Abstract:
BACKGROUND:We have shown previously that current recommendations in UK guidelines for monitoring long-term conditions are largely based on expert opinion. Due to a lack of robust evidence on optimal monitoring strategies and testing intervals, the guidelines are unclear and incomplete. This uncertainty may underly variation in testing that has been observed across the UK between GP practices and regions. METHODS:Our objective was to audit current testing practices of GPs in the UK; in particular, perspectives on laboratory tests for monitoring long-term conditions, the workload, and how confident GPs are in ordering and interpreting these tests. We designed an online survey consisting of multiple-choice and open-ended questions that was promoted on social media and in newsletters targeting GPs practicing in UK. The survey was live between October-November 2019. The results were analysed using a mixed-methods approach. RESULTS:The survey was completed by 550 GPs, of whom 69% had more than 10 years of experience. The majority spent more than 30 min per day on testing (78%), but only half of the respondents felt confident in dealing with abnormal results (53%). There was a high level of disagreement for whether liver function tests and full blood counts should be done 'routinely', 'sometimes', or 'never' in patients with a certain long-term condition. The free text comments revealed three common themes: (1) pressures that promote over-testing, i.e. guidelines or protocols, workload from secondary care, fear of missing something, patient expectations; (2) negative consequences of over-testing, i.e. increased workload and patient harm; and (3) uncertainties due to lack of evidence and unclear guidelines. CONCLUSION:These results confirm the variation that has been observed in test ordering data. The results also show that most GPs spent a significant part of their day ordering and interpreting monitoring tests. The lack of confidence in knowing how to act on abnormal test results underlines the urgent need for robust evidence on optimal testing and the development of clear and unambiguous testing recommendations. Uncertainties surrounding optimal testing has resulted in an over-use of tests, which leads to a waste of resources, increased GP workload and potential patient harm.
journal_name
BMC Fam Practjournal_title
BMC family practiceauthors
Elwenspoek MMC,Mann E,Alsop K,Clark H,Patel R,Watson JC,Whiting Pdoi
10.1186/s12875-020-01331-6subject
Has Abstractpub_date
2020-12-05 00:00:00pages
257issue
1issn
1471-2296pii
10.1186/s12875-020-01331-6journal_volume
21pub_type
杂志文章abstract:BACKGROUND:Medication review is often recommended to optimize medication use. In clinical practice it is mostly operationalized as an intervention without co-interventions during a short term intervention period. However, most systematic reviews also included co-interventions and prolonged medication optimization inter...
journal_title:BMC family practice
pub_type: 杂志文章,meta分析,评审
doi:10.1186/s12875-016-0577-x
更新日期:2017-01-17 00:00:00
abstract:BACKGROUND:The current reality of primary care (PC) makes it essential to have telemedicine systems available to facilitate communication between care levels. Communities of practice have great potential in terms of care and education, and that is why the Online Communication Tool between Primary and Hospital Care was ...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-018-0739-0
更新日期:2018-05-09 00:00:00
abstract:BACKGROUND:People who are diagnosed with both mental and chronic medical illness present unique challenges for the health care system. In resource-limited settings, such as rural India, people with depression and anxiety are often under-served, due to both stigma and lack of trained providers and resources. These chall...
journal_title:BMC family practice
pub_type: 杂志文章,随机对照试验
doi:10.1186/s12875-018-0845-z
更新日期:2018-09-11 00:00:00
abstract:BACKGROUND:The successful implementation of cardiovascular disease (CVD) prevention guidelines relies heavily on primary care physicians (PCPs) providing risk factor evaluation, intervention and patient education. The aim of this study was to ascertain the degree of awareness and implementation of the Spanish adaptatio...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-14-36
更新日期:2013-03-18 00:00:00
abstract:BACKGROUND:There is some evidence to support a risk-stratified, multi-disciplinary approach to manage patients with hypertension in primary care. The aim of this study is to evaluate the quality of care (QOC) of a multi-disciplinary Risk Assessment and Management Programme for Hypertension (RAMP-HT) for hypertensive pa...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-015-0291-0
更新日期:2015-06-19 00:00:00
abstract:BACKGROUND:Prevalence of insomnia symptoms in the general population is high. Insomnia is linked with high health care use and within primary care there are a number of treatment options available. The objective of this study was to determine the association of persistence and remission of insomnia with primary health ...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-13-8
更新日期:2012-02-16 00:00:00
abstract:BACKGROUND:The relationship between effective organisation of general practices and health improvement is widely accepted. The Maturity Matrix is an instrument designed to assess organisational development in general practice settings and to stimulate quality improvement. It is undertaken by a practice team with the ai...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-7-38
更新日期:2006-06-19 00:00:00
abstract:BACKGROUND:The aim here was to explore trends in patient satisfaction with primary health care and its accessibility and continuity, and to explore whether through reforms and improvements some of the essential goals had been achieved over a 14-year period of time in Finland. METHODS:Nine questionnaire surveys were co...
journal_title:BMC family practice
pub_type: 杂志文章,多中心研究
doi:10.1186/1471-2296-15-98
更新日期:2014-05-15 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:'Ad hoc' help-seeking by trainees from their supervisors during trainee consultations is important for patient safety, and trainee professional development. We explored trainee objectives and activities in seeking supervisor assistance, and trainee perceptions of the outcomes of this help-seeking (including ...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-020-1084-7
更新日期:2020-02-07 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 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:Guidelines for primary prevention of cardiovascular disease provide little guidance on how patients' preferences should be taken into account. We wanted to explore whether general practitioners (GPs) are sensitive to patient preferences regarding survival gains from statin therapy. METHODS:In a cross sectio...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-015-0288-8
更新日期:2015-07-03 00:00:00
abstract:BACKGROUND:Multimorbidity is a major issue for primary care. We aimed to explore primary care professionals' accounts of managing multimorbidity and its impact on clinical decision making and regional health care delivery. METHODS:Qualitative interviews with 12 General Practitioners and 4 Primary Care Nurses in New Ze...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-017-0622-4
更新日期:2017-04-05 00:00:00
abstract:BACKGROUND:The majority of patient contacts occur in general practice but general practice patient safety has been poorly described and under-researched to date compared to hospital settings. Our objective was to produce a set of patient safety tools and indicators that can be used in general practices in any healthcar...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-15-110
更新日期:2014-06-05 00:00:00
abstract:BACKGROUND:Prognosis has been described as an important but neglected branch of clinical science. While patients' views have been sought in the context of life-threatening illness, similar research is lacking for patients presenting with common, non-life-threatening musculoskeletal complaints. The aim of this study was...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-10-50
更新日期:2009-07-07 00:00:00
abstract:BACKGROUND:The benefits of smoking cessation among older people are well documented. Despite this, evidence suggests that older smokers are rarely engaged in smoking cessation efforts, and that existing tobacco dependence treatments require further tailoring to the specific needs of older smokers. This study assesses t...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-015-0317-7
更新日期:2015-08-06 00:00:00
abstract:BACKGROUND:Registered Sick Children's Nurses and District Nurses employed at Child Health Care centres are in a position to help prevent childhood overweight and obesity. Prevention of this challenging public health threat could be improved through having a better understanding of how this group of nurses perceives chi...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-13-57
更新日期:2012-06-14 00:00:00
abstract:BACKGROUND:The aim of this study is in a general practice trial setting to identify predictive factors for weight loss after 1 year among young adults who are over-weight or obese and who have several psychosocial problems. METHODS:Twenty-eight general practitioners recruited 495 patients aged 20-45 years with psychos...
journal_title:BMC family practice
pub_type: 杂志文章,随机对照试验
doi:10.1186/s12875-016-0437-8
更新日期:2016-04-11 00:00:00
abstract:BACKGROUND:Late diagnosis is considered to be a major factor contributing to poorer cancer survival rates in the UK. Interventions have focussed on the promotion of earlier diagnosis in patients with potential cancer symptoms. However, to assess the effectiveness of these interventions, the time from symptom onset to p...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-014-0167-8
更新日期:2014-10-25 00:00:00
abstract:BACKGROUND:Evidence-based medicine (EBM) is gradually being recognized worldwide as an important clinical skill and plays an important role in health care. Although the concept has successfully spread in the health care field, EBM still has not been widely incorporated into clinical decisions in primary care due to pot...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-019-1062-0
更新日期:2019-12-06 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
abstract:BACKGROUND:People with long term conditions (LTCs) make most of the daily decisions and carry out the activities which affect their health and quality of life. Only a fraction of each contact with a health care professional (HCP) is spent supporting this. This paper describes how care and support planning (CSP) and an ...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-019-1042-4
更新日期:2019-11-08 00:00:00
abstract:BACKGROUND:The work of general practitioners (GPs) is increasingly being looked at from the perspective of the strategies and factors shaping it. This reflects the importance given to primary care services in health care system reform. However, the literature provides little insight into the medical decision-making pro...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-9-12
更新日期:2008-02-19 00:00:00
abstract:BACKGROUND:Māori men in New Zealand have higher mortality from prostate cancer, despite having lower incidence rates. The objective of this study was to examine patterns of screening for prostate cancer in primary care and follow-up investigations after an elevated prostate-specific antigen (PSA) result in Māori and no...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-15-145
更新日期:2014-08-26 00:00:00
abstract:BACKGROUND:International disease management guidelines recommend the regular assessment of depression and anxiety in heart failure patients. Currently there is little data on the effect of screening for depression and anxiety on the quality of life and the prognosis of heart failure (HF). We will investigate the associ...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-14-180
更新日期:2013-11-27 00:00:00
abstract:BACKGROUND:Primary health care systems are designed to provide comprehensive patient care. However, the ICD 9 coding system used for billing purposes in Canada neither characterizes nor captures the scope of clinical practice or complexity of physician-patient interactions. This study aims to describe the content of pr...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-13-7
更新日期:2012-02-15 00:00:00
abstract:BACKGROUND:The purpose of this study is to better understand differences in diabetes self-management, specifically needs, barriers and challenges among men and women living with type 2 diabetes mellitus (T2DM). METHODS:35 participants were recruited from a diabetes education center (DEC) in Toronto, Canada. Five focus...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-13-122
更新日期:2012-12-19 00:00:00
abstract:BACKGROUND:It is argued that the ways in which women express emotional distress mean that they are more likely to be diagnosed with depression, while men's relative lack of articulacy means their depression is hidden. This may have consequences for communicating with health professionals. The purpose of this analysis w...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-8-43
更新日期:2007-07-24 00:00:00
abstract:BACKGROUND:The general practitioner (GP) can play an important role in promoting a healthy lifestyle, which is especially relevant in people with an elevated risk of cardiovascular diseases due to hypertension. Therefore, the aim of this study was to determine the frequency and content of lifestyle counseling about wei...
journal_title:BMC family practice
pub_type: 杂志文章,多中心研究
doi:10.1186/1471-2296-9-58
更新日期:2008-10-14 00:00:00