General Practice Setting Research Articles

Could it be osteoarthritis? How dog owners and veterinary surgeons describe identifying canine osteoarthritis in a general practice setting

Canine osteoarthritis is a common, painful condition that is typically managed in a general practice setting. Osteoarthritis may have significant negative impacts on the welfare of both dogs and their owners. Anticipated early clinical signs of canine osteoarthritis and the preferred route to its diagnosis are well described by veterinary subject experts in published literature. However, little is known about changes owners first recognise in a dog ultimately diagnosed with osteoarthritis, how they make decisions about when to present that dog to a general practitioner, or whether the described diagnostic pathways are followed by general practitioners. The aim of this research was to investigate how dog owners and veterinary surgeons describe identifying and diagnosing canine osteoarthritis.Owners of osteoarthritic dogs were recruited for semi-structured interview, and veterinary surgeons working in general practice were invited to take part in practice-based focus groups. Transcripts from both datasets were thematically analysed using a contextualist epistemology with an ontology based on critical realism to construct convergent themes from latent and semantic codes. Thirty-two interviews were completed with 40 owners from 32 households who discussed 35 dogs with osteoarthritis, and 26 veterinary surgeons engaged in four practice-based focus groups.Owners described identifying a wide range of acute and chronic, typically subtle and intermittent, behavioural and demeanour changes prior to their dogs’ osteoarthritis diagnosis. Few attributed these changes to canine osteoarthritis, and some waited many months before presenting their dog to a veterinary practice. Veterinary surgeons described a consistent ‘typical osteoarthritis’ presentation that they recognised through history taking and clinical examination. Their diagnostic work-up rarely followed that advocated by subject experts for reasons including lack of time and perceptions that it would not change the outcome. Many veterinary surgeons described frustration that some owners did not accept their recommendations to provide analgesia for affected dogs. Short consultation lengths, poor awareness of owner knowledge levels, and lack of recognition of the importance of owners’ prior knowledge, beliefs and assumptions may contribute to these consultations being perceived as challenging by some veterinary surgeons and owners.This research demonstrates that veterinary surgeons and owners want dogs with clinical signs of osteoarthritis to be happy and comfortable, but that ineffective communication and lack of trust in the consulting room may be a barrier. Our data identifies many new avenues for future research and improved communication strategies that could facilitate earlier identification and treatment of canine osteoarthritis in general practice.

Are we preparing Victorian general practice registrars to be confident in all aspects of primary care paediatrics?

General practitioners provide essential primary care topaediatric patients. The aim of this study was to explore associations between prevocational paediatric experiences of general practice registrars and their confidence in providing paediatric care in the general practice setting. This was a cross-sectional observational study. Paediatric experiences and level of confidence ratings were collected using an online survey emailed to 530 Victorian general practice registrars in 2017; the response rate was 41% (217/530). Analysis used descriptive statistics, cross tabulation and Fishers' exact test. The most common paediatric training was undertaken in a general hospital emergency department (180/197, 91%). The majority of registrars reported that they felt confident or very confident in managing acute presentations (92% for upper respiratory tract infection, 80% for asthma, 81% forimmunisation), but fewer were confident in managing mental health, behavioural or developmental presentations (all <36%). Registrars felt more confident managing acute presentations. However, the predominantly hospital-based prevocational paediatric training offers limited exposure to - and, thus, confidence in - managing behavioural, mental health and developmental issues. Training opportunities to address this identified gap should be explored.

User redesign, testing and evaluation of the Monitoring Risk and Improving System Safety (MoRISS) checklist for the general practice work environment

BackgroundInadequate checking of safety-critical issues can compromise care quality in general practice (GP) work settings. Adopting a systemic, methodical approach may lead to improved standardisation of processes and reliability of...

COVID-19 outpatients: early risk-stratified treatment with zinc plus low-dose hydroxychloroquine and azithromycin: a retrospective case series study

The aim of this study was to describe the outcomes of patients with coronavirus disease 2019 (COVID-19) in the outpatient setting after early treatment with zinc, low-dose hydroxychloroquine and azithromycin (triple therapy) dependent on risk stratification. This was a retrospective case series study in the general practice setting. A total of 141 COVID-19 patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the year 2020 were included. The main outcome measures were risk-stratified treatment decision and rates of hospitalisation and all-cause death. A median of 4 days [interquartile range (IQR) 3–6 days; available for n = 66/141 patients] after the onset of symptoms, 141 patients (median age 58 years, IQR 40–67 years; 73.0% male) received a prescription for triple therapy for 5 days. Independent public reference data from 377 confirmed COVID-19 patients in the same community were used as untreated controls. Of 141 treated patients, 4 (2.8%) were hospitalised, which was significantly fewer (P < 0.001) compared with 58 (15.4%) of 377 untreated patients [odds ratio (OR) = 0.16, 95% confidence interval (CI) 0.06–0.5]. One patient (0.7%) in the treatment group died versus 13 patients (3.4%) in the untreated group (OR = 0.2, 95% CI 0.03–1.5; P = 0.12). No cardiac side effects were observed. Risk stratification-based treatment of COVID-19 outpatients as early as possible after symptom onset using triple therapy, including the combination of zinc with low-dose hydroxychloroquine, was associated with significantly fewer hospitalisations.

A systematic review of postgraduate training programmes directed at pharmacists entering primary care

This systematic review explores the international postgraduate education and training programmes designed to provide or develop knowledge or skills focused on enabling pharmacists to work in a general practice setting. Four thousand, eight hundred and seventy-one (4,871) articles were identified from database searches of SCOPUS, EMBASE, Medline, CINAHL, IPA, Web of Science and ERIC. After removal of duplicates and article screening, seven articles were included. Educational content, setting, contact time and methods of assessment varied across all studies. There is paucity of published literature relating to the development and evaluation of education programmes directed at pharmacists entering into general practice. A combination of work and classroom-based education provided by general practitioners and pharmacists already working in primary care is deemed most beneficial coupled with systematic debriefing sessions at the completion of training courses. The findings suggest future training should focus on specific disease states.

Not just an information-delivery tool. An ethnographic study exploring Danish GPs’ perspectives on and experiences with the relational potential of email consultation

Objective To explore GPs’ perspectives on and daily experiences with the relational potential of email consultations. Design Qualitative study with data from participant observation and semi-structured interviews Setting General practice setting in Denmark Subjects Practice personnel from four clinics were observed and 16 GPs (seven women and nine men, between 35 and 70 years of age) interviewed. Field notes and interview data were analysed using an inductive thematic analysis approach. Main outcome measures Main themes and subthemes reporting GPs’ perspectives on and experiences with the relational potential of email consultations. Results The analyses showed that due to perceived interpretational shortcomings, the GPs generally experienced email consultation as unsuitable for communication about relational, socio-emotional and sensitive matters. In doctor–patient relationships founded on mutual knowledge and trust, the email consultation was however used as a supportive communication channel, as a way for the patient to express emotions and affect and for the GP to proactively show interest and compassion towards the patient. Conclusion Email consultations were highly context-variant. Within continuing relationships and in conjunction with face-to-face consultations, email consultation was used for supportive communication holding the potential for maintaining, strengthening and/or dissolving the GP-patient relationship. Therefore, email consultation is not simply an information-delivery tool but also holds more explicit relational potentials. KEY POINTS Overall, the GPs perceived email consultation as unsuitable for non-medical, relationship-oriented purposes. Nonetheless, the GPs experienced that email consultations oftentimes comprised communication about relational and socio-emotional issues. Knowledge of the patient was a vital factor for the GP’s comfort in and acceptability of relational functions of email consultation. Email consultation is not simply an information-delivery tool as it holds the potential for maintaining, strengthening and/or dissolving the GP-patient relationship.

The rich potential for education research in family medicine and general practice.

Medical education is a rapidly growing field of research, incorporating diverse disciplinary perspectives to assist physician trainees in developing the complex skills needed for practice. Education science is happening in many medical specialties; however, Family Medicine or General Practice settings have not seen a proportional share of theory-driven education research. The limited nature of education research in Family Medicine is surprising, given that there are several aspects of general practice that make it a particularly unique and interesting context to study issues of general importance to medical education, and there is a particular need for education research to further the discipline of Family Medicine. It is important that the community of medical education researchers in Family Medicine have a strong understanding and perspective on the breadth and potential impact of their work, and what this means for the training that occurs within and for the discipline. This Reflection aims to inform strategic thinking, collaboration, and innovation in medical education research as it pertains to Family Medicine. It does so by discussing four hallmarks of Family Medicine practice and outlining their independent and interactive potential for medical education research.

Prescribing direct-acting antivirals to treat hepatitis C virus in a general practice setting in Australia: 'so why not do it'?

The recent implementation of a scheme to provide universal access to direct-acting antiviral (DAA) medication to treat hepatitis C virus (HCV) places Australia in a unique position to reach global HCV elimination goals. To achieve this, increasing the uptake and success of DAA treatment in general practice settings is essential. To explore current enablers and residual barriers to HCV treatment in general practice settings in the post-interferon era from both general practitioner (GP) and patient perspectives. Semi-structured interviews with 11 GP and 27 patients were conducted to draw out both challenges and facilitators particularly relevant to DAA uptake and treatment journeys. Key enablers for successful treatment identified by this study included peer-led GP support and skill development, utilisation of electronic reminder systems, trusting relationships with patients and engaging with patients' social and family networks. Barriers related to accessible testing facilities and knowledge and confidence with DAA treatment continue to limit GP-led treatment. Despite a universal access scheme, barriers to DAA prescription in general practice settings remain. These include access to fibrosis testing and GP confidence in DAA prescription. Strengthening peer-led GP skill development and utilisation of electronic reminder systems may help GP prioritise HCV treatment. Access to fibrosis testing and pathology services with no out-of-pocket costs to patients, particularly in outer-metropolitan areas, should be urgently addressed.

Unguided online Cognitive Behavioral Therapy for insomnia in General Practice: a mixed method study

Abstract Background Sleep contributes to physical, cognitive and emotional restoration. Sleep problems may eventually cause physical and mental dysfunctions. Insomnia symptoms are the most common, leading to insufficient sleep. Unguided online interventions for insomnia merit further study, because of their potential for care avoiders and their potential cost-efficiency in General Practice settings. The research question is which factors contribute to its' effectiveness and intention to use. Methods A mixed method approach was implemented with patients with insomnia symptoms of a General Practice in Amsterdam. Semi- structured in-depth interviews were administered after completion of an online CBTI of five sessions (N = 7 females; age from 30 to 54) A questionnaire was administered (N = 118; female: 68%; [Mean age = 24.5, sd = 7.8]) Severity of insomnia was measured with the ISI. Regression analysis was deployed in a prediction model to predict intention to use unguided online CBTI based on the Technology Acceptance Model. Results The interviews revealed that the level of knowledge, duration of the intervention and severity of symptoms contributed to the effectiveness of online CBTI. Additionally, therapeutic support is needed to convert knowledge into action. Unguided CBTI is more suitable for individuals with onset or milder insomnia symptoms. Results of the questionnaire indicated that the severity of symptoms predicted the intention to use. F(8, 110) = 14.36, p = .000; β = 0.20, t(113) = 3.01, p = 0.003. Conclusions These findings indicate a healthcare challenge: online unguided CBTI is perhaps more suitable for individuals with onset or milder symptoms, however they are less inclined to use such an intervention. Therefore, their awareness of potential CBTI treatments should be increased. Furthermore, the level of knowledge and capability to transfer that knowledge into action should be considered in order to determine the amount of support an individual needs. Key messages Unguided online CBTI has potential for insomnia patients in a General Practice setting; awareness of this should especially increase amongst those with less severe symptoms. Online CBTI for insomnia should also take into account, the level of knowledge and capability to transfer that knowledge into action to determine its content and communication.

Six-year survival of single crowns — A massive data analysis

ObjectivesNumerous clinical trials have proven the long-term stability of metal and metal-ceramic crowns. However, data on their performance under practice conditions are rare. PurposeTo evaluate the longevity of crowns by means of massive data analyses. MethodsThe data were extracted from the data warehouse of a major German national health insurance company (BARMER, Berlin, Germany). The analysis focused on crown types with the lowest deductibles. Metal crowns and metal-ceramic crowns with ceramic veneering on the vestibular aspects of teeth 15–25 and 34–44 placed from 2012 to 2017 were included. The placement of the crowns, crown removals and tooth extractions were identified using the corresponding fee codes. Kaplan–Meier survival analyses were conducted for the outcomes “crown removal or extraction” and for “extraction”. ResultsThe cumulative six-year survival rates were 88.0 % for the outcome “crown removal or extraction” and 92.5 % for the outcome “extraction” (N = 192,868). The survival functions had slightly steepening but close to linear courses. ConclusionsThe outcome of the treatment with metal and metal-ceramic crowns was moderately inferior in comparison to clinical trials. However, treatment with metal and metal-crowns is judged to be a reliable and safe option under practice conditions. Clinical significance statementClinicians must inform patients about potential treatment outcomes. Therefore, additional knowledge about single crown outcomes under general practice settings based on large database analyses is important.

Association Between Region of Birth and Advance Care Planning Documentation Among Older Australian Migrant Communities: A Multicenter Audit Study.

ObjectivesThis study explored associations between birth region, sociodemographic predictors, and advance care planning (ACP) uptake.MethodsA prospective, multicenter, cross-sectional audit study of 100 sites across 8 Australian jurisdictions. ACP documentation was audited in the health records of people aged 65 years or older accessing general practice (GP), hospital, and long-term care facility (LTCF) settings. Advance care directives (ACDs) completed by the person (“person completed ACDs”) and ACP documents completed by a health professional or other person (“health professional or someone else ACP”) were counted. Hierarchical multilevel logistic regression assessed associations with birth region.ResultsFrom 4,187 audited records, 30.0% (1,152/3,839) were born outside Australia. “Person completed ACDs” were less common among those born outside Australia (21.9% vs 28.9%, X2 (1, N = 3,840) = 20.3, p < .001), while “health professional or someone else ACP” was more common among those born outside Australia (46.4% vs 34.8%, X2 (1, N = 3,840) = 45.5, p < .001). Strongest associations were found for those born in Southern Europe: “person completed ACD” (odds ratio [OR] = 0.56, 95% confidence interval [CI] = 0.36–0.88), and “health professional or someone else ACP” (OR = 1.41, 95% CI = 1.01–1.98). English-language proficiency and increased age significantly predicted both ACP outcomes.DiscussionRegion of birth is associated with the rate and type of ACP uptake for some older Australians. Approaches to ACP should facilitate access to interpreters and be sensitive to diverse preferences for individual and family involvement in ACP.

The VRIMM study: Virtual Reality for IMMunisation pain in young children—protocol for a randomised controlled trial

IntroductionPain caused by routine immunisations is distressing to children, their parents and those administering injections. If poorly managed, it can lead to anxiety about future medical procedures, needle phobia and...

Barriers to and Facilitators of the Prescription of mHealth Apps in Australian General Practice: Qualitative Study.

BackgroundThe ubiquity of smartphones and health apps make them a potential self-management tool for patients that could be prescribed by medical professionals. However, little is known about how Australian general practitioners and their patients view the possibility of prescribing mobile health (mHealth) apps as a nondrug intervention.ObjectiveThis study aimed to determine barriers and facilitators to prescribing mHealth apps in Australian general practice from the perspective of general practitioners and their patients.MethodsWe conducted semistructured interviews in Australian general practice settings with purposively sampled general practitioners and patients. The audio-recorded interviews were transcribed, coded, and thematically analyzed by two researchers.ResultsInterview participants included 20 general practitioners and 15 adult patients. General practitioners’ perceived barriers to prescribing apps included a generational difference in the digital propensity for providers and patients; lack of knowledge of prescribable apps and trustworthy sources to access them; the time commitment required of providers and patients to learn and use the apps; and concerns about privacy, safety, and trustworthiness of health apps. General practitioners perceived facilitators as trustworthy sources to access prescribable apps and information, and younger generation and widespread smartphone ownership. For patients, the main barriers were older age and usability of mHealth apps. Patients were not concerned about privacy and data safety issues regarding health app use. Facilitators for patients included the ubiquity of smartphones and apps, especially for the younger generation and recommendation of apps by doctors. We identified evidence of effectiveness as an independent theme from both the provider and patient perspectives.ConclusionsmHealth app prescription appears to be feasible in general practice. The barriers and facilitators identified by the providers and patients overlapped, though privacy was of less concern to patients. The involvement of health professionals and patients is vital for the successful integration of effective, evidence-based mHealth apps with clinical practice.

What Use is Anatomy in First Opinion Small Animal Veterinary Practice? A Qualitative Study.

Despite the uncontested importance of anatomy as one of the foundational aspects of undergraduate veterinary programs, there is still limited information available as to what anatomy knowledge is most important for the graduate veterinarian in their daily clinical work. The aim of this study was therefore to gain a deeper understanding of the role that anatomy plays in first opinion small animal veterinary practice. Using ethnographic methodologies, the authors aimed to collect rich qualitative data to answer the question "How do first opinion veterinarians use anatomy knowledge in their day-to-day clinical practice?" Detailed observations and semi-structured interviews were conducted with five veterinarians working within a single small animal first opinion practice in the United Kingdom. Thematic analysis was undertaken, identifying five main themes: Importance; Uncertainty; Continuous learning; Comparative and dynamic anatomy; and Communication and language. Anatomy was found to be interwoven within all aspects of clinical practice; however, veterinarians were uncertain in their anatomy knowledge. This impacted their confidence and how they carried out their work. Veterinarians described continually learning and refreshing their anatomy knowledge in order to effectively undertake their role, highlighting the importance of teaching information literacy skills within anatomy curricula. An interrelationship between anatomy use, psychomotor, and professional skills was also highlighted. Based on these findings, recommendations were made for veterinary anatomy curriculum development. This study provides an in-depth view within a single site small animal general practice setting: further work is required to assess the transferability of these findings to other areas of veterinary practice.

What is the role of the practice nurse in the care of people living with dementia, or cognitive impairment, and their support person(s)?: a systematic review

BackgroundThe potential value of expanding the Practice Nurse role to include the recognition and management of dementia has been acknowledged. Practice Nurses are well-positioned to provide comprehensive dementia information and support so that people living with dementia are better equipped to self-manage their health and live well with dementia. The purpose of this review was to systematically examine published literature to identify existing and potential roles of Practice Nurse’s in the delivery of care to people affected by dementia and to describe the characteristics and effectiveness of nurse interventions in dementia models of care.MethodsThe PRISMA statement guided the systematic review of the quantitative and qualitative evidence for roles and characteristics of the Practice Nurse in the delivery of dementia care. A comprehensive literature search of seven electronic databases and Google scholar identified relevant original research published in English between January 2000 and January 2019. Thirteen articles met the inclusion criteria and were extracted into the Covidence software for analysis.ResultsThe heterogeneity of the included studies purpose, design and outcomes measures and the diversity in health systems and primary care nurses scope of practice made it difficult to synthesise the findings and draw conclusions. The heterogeneity did, however, provide important insights into the characteristics of roles undertaken by nurses working in the general practice setting, which were potentially beneficial to people living with dementia and their support person. These included patient accessibility to the Practice Nurse, early recognition and management of cognitive changes, care management and collaboration with the General Practitioner. Limitations of the provision of dementia care by Practice Nurses included a lack of definition of the role, inadequate dementia specific training, time constraints and poor communication with General Practitioners.ConclusionsEmbedding an evidence-based model that describes the role of the Practice Nurse in dementia care provision has the potential to increase early recognition of cognitive impairment and more appropriate primary care management of dementia.Systematic review registrationPROSPERO 2018 CRD42018088191.

Diagnostic parameters of modified two-tier testing in European patients with early Lyme disease

Modified two-tier testing (MTTT) for Lyme borreliosis (i.e. confirmation with an EIA instead of an immunoblot) has been shown to have improved sensitivity compared with standard two-tier testing (STTT) in samples from American patients, without losing specificity. The current study assesses the sensitivity and specificity of various algorithms of MTTT in European patients with erythema migrans (EM) as a model disease for early Lyme borreliosis, and in appropriate controls. Four different immunoassays were used in the first tier, followed by either an immunoblot or the C6-EIA, or were used as standalone single-tier test. These tests were performed on consecutively collected sera of 228 Dutch patients with physician-diagnosed EM in the setting of general practice, 231 controls from the general population, and 50 controls with potentially cross-reactive antibodies. All the variants of MTTT that were studied had significantly higher sensitivity compared with their equivalent STTT, while retaining comparable specificity. Within the MTTT algorithms, classifying equivocal results as positive yielded better diagnostic parameters than classifying equivocal results as negative. The best diagnostic parameters were found using the Enzygnost-2 assay in the first tier, followed by a C6-ELISA in the second tier (sensitivity 77.6%, 95% CI 71.7–82.9; specificity 96.1%, 95% CI 92.7–98.2). This algorithm performed significantly better than the equivalent STTT algorithm in terms of sensitivity (p < 0.001), while maintaining comparable specificity (population controls p = 0.617). Our results show that MTTT can be a useful tool for the serodiagnosis of European patients with early Lyme borreliosis.

Hormone therapy for trans and gender diverse patients in the general practice setting.

In recent years there has been a significant increase in the number of trans, gender diverse and non-binary (TGDNB) people accessing healthcare. For many of these individuals the first port of call will be to their local general practitioner (GP). The TGDNB community is a high-priority population with the highest suicide rates of any population group in Australia. There is evidence that mental health outcomes improve significantly when individuals areable to access gender-affirming hormones. The aim of this article is to provide GPs working in Australia with a practical guide to prescribe gender-affirming hormone therapy to TGDNB patients. GPs are ideally placed to provide care forTGDNB patients in the primary care setting. Gender incongruence is no longer viewed as a mental health disorder. In recent years there has been a move away from mandatory psychiatric assessment to more contemporary patient-centred models of care.

Gender differences in COPD management in a Sicilian general practice setting: a cohort study evaluating the impact of educational interventions.

AimThe aim of this study was to measure gender differences among COPD patients' quality of care (QOC) before and after two educational interventions in Southern Italy.MethodsIn this prospective cohort study, COPD patients were identified from primary care electronic medical records (EMRs). Twelve process indicators concerning diagnosis, preventative measures and therapeutic processes were developed as a measure of QOC. Educational interventions consisted of clinical seminars and audits on COPD QOC at baseline, and at 12 and 24 months. QOC indicators were stratified by gender: odds ratios (ORs) (males as reference group) of having a good QOC indicator were calculated at baseline, 12 and 24 months, with 95% confidence intervals (CIs) using hierarchical generalised linear models.ResultsOf 46 326 people registered in the EMRs, 1463 COPD patients (3.1%) were identified, of which 37% were women. QOC indicators reflecting best practice 24 months after the educational programme were generally not different to baseline, often favouring men. On the other hand, the composite global QOC indicator suggested that while a good overall QOC at baseline was significantly higher in men than women (OR: 0.74; 95% CI: 0.57–0.96), it became nonsignificant at 24 months (OR: 0.96; 95% CI: 0.72–1.29).ConclusionsSpecific QOC indicators among COPD patients often favoured men. However, several gender disparities seen at baseline disappeared at 24 months, suggesting that even general educational interventions which do not target gender can improve the gender disparity in QOC.

\u2018Very brief advice\u2019 (VBA) on smoking in family practice: a qualitative evaluation of the tobacco user\u2019s perspective

BackgroundVery Brief Advice on smoking (VBA) is an evidence-based intervention designed to increase quit attempts among patients who smoke. VBA has been widely disseminated in general practice settings in the United Kingdom, however its transferability to Southern European settings is not well established. This study sought to document the perspectives of Greek general practice patients in terms of the acceptability and satisfaction with receiving VBA from their general practitioner (GP) and its influence on patients’ motivation to make a quit attempt. We also examine patient identified barriers and facilitators to acting on VBA.MethodsSemi-structured interviews were conducted with 50 patients who reported current tobacco use recruited from five general practices in Crete, Greece. All patients received VBA from their GP and interviews were conducted immediately after the GP appointment. Thematic analysis was used to analyze data.ResultsThe majority of patients were satisfied with the VBA intervention. Approximately one quarter of patients reported they were motivated to make an attempt to quit smoking after receiving VBA from their GP. Patients identified a clear preference for VBA to be delivered in a supportive manner, which communicated genuine concern versus fear-based approaches. Patients with an existing smoking-related illness were more likely to report plans to act on their GP’s VBA. Patients not ready to quit smoking indicated they would be likely to seek the support of their GP for future quit attempts as a result of VBA. Many patients reported low self-efficacy with quitting and apprehension about available quit smoking supports.ConclusionsVBA was positively received by the majority of smokers interviewed. Participating patients confirmed the motivational role of advice when delivered in a supportive and caring manner. Personal health status, beliefs about quit smoking supports, and low self-efficacy appear to influence patient’s motivation to make an aided quit attempt.

Assessment of female fertility in the general practice setting.

An assessment of female fertility may be undertaken in the general practice setting for a variety of reasons. These include concerns about future fertility when pregnancy is not immediately planned, adesire to consider elective oocyte cryopreservation and difficulty conceiving. The aim of this article is to summarise indications, rationale and components ofa comprehensive female fertility assessment in a primary care setting. The primary care physician has an essential role in providing women withguidance, counselling and assessment regarding fertility concerns. A complete initial assessment includes pre-pregnancy screening and counselling, and assessment of ovulation, ovarian reserve and pelvic anatomy to guide further investigation and management.