General Practice Consultations Research Articles

General practitioner consultations for mental health reasons prior to and following bereavement by suicide

PurposePrior research has shown that the majority of those bereaved by suicide express a need for mental health care services. However, there is a lack of knowledge about these individuals’ use of primary health care. The objective of our study was to estimate the association between suicide bereavement and general practitioner (GP) consultations for mental health reasons.MethodsA population-wide, register-based cohort study identifying 25,580 individuals bereaved by suicide. Estimations of increases in consultation rate were modeled through individual fixed-effects linear analyses adjusted for age and time-period.ResultsOverall, 35% of those bereaved by suicide had a GP consultation for mental health reasons during the first 1–2 months, and 53% after two years. In the month immediately after bereavement by suicide, there was a large increase in the consultation rate with a GP for mental health reasons. In the months that followed, the consultation rate gradually decreased. One year after bereavement, the consultation rate stabilized at a somewhat higher level than before the death. The increase in consultation rate was evident across all kinship groups, and the increase was greatest for partners and smallest for siblings. Women had more contact with the GP before the suicide and a greater increase in contact than men.ConclusionOur findings suggest that many of those bereaved by suicide seek assistance from primary health care, and that some are in need of prolonged follow-up from the GP. Health governments should be aware of this and seek to strengthen the GPs knowledge of the needs and challenges associated with this patient group. Measures should also be taken to remove barriers to contact the health care system, especially for men and bereaved siblings.

Patterns of psychotropic drug prescriptions and general practice consultations among community-dwelling older people with dementia during the first two years of the COVID-19 pandemic

BackgroundThe COVID-19 pandemic and subsequent lockdown measures had serious implications for community-dwelling older people with dementia. While the short-term impacts of the pandemic on this population have been well studied, there is limited research on its long-term impacts. Quantifying the long-term impacts may provide insights into whether healthcare adaptations are needed after the acute phase of the pandemic to balance infection prevention measures with healthcare provision. This study aims to examine patterns of psychotropic drug prescriptions and general practice consultations in community-dwelling older people with dementia during the first two years of the pandemic.MethodsWe utilised routine electronic health records from three Dutch academic general practice research networks located in the North, East, and South, between 2019 and 2021. We (1) compared the weekly prescription rates of five groups of psychotropic drugs and two groups of tracer drugs, and weekly general practice consultation rates per 1000 participants, between the first two years of the pandemic and the pre-pandemic phase, (2) calculated changes in these rates during three lockdowns and two relaxation phases relative to the corresponding weeks in 2019, and (3) employed interrupted time series analyses for the prescription rates. Analyses were performed for each region separately.ResultsThe study population sizes in the North, East, and South between 2019 and 2021 were 1726 to 1916, 93 to 117, and 904 to 960, respectively. Data from the East was excluded from the statistical analyses due to the limited sample size. During the first two years of the pandemic, the prescription rates of psychotropic drugs were either lower or similar to those in the pre-pandemic phase, with differences varying from -2.6‰ to -10.2‰. In contrast, consultation rates during the pandemic were higher than in the pre-pandemic phase, increasing by around 38‰.ConclusionsThis study demonstrates a decrease in psychotropic drug prescriptions, but an increase in general practice consultations among community-dwelling older people with dementia during the first two years of the pandemic. However, reasons for the decrease in psychotropic drug prescriptions are unclear due to limited information on the presence of neuropsychiatric symptoms and the appropriateness of prescribing.

Skin health of urban-living Aboriginal children attending a primary care Aboriginal Community Controlled Health Organisation clinic.

Despite increasing urbanisation, little is known about skinhealth for urban-living Aboriginal children and youngpeople (CYP, aged <18 years). This study aimed toinvestigate the primary care burden and clinical characteristics of skin conditions in this cohort. A one-year retrospective cohort study of urban-living Aboriginal CYP presenting for general practitioner (GP) consultation at an Aboriginal Community Controlled Health Organisation (ACCHO) was conducted. At least one dermatological diagnosis was made in 27% (253/939) of GP face-to-face consultations for the 585 urban-living Aboriginal CYP included. Infections and dermatitis accounted for 54% (152/284) and 18% (50/284) of all dermatological diagnoses, respectively. Bacterial skin infection (BSI) cumulative incidence was 13% (74/585; 95% CI 10-16%), with recurrent BSI affecting <1% (5/585; 95% CI 0.3-2%) and hospitalisation required in1% (1/82; 95% CI 0.06-7%) of incident BSI cases. We present a culturally secure, multidisciplinary skin health assessment model within an urban ACCHO, wheredermatological conditions account for a significant proportion of GP workload.

Adverse respiratory outcomes among patients with resolved asthma: matched retrospective cohort study.

Patients with asthma may have symptom remission leading to a primary care code of resolved asthma. Little is known about subsequent rates of exacerbations and respiratory tract infections (RTIs). To assess the risk of adverse respiratory outcomes for people with resolved asthma compared with those with active asthma and without asthma. This was a retrospective cohort study of patients aged >5 years, registered with a general practice in England contributing data to the Clinical Practice Research Datalink between January 2010 and December 2019. Patients with resolved asthma were matched to non-asthma controls and active asthma controls for age, sex, and practice. Negative binomial regression was used to estimate incidence rate ratios (IRRs) with 95% confidence intervals (CIs) for asthma exacerbations, RTIs, flu/pneumonia, and antibiotic prescriptions. Cohorts included 16 023 patients (8720 (54.4%) females, mean age 37 years). Compared with the active asthma cohort, the resolved cohort had fewer hospital admissions (adjusted IRR 0.29, 95% CI = 0.27 to 0.32) and general practice consultations (adjusted IRR 0.05, 95% CI = 0.04 to 0.07) for asthma exacerbations. The resolved and non-asthma cohorts had similar rates of hospital admissions for RTIs or flu/pneumonia. However, the resolved cohort had significantly greater incidence of general practice consultations for lower RTIs (adjusted IRR 2.34, 95% CI = 2.08 to 2.64) and antibiotic prescriptions (adjusted IRR 1.37, 95% CI = 1.30 to 1.44). Patients with resolved asthma had greater risk of general practice RTI and antibiotic prescription than the general population and may benefit from defined strategies for reassessing symptoms and reinitiating asthma therapy.

Video consultation in general practice during COVID-19: a register-based study in Denmark.

During the COVID-19 pandemic, general practices in Denmark rapidly introduced video consultations (VCs) to prevent viral transmission. To study the use of VCs in daytime general practice by describing the rate of VCs, and the patient characteristics associated with having VCs. Register-based study of consultations in daytime general practice in Denmark. We included all consultations in daytime general practice from 1 January 2019-30 November 2021. We calculated the rate of video use and categorised the general practices into no, low, and high use. Logistic regression was used to calculate adjusted odds ratios (aOR) for having a VC for different patient characteristics when contacting a video-using practice, stratified for low- and high-using practices. A total of 30 148 478 eligible consultations were conducted during the pandemic period. VCs were used mostly during the early stage pandemic period, declining to about 2% of all clinic consultations in the late-stage period. Patients having more VCs were young, had a long education, were employed, and lived in big cities. In low-using practices, native Danes and 'western' immigrants had higher odds of receiving a VC than 'non-western' immigrants, and patients with ≥2 comorbidities had lower odds than those without comorbidities. Patients of a younger age, with long education, or employment had higher odds of receiving a VC, while patients of an older age and patients who had retired had lower odds. This difference in the access to VCs warrants further attention.

My time, your time, our time. Older patients’ and GPs’ time sensibilities around email consultations

ABSTRACT In this study, we discuss how email consultations in general practice operate as a temporal technology, transforming working conditions and power relations between general practitioners (GPs) and patients. We draw on empirical material from Denmark in the form of a set of semi-structured interviews with 53 patients and 15 GPs, including two focus group discussions with 17 GPs. Our theoretical point of departure stems primarily from media theorist Sarah Sharma’s (2014) concept of power-chronography, which describes how power is embedded in temporal relations and everyday life and secondarily from sociologist, Judy Wajcman’s (2015) concept of multiple temporal landscapes. Patients and GPs calibrate their own time and attune their mutual time according to their expectations and ideas about the other party’s time. The patient and the GP can both be viewed as ‘time workers’ and the email consultation as a digital technology fostering the recalibration of one person’s time to that of another, requiring significant labour. The email consultation rearranges the GP-patient boundaries and thereby the power relations. Health institutions ought to consider whose time and labour is being ‘saved’ with digital systems.

ADVANCED TENDON REPAIR STRATEGIES: FROM EVS TO MRNA-BASED APPROACHES

Approximately 30% of general practice consultations for musculoskeletal pain are related to tendon disorders, causing substantial personal suffering and enormous related healthcare costs. Treatments are often prone to long rehabilitation times, incomplete functional recovery, and secondary complications following surgical repair. Overall, due to their hypocellular and hypovascular nature, the regenerative capacity of tendons is very poor and intrinsically a disorganized scar tissue with inferior biomechanical properties forms after injury. Therefore, advanced therapeutic modalities need to be developed to enable functional tissue regeneration within a degenerative environment, moving beyond pure mechanical repair and overcoming the natural biological limits of tendon healing.Our recent studies have focused on developing biologically augmented treatment strategies for tendon injuries, aiming at restoring a physiological microenvironment and boosting endogenous tissue repair. Along these lines, we have demonstrated that the local application of mesenchymal stromal cell-derived small extracellular vesicles (sEVs) has the potential to improve rotator cuff tendon repair by modulating local inflammation and reduce fibrotic scarring. In another approach, we investigated if the local delivery of the tendon ECM protein SPARC, which we previously demonstrated to be essential for tendon maturation and tissue homeostasis, has the potential to enhance tendon healing. Finally, I will present results demonstrating the utility of nanoparticle-delivered, chemically modified mRNAs (cmRNA) to improve tendon repair.

A patient-centred care model for patients with complicated multimorbidity: Protocol for a pilot cluster randomised trial in general practice, municipalities, and hospitals.

Current care is inadequate for patients with complicated multimorbidity, and frequently results in fragmented care. There is no widely agreed-upon optimal organisation of healthcare services for this patient group. By drawing upon existing literature and prior studies, we developed a patient-centred complex intervention for multimorbidity (CIM) and subsequently refined it into CIM version 2 (CIM2). This paper describes the study protocol for a pilot cluster randomised control trail (RCT) evaluating the effectiveness of a general practice-based intervention. CIM2 aims to support integrated care for patients with complicated multimorbidity. CIM2 comprises five elements: 1) Training healthcare professionals, 2) an extended overview consultation in general practice, 3) a nurse care coordinator in general practice supporting the planning of the patient trajectory, 4) follow-up care services in general practice, and 5) improving the integration of care between general practice, municipality, and hospital. The pilot cluster RCT involve 350 patients with complicated multimorbidity across 14 general practices in Region Zealand and The Capital Region of Denmark. Patients are randomly assigned to either the intervention group or the usual care group. The primary outcome measure is the patients experience of quality of care measured by the Patient Assessment Chronic Illness Care Questionnaire (PACIC). Secondary outcomes include the patient's health-related quality of life, measured by the EuroQol-5 Domain questionnaire (EQ-5D-5L) and the treatment burden measured by the Multimorbidity Treatment Burden Questionnaire (MTBQ). Data on chronic conditions, healthcare utilization, and demographic information such as sex, age, and educational attainment will be collected from national registries. The outcome measures will be recorded before, during, and after implementing the intervention. Qualitative evaluation will include semi-structured interviews with healthcare professionals across various sectors as well as patients. The cost-effectiveness and Incremental Cost Effectiveness Ratio (ICER) of the CIM2 will be assessed using Diagnose Related Group rates. ClinicalTrials.gov Identifier: NCT05406193. https://clinicaltrials.gov/study/NCT05406193.

How to support caregivers in general practice: development of the Caregiver Care Model.

Caring for a family member can be demanding, particularly when caregivers experience profound distress. Supportive interventions may help prevent mental and physical illness in the caregiver. General practice plays a key role by regularly engaging with patients and caregivers, thereby being able to identify their support needs, offer talk therapy and refer to care initiatives. This study aimed to develop and pilot-test the Caregiver Care Model to mitigate grief reactions among caregivers in general practice. A participatory intervention development study. A prototype was developed in a workshop with healthcare professionals. The prototype was refined based on a pilot-test among 40 caregivers from 5 general practice clinics and a workshop with general practitioners. The data were obtained from workshops, feedback questionnaires completed by healthcare professionals, and interviews with caregivers and general practitioners. The analysis focused on model development and mechanisms of impact. The prototype was refined by focusing the dialogue questionnaire, minimising the grief facilitation tools and expanding the target group. The prototype seemed to accommodate the needs among caregivers by acknowledging their situation. The final model includes up to seven caregiver consultations in general practice. A dialogue questionnaire filled in by the caregiver serves as a fixed starting point and preparation for the first consultation. If needed, talk therapy in general practice or referrals to other services are used. The model offers promising support for caregivers. Its flexible structure allows for customisation. The viability of the model should be further tested.

Sickness absence and associations with sociodemographic factors, health risk behaviours, occupational stressors and adverse mental health in 40,343 UK police employees.

Police employees may experience high levels of stress due to the challenging nature of their work which can then lead to sickness absence. To date, there has been limited research on sickness absence in the police. This exploratory analysis investigated sickness absence in UK police employees. Secondary data analyses were conducted using data from the Airwave Health Monitoring Study (2006-2015). Past year sickness absence was self-reported and categorised as none, low (1-5 days), moderate (6-19 days) and long-term sickness absence (LTSA, 20 or more days). Descriptive statistics and multinomial logistic regressions were used to examine sickness absence and exploratory associations with sociodemographic factors, occupational stressors, health risk behaviours, and mental health outcomes, controlling for rank, gender and age. From a sample of 40,343 police staff and police officers, forty-six per cent had no sickness absence within the previous year, 33% had a low amount, 13% a moderate amount and 8% were on LTSA. The groups that were more likely to take sick leave were women, non-uniformed police staff, divorced or separated, smokers and those with three or more general practitioner consultations in the past year, poorer mental health, low job satisfaction and high job strain. The study highlights the groups of police employees who may be more likely to take sick leave and is unique in its use of a large cohort of police employees. The findings emphasise the importance of considering possible modifiable factors that may contribute to sickness absence in UK police forces.

Evolving migraine management: Lithuania's telemedicine experience.

COVID-19 challenges have underscored the potential of telemedicine in migraine management. This study focuses on assessing patients' telemedicine experience for headache management in Lithuania and identifying key barriers and facilitators for its wider use. A nationwide e-survey was conducted in 2023 via the Lithuanian Association of Migraine Patients' website, social media platforms, websites of public and private healthcare facilities, and migraine self-help groups. The survey covered sociodemographics, migraine characteristics, previous experience with teleconsultations for headaches with neurologists and general practitioners (GP), perceived advantages and disadvantages of telehealth, and preferred future consultation types. Eight hundred and forty seven respondents with a confirmed migraine diagnosis were analyzed. The majority were female (97.2%), with a median age of 35 (IQR 30-42) years and an average of 5 (IQR 3-9) monthly headache days (MHDs). 7.0% of respondents had chronic migraine (CM). Prior teleconsultations for headaches were reported by 35.2% of respondents, 26.2% with a GP and 17.0% with a neurologist (p < 0.0001). Teleconsultation outcomes included continuation of a prescribed treatment (84.7% for GPs and 83.3% for neurologists, p = 0.7295), initiation of new acute medications (12.2% for GPs with 70.4% reported as effective and 27.1% for neurologists with 84.6% effective, p = 0.0005 and p < 0.0001, respectively). Reasons for not undergoing remote neurology consultations: the lack of inquiry (69.7%), unavailability from neurologists (18.1%) and respondent's opposition to remote consultations (12.2%). Patients evaluated their experience with remote neurology services better than that of GPs (p = 0.0289). 67.3% of respondents preferred a mixed-mode approach for future consultations. In-person-only preference (29.0%) correlated with multiple factors, including history of remote primary neurology consultations (OR 5.89, p = 0.0022), lower education (OR 2.20, p = 0.0001), physically demanding work (OR 1.95, p = 0.0001), and number of drawbacks in telemedicine identified (OR 1.30, p < 0.0001), and worse experience of a prior remote GP consultation (OR 0.704, p < 0.0001). The main indicator of preference for remote-only consultations was the perception of fewer telemedicine disadvantages (OR 0.503, p = 0.0007). Our findings confirm that telemedicine contributes to effective migraine management and is used limitedly in Lithuania. Despite one-third of respondents having experienced teleconsultations, significant barriers remain. Our study highlights a clear preference for a hybrid consultation type.

Ethical assessment of virtual consultation services: scoping review and development of a practical ethical checklist.

Introduction The use of telephone and video consultations has vastly increased since the onset of the COVID-19 pandemic. Health care providers in traditional clinical practices have embraced these virtual consultations as an alternative to face-to-face consultations, but there has also been a simultaneous increase in services offered directly to consumers via commercial entities. One of the main challenges in telemedicine (and the broader field of digital health) is how to conduct a meaningful ethical assessment of such services. Aim This article presents a novel framework for practical ethical analysis of direct-to-consumer virtual general practitioner consultation services in Aotearoa New Zealand. Methods First, a scoping review of academic and policy documents identified the core ethical challenges arising from virtual consultations. Second, a qualitative analysis was conducted to translate the main ethical themes and subthemes into practical questions to assess virtual general practice services. Results A total of 49 relevant documents were selected for review. The six key ethical themes related to telemedicine were: privacy, security, and confidentiality; equity; autonomy and informed consent; quality and standards of care; patient empowerment; and continuity of care. A practical ethical checklist consisting of 25 questions was developed from these themes and their subthemes. Discussion The checklist provides an accessible way of incorporating ethics into technology assessment and can be used by all relevant stakeholders, including patients, health care providers, and developers. Application of the framework contributes to improving the quality of virtual consultation services with a specific focus on ethics.

Unmet need for primary health care and subsequent inpatient hospitalisation in Aotearoa New Zealand. A cohort study.

Introduction The inability to afford a consultation with a general practitioner may lead to delays in accessing care pathways. Aim This study aimed to explore the characteristics of people by their unmet need for a general practitioner consultation because of cost, and the characteristics of subsequent inpatient hospitalisations. Methods From the New Zealand Health Surveys (2013/14-2018/19), two groups were formed based on their unmet need for a general practitioner consultation due to cost. These groups were compared by socio-demographic factors and subsequent inpatient hospitalisation characteristics during follow-up. Time to an inpatient hospitalisation was the outcome in a proportional hazards regression model with need status as the key variable. The model was expanded to include confounding variables: sex, age group, ethnicity, the New Zealand Deprivation Index and self-rated health. Results The need group, characterised by having a higher proportion of females, younger adults, Māori, increased socioeconomic deprivation and poorer self-rated health experienced a greater chance of hospitalisation, a similar number of visits during follow-up, shorter stays and a quicker time to hospitalisation compared to the no-need group. Proportional hazards survival models gave a 28% higher hazard rate for the time to an inpatient hospitalisation for the need group compared to the no-need group. The inclusion of all the confounders in the model gave a similar hazard ratio. Discussion Although consultation fees vary across general practices, it is evident that this may not eliminate the cost barriers to accessing care for some groups. Needing multiple consultations may contribute to persistent unmet needs.

Psychiatric disorders and the cancer diagnostic process in general practice: a combined questionnaire and register study exploring the patients’ experiences in Denmark

Objective Patients with psychiatric disorders are at risk of experiencing suboptimal cancer diagnostics and treatment. This study investigates how this patient group perceives the cancer diagnostic process in general practice. Design Cross-sectional study using questionnaire and register data. Setting General practice in Denmark. Subjects Patients diagnosed with cancer in late 2016 completed a questionnaire about their experiences with their general practitioner (GP) in the cancer diagnostic process (n = 3411). Information on pre-existing psychiatric disorders was obtained from register data on psychiatric hospital contacts and primary care treated psychiatric disorders through psychotropic medications. Logistic regression was used to analyse the association between psychiatric disorders and the patients’ experiences. Main outcome measures Patients’ experiences, including cancer worry, feeling being taken seriously, and the perceived time between booking an appointment and the first GP consultation. Box 1. Included survey items on the patients’ experiences Results A total of 13% of patients had an indication of a psychiatric disorder. This group more often perceived the time interval as too short between the first booking of a consultation and the first GP consultation. Patients with primary care treated psychiatric disorders were more likely to worry about cancer at the first presentation and to share this concern with their GP compared with patients without psychiatric disorders. We observed no statistically significant association between patients with psychiatric disorders and perceiving the waiting time to referral from general practice, being taken seriously, trust in the GP’s abilities, and the patients’ knowledge of the process following the GP referral. Conclusion The patients’ experiences with the cancer diagnostic process in general practice did not vary largely between patients with and without psychiatric disorders. Worrying about cancer may be a particular concern for patients with primary care treated psychiatric disorders.

Patient portal registration and healthcare utilisation in general practices in England: a longitudinal cohort study.

Patient portals introduced in most of England's general practices since 2015 have the potential to improve healthcare efficiency. There is a paucity of information on the use of patient portals within the NHS general practices and the potential impact on healthcare utilisation. To investigate the association between patient portal registration and care utilisation (measured by the number of general practice consultations) among general practice patients. A longitudinal analysis using electronic health record data from the Clinical Practice Research Datalink (CPRD). We analysed patients registered for patient portals (n = 284 666), aggregating their consultations 1 year before and 1 year after registration. We ran a multilevel negative binomial regression model to examine patient portal registration's association with face-to-face and remote consultations. Patients who registered to the portal had a small decrease in the total number of face-to-face consultations after registering to the patient portal (incidence rate ratio = 0.93, 95% confidence interval [CI] = 0.93 to 0.94). Patients who registered to the portal had an increase in the total number of remote consultations after registering to the portal (incidence rate ratio = 1.16, 95% CI = 1.15 to 1.18). The study found minor changes in consultation numbers post-patient portal registration, notably with an increase in remote consultations. While causality between portal registration and consultation number remains unclear, the potential link between patient portal use and healthcare utilisation warrants further investigation, especially within the NHS, where portal impacts are not well-studied. Detailed portal utilisation data could clarify this relationship.

Video versus telephone for telehealth delivery: a cross-sectional study of Australian general practice trainees.

Remunerated telehealth consultations were introduced in Australia in 2020 in response to the COVID-19 pandemic. Videoconferencing has advantages over telephone-consulting, including improved diagnostic and decision-making accuracy. However, videoconferencing uptake in Australia has been low. This study aimed to establish prevalence and associations of video versus telephone consultations in Australian general practice (GP) registrars' practice. A cross-sectional analysis of data from 2020 to 2021 (three 6-monthly data-collection rounds) from the Registrars Clinical Encounters in Training (ReCEnT) study. GP registrars record details of 60 consecutive consultations every 6-month term, for a total of 3 terms. Univariable and multivariable logistic regression were performed within the Generalized Estimating Equations framework with the outcome video versus telephone. 102,286 consultations were recorded by 1,168 registrars, with 21.4% of consultations performed via telehealth. Of these, telephone accounted for 96.6% (95% CI: 96.3-96.8%) and videoconferencing for 3.4% (95% CI: 3.2-3.7%). Statistically significant associations of using videoconferencing, compared to telephone, included longer consultation duration (OR 1.02, 95% CI: 1.01-1.03 per minute; and mean 14.9 versus 12.8 min), patients aged 0-14 years old (OR 1.29, 95% CI: 1.03-1.62, compared to age 15-34), patients new to the registrar (OR 1.19, 95% CI: 1.04-1.35), part-time registrars (OR 1.84, 95% CI: 1.08-3.15), and areas of less socioeconomic disadvantage (OR 1.27, 95% CI: 1.00-1.62 per decile). Registrars' telehealth consultations were mostly performed via telephone. Telephone use being associated with socioeconomic disadvantage has health equity implications. Future research should explore barriers to videoconferencing use and strategies to increase its uptake.

Identifying Existing Evidence to Potentially Develop a Machine Learning Diagnostic Algorithm for Cough in Primary Care Settings: Scoping Review.

Primary care is known to be one of the most complex health care settings because of the high number of theoretically possible diagnoses. Therefore, the process of clinical decision-making in primary care includes complex analytical and nonanalytical factors such as gut feelings and dealing with uncertainties. Artificial intelligence is also mandated to offer support in finding valid diagnoses. Nevertheless, to translate some aspects of what occurs during a consultation into a machine-based diagnostic algorithm, the probabilities for the underlying diagnoses (odds ratios) need to be determined. Cough is one of the most common reasons for a consultation in general practice, the core discipline in primary care. The aim of this scoping review was to identify the available data on cough as a predictor of various diagnoses encountered in general practice. In the context of an ongoing project, we reflect on this database as a possible basis for a machine-based diagnostic algorithm. Furthermore, we discuss the applicability of such an algorithm against the background of the specifics of general practice. The PubMed, Scopus, Web of Science, and Cochrane Library databases were searched with defined search terms, supplemented by the search for gray literature via the German Journal of Family Medicine until April 20, 2023. The inclusion criterion was the explicit analysis of cough as a predictor of any conceivable disease. Exclusion criteria were articles that did not provide original study results, articles in languages other than English or German, and articles that did not mention cough as a diagnostic predictor. In total, 1458 records were identified for screening, of which 35 articles met our inclusion criteria. Most of the results (11/35, 31%) were found for chronic obstructive pulmonary disease. The others were distributed among the diagnoses of asthma or unspecified obstructive airway disease, various infectious diseases, bronchogenic carcinoma, dyspepsia or gastroesophageal reflux disease, and adverse effects of angiotensin-converting enzyme inhibitors. Positive odds ratios were found for cough as a predictor of chronic obstructive pulmonary disease, influenza, COVID-19 infections, and bronchial carcinoma, whereas the results for cough as a predictor of asthma and other nonspecified obstructive airway diseases were inconsistent. Reliable data on cough as a predictor of various diagnoses encountered in general practice are scarce. The example of cough does not provide a sufficient database to contribute odds to a machine learning-based diagnostic algorithm in a meaningful way.

Diagnosis and management of acute infections during telehealth consultations in Australian general practice: a qualitative study.

The use of telehealth has increased dramatically since the beginning of the COVID-19 pandemic. Little is known about how GPs manage acute infections during telehealth, and the potential impact on antimicrobial stewardship. To explore the experiences and perceptions of GP trainees' and supervisors' use of telehealth, and how it influences their management of acute infections. Australian GP registrars (trainees) and supervisors were recruited via email through their training organisations. Semi-structured interviews with 18 participants were conducted between July and August 2022. Interviews were transcribed verbatim and analysed using a reflexive thematic approach. We identified six overall themes. 1. Participants experienced impaired diagnostic capacity during telehealth consultations. 2. Attempts to improve diagnostic acuity included various methods, such as having patients self-examine. 3. The management of clinical uncertainty frequently entailed referring patients for in-person assessment, overinvestigating, or overtreating. 4. Antibiotic prescribing decisions during telehealth were informed by less information than were in-person consults, with varying impact. 5. Participants believed that other GPs improperly prescribed antibiotics during telehealth. 6. Supervisors believed that registrars hadn't developed the knowledge or skills to determine when conditions could be managed appropriately via telehealth. Telehealth has potential for reducing transmission of acute infections and increasing access to healthcare. However, the implications of GPs, especially less experienced GPs, making diagnoses with less certainty, and consequently compromising antimicrobial stewardship, are a concern. Patient self-assessment tools may improve outcomes of telehealth consultations for acute infections.

Use of visual aids in general practice consultations: A questionnaire-based survey.

Visual aids (VAs) seem effective to improve doctor-patient communication. The objective was to describe how VAs are used in consultation and what French general practitioners (GPs) expect of them. Cross-sectional study using a self-administered questionnaire among French GPs in 2019. Descriptive and multinominal logistic regression analyses were performed. Of the 376 respondents, 70% used VAs at least weekly and 34% daily; 94% considered VAs useful/very useful; 77% felt they did not use VAs enough. Sketches were the most used VAs and considered the most useful. Younger age was significantly associated with a higher rate of use of simple digital images. VAs were mainly used to describe anatomy and facilitate patient comprehension. Main reasons for not using VAs more often were time spent searching, lack of habit and poor quality of available VAs. Many GPs requested a database of good quality VAs. GPs use VAs regularly in consultations but would like to use them more often. Informing GPs of the usefulness of VAs, training them to draw adapted sketches and creating a good quality databank are some possible strategies to increase the use of VAs. This study described in detail the use of VAs as tool for doctor-patient communication.

Resource utilisation and outcomes of people with heart failure in England: a descriptive analysis of linked primary and secondary care data – the PULSE study

BackgroundHeart failure (HF) is associated with high levels of resource use and mortality, but prior UK studies have not compared outcomes by HF subtype (HF with reduced ejection fraction (HFrEF)...