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Preview: Family Practice - current issue

Family Practice Current Issue





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

Last Build Date: Tue, 16 Jan 2018 04:44:32 GMT

 



Depression screening and management in primary care

Mon, 18 Dec 2017 00:00:00 GMT

A mental health catch phrase in the 1980s was that depression went undetected in more than half of primary care patients and, even when recognized, it was inadequately treated at least half of the time. This admonishment often came from mental health professionals who did not fully understand the presentation of depression in primary care nor the context and complexity of general practice. This is particularly salient given the fact that three-fourths of patients are treated for depression exclusively in primary care (1).



Corrigendum

Mon, 18 Sep 2017 00:00:00 GMT

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



Quick screening tool for patients with severe negative emotional reactions to chronic illness: psychometric study of the negative emotions due to chronic illness screening test (NECIS)

Thu, 31 Aug 2017 00:00:00 GMT

Abstract
Background
Severe negative emotional reactions to chronic illness are maladaptive to patients and they need to be addressed in a primary care setting.
Objective
The psychometric properties of a quick screening tool—the Negative Emotions due to Chronic Illness Screening Test (NECIS)—for general emotional problems among patients with chronic illness being treated in a primary care setting was investigated.
Method
Three studies including 375 of patients with chronic illness were used to assess and analyze internal consistency, test–retest reliability, criterion-related validity, a cut-off point for distinguishing maladaptive emotions and clinical application validity of NECIS. Self-report questionnaires were used.
Results
Internal consistency (Cronbach’s α) ranged from 0.78 to 0.82, and the test–retest reliability was 0.71 (P < 0.001). Criterion-related validity was 0.51 (P < 0.001). Based on the ‘severe maladaptation’ and ‘moderate maladaptation’ groups defined by using the ‘Worsening due to Chronic Illness’ index as the analysis reference, the receiver-operating characteristic curve analysis revealed an area under the curve of 0.81 and 0.82 (ps < 0.001), and a cut-off point of 19/20 was the most satisfactory for distinguishing those with overly negative emotions, with a sensitivity and specificity of 83.3 and 69.0%, and 68.5 and 83.0%, respectively. The clinical application validity analysis revealed that low NECIS group showed significantly better adaptation to chronic illness on the scales of subjective health, general satisfaction with life, self-efficacy of self-care for disease, illness perception and stressors in everyday life.
Conclusion
The NECIS has satisfactory psychometric properties for use in the primary care setting.



Patient characteristics do not predict the individual response to antihypertensive medication: a cross-over trial

Thu, 31 Aug 2017 00:00:00 GMT

Abstract
Background
International guidelines on hypertension management do not agree on whether patient characteristics can be used for the first choice of treatment of uncomplicated essential hypertension.
Objective
We wanted to identify predictive patient characteristics to the response of two different classes of antihypertensive drugs in patients with newly diagnosed hypertension in primary care.
Methods
We conducted a prospective, open label, blinded endpoint cross-over trial in 120 patients with a new diagnosis of hypertension from 10 family practices. Patients received 4 weeks of 12.5 mgr hydrochlorothiazide once daily and 4 weeks of 80 mgr valsartan once daily, each followed by a 4-week washout. The sequence of drugs was randomized. Age, sex and menopausal state were recorded at run in and 24 h ambulatory blood pressure, office blood pressure, plasma renin concentration, NT-proBNP, potassium, estimated glomerular filtration rate, urinary albumin, body mass index and waist circumference at each regimen change. The difference in systolic blood pressure response between both study drugs, calculated from mean daytime ambulatory blood pressures, was the main outcome measure.
Results
Ninety-eight patients (52% female; median age 53 years) were eligible for per-protocol-analysis. None of the studied variables were predictive for the difference in systolic blood pressure response. Individual systolic blood pressure responses ranged from an increase by 18 mmHg to a decrease of 39 mmHg.
Conclusion
In a relevant group of primary care patients with newly diagnosed hypertension, we were unable to detect predictors of treatment response. This study rather supports the United States and European guidelines than the United Kingdom and Dutch guidelines on hypertension.



General practitioners’ perspective on poverty: a qualitative study in Montreal, Canada

Thu, 24 Aug 2017 00:00:00 GMT

Abstract
Background
Social inequalities in healthcare systems persist worldwide. Physicians’ prejudices and negative attitudes towards people living in poverty are one of the determinants of healthcare inequalities. We know very little about general practitioners’ (GPs) perceptions of poverty, which shape their attitudes.
Objective
To identify the perceptions of poverty of GPs who deal with it in everyday practice.
Methods
A qualitative study based on interviews with GPs working in deprived urban neighbourhoods. In-depth semi-structured interviews were conducted with physicians working in disadvantaged neighbourhoods in Montreal, Canada. Interviews were audio-recorded and transcribed verbatim. Analysis consisted of interview debriefing, transcript coding, and thematic analysis using an inductive and iterative approach.
Results
Our study revealed two contrasting perceptions of poverty. The global conception of poverty referred to social determinants and was shared by the majority of physicians interviewed, while the moral conception, centring on individual responsibility, was shared by a minority of participants.
Conclusion
The moral judgments and misunderstandings evidenced by GPs regarding poverty suggest avenues for improving general medical training. Understanding social determinants of health should be an important component of this training, to improve access to care for people living in poverty.



Just a click away: exploring patients’ perspectives on receiving care through the Champlain BASETM eConsult service

Tue, 08 Aug 2017 00:00:00 GMT

Abstract
Background
Excessive wait times for specialist care can have a substantial negative impact on health outcomes. The Champlain BASETM (Building Access to Specialists through eConsultation) eConsult service based in Ottawa, Canada has demonstrated the ability to improve patients’ access to specialist care.
Objective
We interviewed patients who were treated using eConsult in order to explore their attitudes towards the service and their experiences of receiving care via the service.
Methods
We conducted a thematic analysis of patient interviews using a constant comparative approach. Patients whose primary care providers used the eConsult service in their care were contacted by telephone between June 2015 and January 2016 and completed 15-min semi-structured interviews.
Results
Of 43 contacted participants, 30 completed interviews (70%). Over half of all respondents (n = 16) reported receiving a follow-up call or appointment within 1 week, and 26 stated that eConsult was useful in their case. Participants unanimously agreed that eConsult was an acceptable way to access specialist care, and 29 stated that they would ask their primary care provider to use eConsult on their behalf in the future. Three themes emerged from the thematic analysis of patient comments: access, acceptability of eConsult and strengthened role of the primary care provider.
Conclusions
Patients expressed acceptance for eConsult as a model for improving access to specialist care, had largely positive experiences with it as a model of care delivery, and supported its use in their future care.



Physician and practice characteristics associated with immunoglobulin test ordering

Sat, 05 Aug 2017 00:00:00 GMT

Abstract
Background
Primary care test requests for serum immunoglobulins are rising rapidly, with concerns that many requests may be unnecessary. Evidence suggests some characteristics of general practitioners (GPs) and practices are associated with higher test ordering.
Objective
To identify the physician and practice characteristics associated with immunoglobulin test ordering.
Methods
Retrospective, cross-sectional study using routine laboratory data on primary care serum immunoglobulin requests. Data were linked with GP patient list size data. The primary outcome measure was the count of test requests per GP. Predictor variables were physician gender, years experience, practice region and type (number of GPs), GP patient list size and composition. Mixed-effects multilevel regression models were used to calculate incidence rate ratios (IRRs) with 95% confidence intervals (CIs) for the associations between physician and practice characteristics and GP requesting. Sensitivity analysis was performed by limiting the model to the more than 70 years age category.
Results
In total, 5990 immunoglobulin tests were ordered by 481 GPs in the South of Ireland during 2013. The number of tests ordered by individual GPs varied from one to 377. In the final fully adjusted Poisson regression analysis, female gender (IRR: 1.81; 95% CI: 1.45–2.26) and less experience (IRR: 2.27; 95% CI: 1.47–3.51) were associated with higher requesting (P < 0.001). None of the practice factors were associated with test ordering. Sensitivity analysis on the 70 years or more age category found similar results.
Conclusion
Further research is required to explore the potential reasons for higher requesting among GPs with fewer years of experience and also among female GPs.



Exploring the impact and use of patients’ feedback about their care experiences in general practice settings—a realist synthesis

Thu, 03 Aug 2017 00:00:00 GMT

Abstract
Background
Policy encourages health care providers to listen and respond to feedback from patients, expecting that it will enhance care experiences. Enhancement of patients’ experiences may not yet be a reality, particularly in primary health care settings.
Objective
To identify the issues that influence the use and impact of feedback in this context.
Design and Setting
A realist synthesis of studies of the use of patient feedback within primary health care settings.
Methods
Structured review of published studies between 1971 and January 2015.
Results
Eighteen studies were reported in 20 papers. Eleven studies reported patient survey scores as a primary outcome. There is little evidence that formal patient feedback led to enhanced experiences. The likelihood of patient feedback to health care staff stimulating improvements in future patients’ experiences appears to be influenced predominantly by staff perceptions of the purpose of such feedback; the validity and type of data that is collected; and where, when and how it is presented to primary health care teams or practitioners and teams’ capacity to change.
Conclusions
There is limited research into how patient feedback has been used in primary health care practices or its usefulness as a stimulant to improve health care experience. Using a realist synthesis approach, we have identified a number of contextual and intervention-related factors that appear to influence the likelihood that practitioners will listen to, act on and achieve improvements in patient experience. Consideration of these may support research and improvement work in this area.



Treatment of nocturnal leg cramps by primary care patients over the age of 60

Mon, 24 Jul 2017 00:00:00 GMT

Abstract
Background
Approximately one out of two individuals over the age of 60 suffers from nocturnal leg cramps. These often have an important impact on the person’s quality of life. Different drug and non-drug treatments are proposed to treat these cramps, but none to date have been shown to be both safe and effective. The objective of this study was to describe the drug and non-drug treatments used by primary care patients suffering from cramps.
Methods
We used data collected as part of two cross-sectional surveys of patients aged 60 years and older attending general practices in the French region of Alsace. We asked the participants suffering from cramps if they were currently using a treatment for their cramps. We distinguished potentially harmful from unharmful treatments.
Results
Overall, 632 patients suffering from cramps were included in our study. Only 133 patients (19.5%) were taking a treatment for cramps. 82 patients used one or several of 17 different drug treatments. 58 patients used one or several of 13 different types of non-drug treatments. Potentially harmful treatments, mostly Quinine made up 16,7% (n = 25) of all treatments used for cramps.
Conclusions
This study sheds light on the great diversity of therapeutic practices for cramps in outpatient care. Many of the treatments reported by patients have not previously been described in the medical literature. We recommend GPs to ask their patients about the treatments they take for cramps in order to make sure that they are safe.



Evaluating an Indigenous health curriculum for diabetes prevention: engaging the community through talking circles and knowledge translation of results

Mon, 24 Jul 2017 00:00:00 GMT

Abstract
Background
Kahnawà:ke is a Kanien’kehá:ka (Mohawk) community in Quebec, Canada. In 1997, the community-controlled Kateri Memorial Hospital Centre in partnership with the Kahnawake Education Center, and the Kahnawake Schools Diabetes Prevention Project (KSDPP) developed an elementary school diabetes prevention health education program, aimed to increase knowledge of Type 2 diabetes, healthy eating and active lifestyles. Long-term goals for KSDPP community and school interventions are to decrease obesity and diabetes.
Objectives
To evaluate the Kateri Memorial Hospital Centre Health Education Program for Diabetes Prevention (HEP) and use key principles of knowledge translation to promote understanding of results to upgrade HEP content and improve delivery.
Methods
A KSDPP community-based participatory research team used mixed methods for evaluation, combining a cross-sectional survey for 23 teachers with interviews of two elementary school principals and three culturally appropriate Indigenous talking circles with HEP authors, teachers and parents. Questionnaire results were presented as descriptive statistics. The thematic textual analysis identified emerging themes from talking circles and interviews.
Results
Facilitators of HEP delivery were an acknowledgement of its importance; appreciation of prepared lesson plans for teachers; and KSDPP’s strong community presence. Barriers included reduced administrative support and instructional time due to competing academic demands; the need for increased Kanien’kehá:ka cultural content; and outdated resource materials. Recommendations included increasing teacher training, Kanien’kehá:ka cultural content and administrative support.
Conclusion
Community researchers undertook detailed knowledge translation activities of facilitators, barriers and recommendations with hospital and education centre administrators and Kahnawà:ke community to maximize uptake of findings before external dissemination of results.



Maintained effect of a training program on attitudes towards depression in family physicians

Sun, 23 Jul 2017 00:00:00 GMT

Abstract
Background
Family doctors’ (FD) attitudes likely play an important role in the recognition and management of depression.
Objective
The purpose of the study was to prospectively analyse the short-term and long-term impact of a specifically designed training program on attitudes towards depression among FDs.
Methods
A prospective, educational intervention, single group pre- and post-test study with three assessments (pre, post, and 6-month follow-up) was conducted. Participants included 1322 certified FDs who had enrolled voluntarily in a structured postgraduate training in depression. This course was mainly practical and guided by case reports and real clinical experiences. The course was based on Patient’s Unmet Needs and Doctors Educational Needs (PUNS & DENS) methodology. Primary outcome was assessed through the Depression Attitudes Questionnaire (DAQ). In total, 970 subjects completed the pre–post assessments, and 787 also completed the 6-month follow-up.
Results
After training, FDs positively changed their attitudes towards the management of depression. A significant change was observed in 18 of 20 items of the DAQ. The distinction between unhappiness and depression was initially found to be difficult in 41% of FDs. After the course, the percentage was reduced to 27%. Agreement with the statement that ‘psychotherapy is an exclusive practice of specialists’ strikingly changed from 57% to 23%. Minimal differences were noted between the post-training assessment and the 6-month follow-up.
Conclusions
Attitudes towards depression in FDs can be modified by a structured training program, and this change is maintained over the long term. A short training in psychotherapy (cognitive-behavioural, problem-solving based and psycho-educative oriented) significantly increases the confidence of FDs in treating depression.



Qualitative research on infertile Chinese couples’ understanding of sexuality

Sun, 23 Jul 2017 00:00:00 GMT

Abstract
Background
Family physicians play an important role in the initial counselling and evaluation of infertility. Despite infertility regarded as a stressor and a life crisis for individuals or couples, little is known about the psychosexual aspects of infertility. On the basis that sexuality is a crucial part of quality of life, it is worthwhile to give more attention to sexuality of infertile couples during their time of experiencing infertility.
Objective
This study aimed to gain insight into the dynamic features of the sexuality of infertile couples and to provide meaningful evidence for improving their quality of life.
Methods
We employed a qualitative approach to conduct this study. Utilizing purposive sampling method, 56 participants (28 infertile Chinese couples) were recruited from the reproductive medicine centre of a general hospital, and in-depth interviews were conducted with each participant. Thematic content analysis was used to analyse the transcripts.
Results
Four themes emerged from the respondents’ narratives; these themes relate to the infertile couples’ understanding of sexuality: (i) gender identity, (ii) communication about sex, (iii) sexual life and (iv) sexual satisfaction. It was further found that Chinese culture’s values of fertility, perceptions about sexuality and sex, social norms regarding gender, and expectations about marital sexual life can have significant effects on infertile Chinese couples’ sexuality.
Conclusion
These findings should be highly considered by family physicians in their practice to provide infertile couples with information related to sexual well-being, coping styles, relationship, etc.



Point-of-care testing in primary care patients with acute cardiopulmonary symptoms: a systematic review

Sun, 23 Jul 2017 00:00:00 GMT

Abstract
Background
Point-of-care tests (POCT) can assist general practitioners (GPs) in diagnosing and treating patients with acute cardiopulmonary symptoms, but it is currently unknown if POCT impact relevant clinical outcomes in these patients.
Objective
To assess whether using POCT in primary care patients with acute cardiopulmonary symptoms leads to more accurate diagnosis and impacts clinical management.
Methods
We performed a systematic review in four bibliographic databases. Articles published before February 2016 were screened by two reviewers. Studies evaluating the effect of GP use of POCT on clinical diagnostic accuracy and/or effect on treatment and referral rate in patients with cardiopulmonary symptoms were included.
Results
Our search yielded nine papers describing data from seven studies, on the clinical diagnostic accuracy of POCT in a total of 2277 primary care patients with acute cardiopulmonary symptoms. Four papers showed data on GP use of D-dimer POCT in pulmonary embolism (two studies); two studies on Troponin T in acute coronary syndrome; one on heart-type fatty acid-binding protein (H-FABP) in acute coronary syndrome; one on B-type natriuretic peptide (BNP) in heart failure; one on 3-in-1 POCT (Troponin T, BNP, D-dimer) in acute coronary syndrome, heart failure and/or pulmonary embolism. Only one study assessed the effect of GP use of POCT on treatment initiation and one on actual referral rates.
Conclusion
There is currently limited and inconclusive evidence that actual GP use of POCT in primary care patients with acute cardiopulmonary symptoms leads to more accurate diagnosis and affects clinical management. However, some studies show promising results, especially when a POCT is combined with a clinical decision rule.



Reducing early career general practitioners’ antibiotic prescribing for respiratory tract infections: a pragmatic prospective non-randomised controlled trial

Mon, 17 Jul 2017 00:00:00 GMT

Abstract
Background
Inappropriate antibiotic prescription and consequent antibacterial resistance is a major threat to healthcare.
Objectives
To evaluate the efficacy of a multifaceted intervention in reducing early career general practitioners’ (GPs’) antibiotic prescribing for upper respiratory tract infections (URTIs) and acute bronchitis/bronchiolitis.
Methods
A pragmatic non-randomized trial employing a non-equivalent control group design nested within an existing cohort study of GP registrars’ (trainees’) clinical practice. The intervention included access to online modules (covering the rationale of current clinical guidelines recommending non-prescription of antibiotics for URTI and bronchitis/bronchiolitis, and communication skills in management of acute bronchitis) followed by a face-to-face educational session. The intervention was delivered to registrars (and their supervisors) in two of Australia’s seventeen regional GP training providers (RTPs). Three other RTPs were the control group. Outcomes were proportion of registrars’ URTI consultations and bronchitis/bronchiolitis consultations prescribed antibiotics. Intention-to-treat analyses employed logistic regression within a Generalised Estimating Equation framework, adjusted for relevant independent variables. The predictors of interest were time; treatment group; and an interaction term for time-by-treatment group. The P value associated with an interaction term determined statistically significant differences in antibiotic prescribing.
Results
Analyses include data of 217 intervention RTPs’ and 311 control RTPs’ registrars. There was no significant reduction in antibiotic prescribing for URTIs. For bronchitis/bronchiolitis, a significant reduction (interaction P value = 0.024) remained true for analysis adjusted for independent variables (P value = 0.040). The adjusted absolute reduction in prescribing was 15.8% (95% CI: 4.2%–27.5%).
Conclusions
A multifaceted intervention reduced antibiotic prescribing for bronchitis/bronchiolitis but not URTIs.



Focus on early-career GPs: qualitative evaluation of a multi-faceted educational intervention to improve antibiotic prescribing

Mon, 17 Jul 2017 00:00:00 GMT

Abstract
Background
We conducted an educational intervention emphasizing rational antibiotic prescribing in early-career General Practitioners (GP) in vocational training (trainees). The intervention consisted of an online introduction module, an online communication training module, face-to-face workshops, and cases to be discussed one-on-one by the trainee–supervisor dyad during regular scheduled education sessions.
Objectives
To explore the participants’ experiences with the intervention.
Methods
A qualitative study of 14 GP trainees and supervisors. Interviews followed a semi-structured interview guide, were transcribed and analysed using concurrent thematic analysis.
Results
Overall, the intervention was well received. Resources were not often used in practice, but GP trainees used the information in communicating with patients. The intervention improved trainees’ confidence and provided new communication strategies, e.g. explicitly asking about patients’ expectations and talking patients through the examination to form an overall clinical picture. Trainees seemed eager to learn and adapt their practice, whereas GP supervisors rather commented that the intervention was reinforcing. None of the participants reported prescribing conflicts between trainee and supervisor. However, most participants identified conflicts within the GP practice or with specialists: other doctors who prescribe more antibiotics perpetuate patients’ ideas that antibiotics will fix everything, which in turn causes conflict with the patient and undermines attempts to improve antibiotic prescribing.
Conclusion
The educational intervention was received positively. Early-career GPs thought it influenced their prescribing behaviour and improved their confidence in non-prescribing. Interventions that target teams (e.g. entire practice) could minimize conflict, ensure consistency of messages and support overall antibiotic stewardship in primary care.



Recruiting primary care practices for practice-based research: a case study of a group-randomized study (TRANSLATE CKD) recruitment process

Sat, 15 Jul 2017 00:00:00 GMT

Abstract
Background
We assessed the challenging process of recruiting primary care practices in a practice-based research study.
Methods
In this descriptive case study of recruitment data collected for a large practice-based study (TRANSLATE CKD), 48 single or multiple-site health care organizations in the USA with a total of 114 practices were invited to participate. We collected quantitative and qualitative measures of recruitment process and outcomes for the first 25 practices recruited. Information about 13 additional practices is not provided due to staff transitions and limited data collection resources.
Results
Initial outreach was made to 114 practices (from 48 organizations, 41% small); 52 (45%) practices responded with interest. Practices enrolled in the study (n = 25) represented 22% of the total outreach number, or 48% of those initially interested. Average time to enroll was 71 calendar days (range 11–107). There was no difference in the number of days practices remained under recruitment, based on enrolled versus not enrolled (44.8 ± 30.4 versus 46.8 ± 25.4 days, P = 0.86) or by the organization size, i.e. large versus small (defined by having ≤4 distinct practices; 52 ± 23.6 versus 43.6 ± 27.8 days; P = 0.46). The most common recruitment barriers were administrative, e.g. lack of perceived direct organizational benefit, and were more prominent among large organizations.
Conclusions
Despite the general belief that the research topic, invitation method, and interest in research may facilitate practice recruitment, our results suggest that most of the recruitment challenges represent managerial challenges. Future research projects may need to consider relevant methodologies from businesses administration and marketing fields.



The association between implementation and outcome of a complex care program for frail elderly people

Sat, 15 Jul 2017 00:00:00 GMT

Abstract
Background
Over the last 20 years, the effectiveness of complex care programs aiming to prevent adverse outcomes in frail elderly people has been disappointing. Recently, we found no effectiveness of the CareWell primary care program. It is largely unknown to what extent incomplete implementation of these complex interventions influences their outcomes.
Objective
To examine the association between the degree of implementation of the CareWell program and the prevention of functional decline in frail elderly people.
Methods
Quantitative process evaluation conducted alongside a cluster-controlled trial. Two hundred and four frail elderly participants from six general practitioner practices in the Netherlands received care according to the CareWell program, consisting of four key components: multidisciplinary team meetings, proactive care planning, case management and medication reviews. We measured time registrations of team meetings, case management and medication reviews and care plan data as stored in a digital information portal. These data were aggregated into a total implementation score (TIS) representing the program’s overall implementation. We measured functional decline with the Katz-15 change score (follow-up score at 12 months minus the baseline score). The association between TIS and functional decline was analyzed with linear mixed model analyses.
Results
We found no statistically significant differences in functional decline between TIS groups (F = 1.350, P = 0.245). In the groups with the highest TISs, we found more functional decline.
Conclusion
A higher degree of implementation of the CareWell program did not lead to the prevention of functional decline in frail elderly people.



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

Fri, 14 Jul 2017 00:00:00 GMT

Abstract
Background
Neuropsychiatric symptoms (NPS) frequently occur in community-dwelling patients with dementia and they are also frequently prescribed psychotropic drugs. The prescription of psychotropic drugs has been found to be associated with the level of NPS. Data on NPS in patients with dementia in general practices are scarce.
Objectives
The aim of this study was to assess the prevalence rates of NPS and psychotropic drug use (PDU) in patients with dementia in general practices.
Methods
We analyzed data from the baseline measurement of a prospective cohort study in a sample of (Dutch) patients in general practices. Prevalence rates of NPS and subsyndromes assessed with the Neuropsychiatric Inventory (NPI) and of PDU were calculated. Prevalence rates of individual NPS are presented both as clinically relevant symptoms (NPI symptom score ≥ 4) and as prevalence rates of symptoms with symptom score > 0.
Results
Of the 117 patients, more than 90% had at least one symptom and more than 65% had at least one clinically relevant symptom. The most common NPS were agitation/aggression, dysphoria/depression and irritability/lability. The most common clinically relevant NPS were aberrant motor behaviour, agitation/aggression and apathy/indifference. Only 28.7% of the patients used at least one, 7.0% used at least two different and 1.7% used at least three different types of psychotropic drugs (excluding anti-dementia medication).
Conclusions
NPS are highly prevalent in patients with dementia in general practices, but PDU is rather low. The most common clinically relevant NPS were aberrant motor behaviour, agitation/aggression and apathy/indifference.



General practitioners’ perceptions of irritable bowel syndrome: a Q-methodological study

Fri, 14 Jul 2017 00:00:00 GMT

Abstract
Background
Irritable bowel syndrome (IBS) is a common disorder that imposes a significant burden upon societies, health care and quality of life, worldwide. While a diverse range of patient viewpoints on IBS have been explored, the opinions of the GPs they ideally need to develop therapeutic partnerships with are less well defined.
Objective
To explore how GPs perceive IBS, using Q-methodology, which allows quantitative interpretation of qualitative data.
Design and Setting
A Q-methodological study of GPs in Leeds, UK.
Method
Thirty-three GPs completed an online Q-sort in which they ranked their level of agreement with 66 statements. Factor analysis of the Q-sorts was performed to determine the accounts that predominated in understandings of IBS. Ten of the GPs were interviewed in person and responses to the statements recorded to help explain the accounts.
Results
Analysis yielded one predominant account shared by all GPs—that IBS was a largely psychological disorder. This account overshadowed a debate represented by a minority, polarized between those who viewed IBS as almost exclusively psychological, versus those who believed IBS had an organic basis, with a psychological component. The overwhelming similarity in responses indicates that all GPs shared a common perspective on IBS. Interviews suggested degrees of uncertainty and discomfort around the aetiology of IBS.
Conclusion
There was overwhelming agreement in the way GPs perceived IBS. This contrasts with the range of patient accounts of IBS and may explain why both GPs and their patients face difficult negotiations in achieving therapeutic relationships.