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Preview: Family Practice - Advance Access

Family Practice Advance Access





Published: Mon, 18 Sep 2017 00:00:00 GMT

Last Build Date: Mon, 18 Sep 2017 12:44:30 GMT

 



Corrigendum

2017-09-18

Neuropsychiatric symptoms and psychotropic drug use in patients with dementia in general practices



Multidisciplinary collaboration in primary care: a systematic review

2017-09-16

Abstract
Background
Several studies have discussed the benefits of multidisciplinary collaboration in primary care. However, what remains unclear is how collaboration is undertaken in a multidisciplinary manner in concrete terms.
Objective
To identify how multidisciplinary teams in primary care collaborate, in regards to the professionals involved in the teams and the collaborative activities that take place, and determine whether these characteristics and practices are present across disciplines and whether collaboration affects clinical outcomes.
Methods
A systematic literature review of past research, using the MEDLINE, ScienceDirect and Web of Science databases.
Results
Four types of team composition were identified: specialized teams, highly multidisciplinary teams, doctor–nurse–pharmacist triad and physician–nurse centred teams. Four types of collaboration within teams were identified: co-located collaboration, non-hierarchical collaboration, collaboration through shared consultations and collaboration via referral and counter-referral. Two combinations were commonly repeated: non-hierarchical collaboration in highly multidisciplinary teams and co-located collaboration in specialist teams. Fifty-two per cent of articles reported positive results when comparing collaboration against the non-collaborative alternative, whereas 16% showed no difference and 32% did not present a comparison.
Conclusion
Overall, collaboration was found to be positive or neutral in every study that compared collaboration with a non-collaborative alternative. A collaboration typology based on objective measures was devised, in contrast to typologies that involve interviews, perception-based questionnaires and other subjective instruments.



Medication-taking experiences in attention deficit hyperactivity disorder: a systematic review

2017-09-16

Abstract
Background
Although attention deficit hyperactivity disorder (ADHD) is a common condition for which pharmacotherapy is considered an effective treatment, guidelines on the treatment of ADHD have been challenging to implement. Considering the views of patients and caregivers involved in medication-taking could help shed light on these challenges.
Objective
This review combines the findings of individual studies of medication-taking experiences in ADHD in order to guide clinicians to effectively share decisions about treatment.
Methods
Five databases (MEDLINE, Embase, PsycINFO, SCOPUS and CINAHL) were systematically searched for relevant published research articles. Articles were assessed for quality using a Critical Appraisal Skills Programme checklist, and synthesis was performed using meta-ethnography.
Results
Thirty-one articles were included in the final synthesis, comprising studies of caregivers, paediatric patients and adult patients across seven countries. Findings were categorized into five different constructs, including coming to terms with ADHD, anticipated concerns about medication, experiences of the effects of medication, external influences and the development of self-management. The synthesis demonstrates that decisions surrounding medication-taking for ADHD evolve as the child patient enters adulthood and moves towards autonomy and self-management. In all parts of this journey, decisions are shaped by a series of ‘trade-offs’, where potential benefits and harms of medication are weighed up.
Conclusions
This review offers a comprehensive insight into medication-taking experiences in ADHD. By considering the shifting locus of decision-making over time and the need for individuals and families to reconcile a variety of external influences, primary care and mental health clinicians can engage in holistic conversations with their patients to share decisions effectively.



Beyond accuracy: hidden motives in diagnostic testing

2017-09-16

Abstract
Background
Diagnostic decision-making is usually disease-focussed and intended to examine the patient’s medical condition accurately. But diagnostic interventions may serve further purposes that are not yet fully understood.
Objective
To explore GPs’ diagnostic behaviour not related to confirming or refuting a specific disease.
Methods
. We recorded 295 primary care consultations in 12 practices. One hundred thirty-four consultations comprised at least one diagnostic episode. GPs were asked to reflect on their own diagnostic thinking in interviews for every single case. Qualitative and quantitative analyses were applied with focus on the GPs’ cognitive processes during diagnostic decision-making.
Results
Primary care physicians clearly stated that they requested some tests for other reasons than diagnosing disease. A feeling of uncertainty stimulated diagnostic procedures aiming to regulate the anticipation of regret. We identified patients’ reassurance, patients’ requests and strategic issues as further motives for diagnostic actions.
Conclusion
Besides focussing on disease in the diagnostic process, emotional and strategic goals are hidden motives that play a critical role in clinical decision-making. They might even represent an initial factor in a cascade of interventions leading to overdiagnosis. How GPs might control these influences provides an important aspect for further research, practice and teaching.



Quality indicators for care of osteoarthritis in primary care settings: a systematic literature review

2017-09-16

Abstract
Background
Despite the high prevalence of osteoarthritis and the prominence of primary care in managing this condition, there is no systematic summary of quality indicators applicable for osteoarthritis care in primary care settings.
Objectives
This systematic review aimed to identify evidence-based quality indicators for monitoring, evaluating and improving the quality of care for adults with osteoarthritis in primary care settings.
Methods
Ovid MEDLINE and Ovid EMBASE databases and grey literature, including relevant organizational websites, were searched from 2000 to 2015. Two reviewers independently selected studies if (i) the study methodology combined a systematic literature search with assessment of quality indicators by an expert panel and (ii) quality indicators were applicable to assessment of care for adults with osteoarthritis in primary care settings. Included studies were appraised using the Appraisal of Indicators through Research and Evaluation (AIRE) instrument. A narrative synthesis was used to combine the indicators within themes. Applicable quality indicators were categorized according to Donabedian’s ‘structure-process-outcome’ framework.
Results
The search revealed 4526 studies, of which 32 studies were reviewed in detail and 4 studies met the inclusion criteria. According to the AIRE domains, all studies were clear on purpose and stakeholder involvement, while formal endorsement and use of indicators in practice were scarcely described. A total of 20 quality indicators were identified from the included studies, many of which overlapped conceptually or in content.
Conclusions
The process of developing quality indicators was methodologically suboptimal in most cases. There is a need to develop specific process, structure and outcome measures for adults with osteoarthritis using appropriate methodology.



Patients’ attitudes toward copayments as a steering tool—results from a qualitative study in Norway and Germany

2017-09-16

Abstract
Background
Copayments are implemented in many health care systems. The effect of copayments differs between countries. Up to now, patients’ attitudes regarding copayments are mainly unknown.
Objectives
Thus, the goal of our analysis was to explore adult patients’ attitudes in Germany and Norway towards copayments as a steering tool.
Methods
We conducted a qualitative comparative study. Episodic interviews were conducted with 40 patients in Germany and Norway. The interviews were analysed by thematic coding in the framework of grounded theory. All text segments related to copayments were analysed in depth for emerging topics and types.
Results
We found three dimensions of patients’ attitudes towards copayments: the perceived steering effect, the comprehensibility, and the assessment of copayments. The perceived steering effect consists of three types: having been influenced by copayments, not having experienced any influence and the experience of other persons to be influenced. The category comprehensibility describes that not all patients understand rules and regulations of copayments and its caps. The assessment of copayments consists of nine subcategories, three of which are rather negative and six of which are rather positive. In all three dimensions the patterns between the German and Norwegian sub-samples differ considerably.
Conclusions
The results of our study point at the importance of communicating clear rules for copayments which are easily comprehensible.