from inefficiencies and rising demand, resulting in excessive wait times for many specialties. We collected referral data from a sample of family doctors across the province of Ontario, Canada as part of a larger program of res...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-017-0654-9
更新日期:2017-08-22 00:00:00
abstract:BACKGROUND:General practitioners (GPs) often lack time and resources to invest in health education; audiovisual messages broadcast in the waiting room may be a useful educational tool. This work was designed to assess the effect of a message inviting patients to ask for a tetanus booster vaccination. METHODS:A quasi e...
journal_title:BMC family practice
pub_type: 杂志文章,随机对照试验
doi:10.1186/1471-2296-12-104
更新日期:2011-09-28 00:00:00
abstract:BACKGROUND:A territory-wide diabetes management program (Risk Assessment Management Program - RAMP) was recently established, providing comprehensive management for all diabetics, helping to delineate current level of control and complications prevalence among primary care diabetic patients in Hong Kong. METHOD:This c...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-15-8
更新日期:2014-01-10 00:00:00
abstract:BACKGROUND:Cooperatives delivering out of hours care in the Netherlands are hesitant about the use of expert systems during triage. Apart from the extra costs, cooperatives are not sure that quality of triage is sufficiently enhanced by these systems and believe that call duration will be prolonged drastically. No figu...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-9-11
更新日期:2008-02-13 00:00:00
abstract:BACKGROUND:Consultations for minor ailments constitute a large part of the workload of general practitioners (GPs). As medical interventions are not always available, specific communication strategies, such as active listening and positive communication, might help GPs to handle these problems adequately. This study ex...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-9-38
更新日期:2008-06-30 00:00:00
abstract:BACKGROUND:Though screening and intervention for alcohol and tobacco misuse are effective, primary care screening and intervention rates remain low. Previous studies have increased intervention rates using vital signs screening for tobacco misuse and clinician prompts for screen-positive patients for both alcohol and t...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-11-18
更新日期:2010-03-05 00:00:00
abstract:BACKGROUND:The role of primary care professionals in lifestyle counseling for smoking, alcohol consumption, physical activity, and diet is receiving attention at the national level in many countries. The U. S. and Sweden are two countries currently establishing priorities in these areas. A previously existing internati...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-15-83
更新日期:2014-05-03 00:00:00
abstract:BACKGROUND:Accreditation is a widespread tool for quality management in health care. However, there is lack of research on the impact of accreditation, particularly in general practice. This study explores how general practitioners and their staff experienced the impact of a mandatory accreditation program in Denmark. ...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-019-1034-4
更新日期:2019-10-28 00:00:00
abstract:BACKGROUND:Patients with psychosocial problems may benefit from a variety of community, educational, recreational and voluntary sector resources, but GPs often under-refer to these through lack of knowledge and time. This study evaluated the acceptability and effectiveness of graduate primary care mental health workers...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-9-27
更新日期:2008-05-07 00:00:00
abstract:BACKGROUND:Depression is prevalent in people with type 2 diabetes and affects both glycemic control and overall quality of life. The aim of this trial was to evaluate the effect of the antidepressant paroxetine on metabolic control, quality of life and mental well-being in mildly depressed women with type 2 diabetes. ...
journal_title:BMC family practice
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1186/1471-2296-4-7
更新日期:2003-05-14 00:00:00
abstract:BACKGROUND:The numbers of learners seeking placements in general practice is rapidly increasing as an ageing workforce impacts on General Practitioner availability. The traditional master apprentice model that involves one-to-one teaching is therefore leading to supervision capacity constraints. Vertically integrated (...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-14-144
更新日期:2013-10-01 00:00:00
abstract:BACKGROUND:To investigate the current practice of Orthopaedic Surgeons & General Practitioners (GP) when presented with patients who have a fracture, with possible underlying Osteoporosis. METHODS:Questionnaires were sent to 140 GPs and 140 Orthopaedic Surgeons. The participants were asked their routine clinical pract...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-7-7
更新日期:2006-02-07 00:00:00
abstract:BACKGROUND:Physical activity (PA) counselling is an effective approach to promote PA in primary health care (PHC). Barriers to PA counselling in PHC include time constraints, lack of knowledge and skills of providers, and systemic barriers. Using electronic health (eHealth) has the potential to promote PA. This scoping...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-020-01304-9
更新日期:2020-11-06 00:00:00
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journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-6-37
更新日期:2005-09-09 00:00:00
abstract:BACKGROUND:Metabolic syndrome (MetS) is a major public health challenge. General practitioners (GPs) could play a key role in its recognition. However, it often remains undiagnosed in primary care. This study assesses how well GPs and patients recognise MetS among patients with coronary heart disease or at least one of...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-10-76
更新日期:2009-11-30 00:00:00
abstract:BACKGROUND:In many countries, general practitioner (GP) care of acute low back pain often does not adhere to evidence-based clinical guidelines. There has been little exploration of this deviation from evidence-based care from the patients' perspective, particularly in relation to patients' care expectations. The aim o...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-14-7
更新日期:2013-01-08 00:00:00
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journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-018-0850-2
更新日期:2018-09-27 00:00:00
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journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-5-21
更新日期:2004-10-06 00:00:00
abstract:BACKGROUND:Interpersonal Psychotherapy (IPT) is recommended in most depression treatment guidelines and proved to be a suitable treatment for elderly depressed patients. Despite the favorable results of IPT in research populations, the dissemination to general practice is surprisingly limited. Little is known about upt...
journal_title:BMC family practice
pub_type: 杂志文章,随机对照试验
doi:10.1186/1471-2296-8-52
更新日期:2007-09-13 00:00:00
abstract:BACKGROUND:The prevalence of coexisting chronic conditions (multimorbidity) is rising. Disease labels, however, give little information about impact on subjective health and personal illness experience. We aim to examine the strength of association of single and multimorbid physical chronic diseases with self-rated hea...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-014-0185-6
更新日期:2014-11-25 00:00:00
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journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-019-1027-3
更新日期:2019-10-23 00:00:00
abstract:BACKGROUND:There is extensive evidence of health inequality across ethnic groups. Inequity is a complex social phenomenon involving several underlying factors, including ethnic discrimination. In the field of health care, it has been established that ethnic discrimination stems partially from bias or prejudice on the p...
journal_title:BMC family practice
pub_type: 杂志文章,随机对照试验
doi:10.1186/1471-2296-15-89
更新日期:2014-05-09 00:00:00