Hospital General Practitioners Research Articles

The association of long-term exposure to outdoor air pollution with all-cause GP visits and hospital admissions by ethnicity and country of birth in the United Kingdom.

Air pollution is associated with poor health. Yet, more research is needed to reveal the association of long-term exposure to outdoor air pollution with less studied health outcomes like hospital admissions and general-practitioner (GP) visits and whether this association is stronger for ethnic minorities compared to the rest of population. This study investigates the association between air pollution and all-cause GP visits and hospital admissions by ethnicity in the United-Kingdom (UK). We used individual-level longitudinal data from the "UK Household Longitudinal Study" including 46,442 adult individuals who provided 140,466 responses across five years (2015-2019). This data was linked to yearly concentrations of NO2, SO2, and particulate-matter (PM10, PM2.5) outdoor pollution using the Lower Super Output Area (LSOA) of residence for each individual. Multilevel mixed-effects ordered logistic models were used to assess the association between air pollution and all-cause GP visits and hospital admissions. We found higher odds of hospital admissions per 1 μg/m3 increase in annual concentrations of NO2 (OR = 1.008; 95%CI = 1.004-1.012), SO2 (OR = 1.048; 95%CI = 1.014-1.083), PM10 (OR = 1.011; 95%CI = 1.003-1.018), and PM2.5 (OR = 1.018; 95%CI = 1.007-1.029) pollutants. Higher odds of GP visits were also observed with increased exposure to NO2 (OR = 1.010; 95%CI = 1.006-1.014) and SO2 (OR = 1.114; 95%CI = 1.077-1.152) pollutants. The observed associations did not differ across ethnic groups, but by country of birth, they were more pronounced in individuals born outside UK than those born in UK. This study supports an association between higher exposure to outdoor air pollution and increased all-cause hospital admissions and GP visits. Further longitudinal studies with longer follow-up time periods may be able to reveal more definite conclusions on the influence of ethnicity on the association between long-term outdoor air pollution and both hospital admissions and GP visits.

The CELTIC ranges project (comprehensive and effective laboratory test reference intervals for Irish children) methodology and results for renal profile tests in plasma on the Roche modularTM system.

The CELTIC ranges project aims to deliver a comprehensive range of reference intervals for commonly ordered laboratory investigations suitable for use in an Irish population as well as enabling comparison with relevant international studies. In this paper, we describe our methodology used throughout the entire project and present paediatric reference intervals for renal profile tests in plasma (sodium, potassium, urea and creatinine). 1023 children aged up to 17years were recruited from our hospital's general practitioner paediatric phlebotomy clinic. Clinical chemistry analyses were performed on the Roche modular system and statistical analysis was completed in line with CLSI guideline EP28-A3c. The plasma reference interval for sodium for ages 0.45-16.99 years was 137-143mmol/L in 1000 subjects (combined genders). For plasma potassium, the corresponding ranges between 1 and 16.99years (combined genders) were 3.6-4.8mmol/L. Apart from neonates and in keeping with other studies, age partitioning for electrolytes was not required. Data for plasma creatinine (enzymatic methodology) and urea is also presented and, as anticipated, required partitioning for both age and gender. Our renal profile findings are broadly consistent with those of international studies, for example, CALIPER, HAPPI, NORDIC, PRINCE and KiGGs. Moreover, the CELTIC ranges study is also based on over 1000 subjects whose samples were analysed on the widely used Roche modular analytics system. We also expect the findings will improve knowledge of children's metabolic health in Ireland.

Triage Competency and Its Associated Factors Among Healthcare Providers in Emergency Department in Kenya

Background: In developing world triage is underutilized and often an ineffective area of health system. In Kenya triage system is considered under developed and there is no National acceptable Accident and Emergency (A&E) triage system. Objective: The main objective of the study was to assess triage competency and its associated factors among healthcare providers in emergency department at selected hospitals in Kakamega County. Methods: This was a cross-sectional study design. Census sampling was used to select the General Practitioner hospitals. Systematic sampling was used to select study participants from the 11selected hospitals. The study participants were 183 health care providers including; doctors, clinical officers and nurses working within the selected hospitals in accident and emergency departments. Data was collected using an observation check list and structured questionnaire. Data was analyzed using statistical package of social science software version 24. Inferential statistics were used to test the strength of association. Results: The triage competency skills observed were; Rapid assessment; high level of skills observed at a mean of 88.9, patient categorization; the skills were moderate at a mean of 79.1, and Patient allocation skills which was moderate at a mean of 79.2. Conclusion: The hospital should organize unit base training on triaging, formulate guidelines triaging, avail resources needed and supervise triage area.

Healthcare use by children in North West London 2015-2019 by deprivation and integrated care access

Abstract Background England has a health system offering universal coverage, but disparities in healthcare use are increasing. Between 2007-2017, children living in more deprived areas had higher rates of unplanned care (Emergency Department (ED) attendance and hospital admissions), whereas children from less deprived areas had higher rates of planned care (General Practitioner (GP) contact and outpatient appointments). More detailed research to find solutions for this divergent pattern is required. Aim To assess the rates of GP contact, outpatient appointments, hospital admissions and ED attendance in North West London, by Index of Multiple Deprivation (IMD) decile of home postcode and access to an integrated care service providing linked care between multiple child health professionals ‘Connecting Care for Children (CC4C)', for children aged 0-18 years between 2015-2019. Methods Retrospective analysis of a de-identified database of integrated care records for 495,357 children. Results Children from the most deprived decile had higher rates of emergency admissions (0.070 per child per year vs. overall mean 0.040), elective admissions (0.076 vs. 0.032), ED attendances (0.754 vs. 0.358) and outpatient appointments (1.702 vs. 0.756) between 01.01.2015- 31.12.2019. Children from the least deprived decile had the second highest rates of outpatient appointments (0.911 vs. 0.756) and GP contact (8.192 vs. 5.390) between 01.01.2015- 31.12.2019. Children with access to the CC4C service, despite being from more deprived backgrounds, had lower rates of emergency admissions (0.028 vs. 0.037) compared to patients with access to usual care. P values <0.001 in all cases. Conclusions Greater deprivation was linked to higher rates of emergency admissions, but this was partially mitigated by access to more integrated healthcare models. Children from the least deprived decile continued to have disproportionately higher use of planned care. Key messages • Despite universal health coverage, children from more deprived areas continue to have disproportionately higher use of unplanned care. • Further research is required to explore whether integrated care solutions can reduce the burden on unplanned health services and inequalities in access to care.

Literature Review: Analysis of Soft Skills Affecting the Recruitment Process for General Practitioners in Hospitals

The purpose of this system is to analyze Soft Skills that affect the recruitment process of general practitioners in hospitals. The literature review in this study was carried out through a systematic selection sought from international databases. The author searches for data sources from various databases, including PubMed (https://www.ncbi.nlm.nih.gov/pubmed/), and SAGE journals (https://journals.sagepub.com/). The articles found were 10 articles that discussed the recruitment process and the influence of soft skills in the recruitment process. In the recruitment process, prospective applicants go through various recruitment and selection stages. The method used by the hospital is done online and offline. The online method is widely used in the form of information that is disseminated through the hospital web, Facebook and Instagram offline by recruiting internal hospitals such as recommendations from hospital employees and foundations. Hospitals under the auspices of the foundation prefer to use the offline method, namely by withdrawing from existing foundations, although it is possible to recruit online.

Literature Review: Analysis of Soft Skills Affecting the Recruitment Process for General Practitioners in Hospitals

Literature Review: Analysis of Soft Skills Affecting the Recruitment Process for General Practitioners in Hospitals

HEALTHCARE PROVIDERS’ FACTORS INFLUENCING TRAUMA CARE PREPAREDNESS IN ACCIDENT AND EMERGENCY DEPARTMENT OF SELECTED HOSPITALS IN KAKAMEGA COUNTY, KENYA

Purpose: The main objective of the study was to determine health care provider factor influencing trauma care preparedness among health care providers working in accident and emergency department of the selected hospitals.
 Materials and Methods: This was a cross-sectional Analytic study. Census sampling was used to select General Practitioner hospitals. Systematic sampling technique was used to choose study participants from 11 selected hospitals. The study participants were 183 health care providers (Doctors, Clinical Officers and Nurses) working in the selected hospitals’ accident and emergency departments. Data was collected using structured questionnaires and observation checklists. Data was analyzed using statistical package for Social Science software version 22.0. Inferential statistics were used to test the strength of association. 
 Findings; Health care providers’ factors that influenced trauma care preparedness were; specific training on trauma care (p=0.002), attending Continuing medical education (p=0.0008) and duration when last update was received (p= 0.04). 
 Unique contributions to Theory, Practice and Policy: Trauma related training, trauma related continuing medical education and duration when last trauma update was received influence trauma. Health care providers working in accident and emergency department should undergo trauma related training and get frequent updates on trauma care.

Contemporary Trends in the Level of Staffing by General Practitioners in Krasnodar Krai

Aim. To evaluate the level of staffing by general practitioners (GP) in medical organizations in Krasnodar Krai.Materials and methods. Indicators characterizing the level of staffing by GPs in Krasnodar Krai hospitals were analysed using data from the state statistical observation form No. 30 “Information about a medical organization” for the 2009–2019 period. According to the data derived from the Krasnodar Krai Patient Register as of 01.01.2020, all GPs were divided into groups in terms of the ratio of the number of served population and the recommended values. Using the data of the Regional Register of Medical Workers as of 01.01.2020, the age composition of GPs was analysed.Results. As of 01.01.2020, Krasnodar Krai featured 228 medical organizations subordinate to the Krasnodar Krai Ministry of Healthcare. Of these, 58 have full-time GP positions. The overall number of GP positions comprises 294, which are currently taken by 198 specialists (1.1% of the total number of doctors and 1.9% of doctors providing medical care on an outpatient basis). Over the studied period, stable indicators of the provision of the Krasnodar Krai population by GPs were noted; however, the level of staffing by GPs in hospitals was decreasing. This indicates a growing trend in the lack of GPs. An analysis of the actual load of 198 GPs showed that, on average, 1 GP serves 1219 people. For 26.8% of GPs, the number of served population increased the recommended values by 1.5 times or more. As a result, over 100,000 adults in the region are served under the conditions of excessive workload on GPs. The average age of GP is 50.1 ± 0.9 years. Currently, more than 25% of GPs are working retirees by age. In the medium term, this value may exceed 50%. Considering specialists who are about to retire, the estimated need for GPs is 146 doctors.Conclusion. In order to provide affordable and high-quality primary health care to the population in Krasnodar Krai, the number of GPs should be increased. In addition, measures should be taken to raise the attractiveness of work in Krasnodar Krai hospitals.

Critères d’indications de la biopsie rénale chez les patients diabétiques de type 2 protéinuriques : enquête auprès des néphrologues français

Diabetic nephropathy is usually a presumptive diagnosis based on clinical and biological evidence. Renal biopsies are performed in diabetic patients with atypical findings evoking non-diabetic renal disease who could benefit from specific therapies. French speaking nephrologists were asked which criteria they retain to indicate renal biopsy in patients with type 2 diabetes and albuminuria>0.5g/day or equivalent through an online anonymous questionnaire. Among the suggested criteria were absence of diabetic retinopathy, hematuria, rapid decrease in GFR, short diabetes duration or rapid raise of proteinuria. 188 people answered the poll among whom interns (12%), fellows (13%), university hospital practitioners (26%), general hospital practitioners (24%), practitioners in a non-profit organization (13%), practitioners on private activity (10%), multi-modal practitioners (3%) and people without clinical activity (2%). Increasing proteinuria was retained as an indication criterion for renal biopsy by 51% of respondents, nephrotic syndrome by 56% of respondents, absence of diabetic retinopathy by 57% of respondents, short diabetes duration by 65% of respondents, rapid GFR decline by 75% of respondents and hematuria by 78% of respondents. These data highlight the high diversity of opinions on this topic and their discrepancies with guidelines and current literature regarding the association between non-diabetic renal disease and clinical and biological features. The lack of adhesion of nephrologists to guidelines was especially noteworthy regarding the absence of diabetic retinopathy. These results emphasize the need for studies focusing on biopsy indication criteria in patients with type 2 diabetes.

Modern Innovative Solutions in Improving Outcomes in Chronic Obstructive Pulmonary Disease (MISSION COPD): Mixed Methods Evaluation of a Novel Integrated Care Clinic.

BackgroundChronic obstructive pulmonary disease (COPD) is the second-leading cause of death in the United Kingdom and accounts for 1.7% of bed days in acute hospitals. An estimated two-third of patients with COPD remain undiagnosed.ObjectiveModern Innovative Solutions in Improving Outcomes in Chronic Obstructive Pulmonary Disease (MISSION COPD) aimed to proactively identify patients from primary care who were undiagnosed or had uncontrolled COPD and to provide a comprehensive integrated multidisciplinary clinic to address the needs of this complex group for improving diagnosis, personalizing therapy, and empowering patients to self-manage their condition.MethodsThis clinic was led by a respiratory specialist team from Portsmouth Hospitals NHS Trust working with five primary care surgeries in Wessex. A total of 108 patients were reviewed, with 98 patients consenting to provide additional data for research. Diagnoses were changed in 14 patients, and 32 new diagnoses were made.ResultsReductions were seen across all aspects of unscheduled care as compared to the prior 12 months, including in emergency general practitioner visits (3.37-0.79 visits per patient, P<.001), exacerbations (2.64-0.56 per patient, P=.01), out-of-hours calls (0.16-0.05 per patient, P=.42), and hospital admissions (0.49-0.12 per patient, P=.48). Improvements were observed in the quality of life and symptom scores in addition to patient activation and patient-reported confidence levels.ConclusionsThis pilot demonstrates that the MISSION model may be an effective way to provide comprehensive gold-standard care that is valued by patients and to promote integration across sectors.

An Assessment of Potential Unintended Consequences Following a National Antimicrobial Stewardship Program in England: An Interrupted Time Series Analysis.

The "Quality Premium" (QP) introduced in England in 2015 aimed to financially reward local healthcare commissioners for targeted reductions in primary care antibiotic prescribing. We aimed to evaluate possible unintended clinical outcomes related to this QP. Using Clinical Practice Research Datalink and Hospital Episode Statistics datasets, we examined general practitioner (GP) consultations (visits) and emergency hospital admissions related to a series of predefined conditions of unintended consequences of reduced prescribing. Monthly age- and sex-standardized rates were calculated using a direct method of standardization. We used segmented regression analysis of interrupted time series to evaluate the impact of the QP on seasonally adjusted outcome rates. We identified 27334 GP consultations and >5 million emergency hospital admissions with predefined conditions. There was no evidence that the QP was associated with changes in GP consultation and hospital admission rates for the selected conditions combined. However, when each condition was considered separately, a significant increase in hospital admission rates was noted for quinsy, and significant decreases were seen for hospital-acquired pneumonia, scarlet fever, pyelonephritis, and complicated urinary tract conditions. A significant decrease in GP consultation rates was estimated for empyema and scarlet fever. No significant changes were observed for other conditions. Findings from this study show that overall there was no significant association between the intervention and unintended clinical consequences, with the exception of a few specific conditions, most of which could be explained through other parallel policy changes or should be interpreted with caution due to small numbers.

Understanding pain among older persons: Part 2—the association between pain profiles and healthcare utilisation

While polypharmacy and multimorbidity predict healthcare utilisation among older people, the influence of differing pain profiles on healthcare utilisation is unclear. To compare healthcare utilisation between people with different pain profiles. Baseline data from The Irish LongituDinal study on Ageing (TILDA), a population-representative cohort study involving over 8,171 community living people resident in Ireland aged 50 or over, was used. Following the creation of four novel pain profiles, variables relating to healthcare utilisation were compared across the different profiles using chi-square tests and logistic regression. Healthcare utilisation differed across the four pain profiles, with pain being an independent predictor of resource use. Pain profiles 3 and 4 had higher use of general practitioner (GP) care and outpatient visits than people with no pain and pain that had less impact. The odds of being a frequent GP attender increased across pain profiles, with those in profile 4 being almost three times as likely to be frequent attenders compared to those with no pain (adjusted odds ratio (OR) = 2.79; 95% CI 2.74, 2.83). People in profile 4 were almost twice as likely to have a hospital outpatient visit compared to people with no pain (adjusted OR = 1.75; 95% 1.73, 1.78). Healthcare utilisation differed between the four pain profiles, with people in profiles 3 and 4 having greater usage of primary and secondary healthcare resources. Pain profile membership was a significant independent predictor of the utilisation of GP care and hospital outpatient visits.

Perspectives on the provision of GDM screening in general practice versus the hospital setting: a qualitative study of providers and patients

ObjectiveA novel gestational diabetes mellitus (GDM) screening programme which involved offering screening at the patient's general practitioner (GP) compared with the traditional hospital setting was trialled. This study investigates perspectives...

Emergence of Extended Spectrum Beta-Lactamase-Producing Gram Negative Bacilli among patients with community acquiredUrinary Tract Infection (CA-UTI) in a Community in South West Nigeria

This study investigated the antimicrobial susceptibility pattern of Gram negative bacilli causing UTI in two Hospitals in a cosmopolitan community in South West, Nigeria. BU is a Tertiary-Care Hospital, and SH is a Private General Practitioner Hospital. One hundred (100) urine samples were collected at each station during the six-month study period and analyzed using standard bacteriology procedures. Bacteria were isolated from the urine samples on MacConkey agar, Blood agar and chocolate agar and isolates tested for susceptibility to 28 different antibiotics using the disc diffusion method. Further, isolates showing resistance to ceftazidime were screened for ESBL production by double disc synergy test (DDST). 20 urine samples (16 from SH and 4 from BU) yielded growth of bacteria which all showed resistance to more than one of the tested antibiotics. The urine samples from a patient yielded growth of two different bacteria species. All isolates showing resistance to ceflazidime (n=15) tested positive for ESBL. Blochemical characterization tests confirmed the ESBL producers as Klebsiella. pneumonia (n=14) and Enterobacter cloacae (n=1). There was an incidence of multiple drug-resistant ESBL producing Gram negative bacilli in this community.

From Cottage to Community Hospitals: Watlington Cottage Hospital and its Regional Context, 1874–2000

The appearance in England from the 1850s of 'cottage hospitals' in considerable numbers constituted a new and distinctive form of hospital provision. The historiography of hospital care has emphasised the role of the large teaching hospitals, to the neglect of the smaller and general practitioner hospitals. This article inverts that attention, by examining their history and shift in function to 'community hospitals'within their regional setting in the period up to 2000. As the planning of hospitals on a regional basis began from the 1920s, the impact of NHS organisational and planning mechanisms on smaller hospitals is explored through case studies at two levels. The strategy for community hospitals of the Oxford NHS Region--one of the first Regions to formulate such a strategy--and the impact of that strategy on one hospital, Watlington Cottage Hospital, is critically examined through its existence from 1874 to 2000.

Health Needs Assessment and Nurse-Led Health Care Services of a Small Island Community: Methodology and Results of a Pilot Study of the Health Status of Residents of Stewart Island, New Zealand

Context : Provision of health care needs to small remote communities is a challenge requiring careful consideration. Stewart Island is a small island located at the far south of New Zealand. First-line primary health care services are provided by two rural nurse specialists supported on the mainland by a general practitioner and regional hospital 72 kms away. Geographical and professional isolation factors and maintaining personal privacy were key aspects in the design of the study. Purpose : To undertake a health needs assessment of a small isolated community considering both resident and health professional perspectives. Methods : A mixed methodology was employed to undertake the health needs assessment: self administered resident survey and semi-structured interviews with four health professional stakeholders (two on the island and two on the mainland). Findings : The survey attracted 106 returns (approx. 30% of adult residents). Stewart Islanders reported similar rates of established chronic conditions compared to New Zealanders as a whole, indicating the need for access to a full range of primary health care services: acute and chronic care; health promotion and illness prevention. Residents and health professional stakeholders supported the current model of nurse-led health service provision with remote interdisciplinary support. Reported gaps included visiting allied health services, and issues of professional isolation and professional development for the rural nurses. Conclusion: Researching health needs of a confined community raises particular issues in confidential data collection and reporting. Remote health service provision brings unique challenges but Stewart Islanders believe the current model of nurse-led service provision largely meets their needs.

The incidence of inflammatory bowel disease in a rural region of Southern Germany: a prospective population-based study

Although important advances in understanding the aetiology and pathogenesis of inflammatory bowel disease (IBD) have been made, many questions remain unanswered. As the most recent data available on the incidence of IBD in Germany were collected about 15 years ago, we set up a new population-based cohort to determine current incidence data for a defined region in Germany and to establish a basic cohort for prospective follow-up. All patients living in the region of Oberpfalz newly diagnosed with IBD between 1 January 2004 and 31 December 2006 were included in this study by setting up a network of reporting clinicians and general practitioners in hospitals as well as in private practices. Demographic and clinical characteristics such as age at first diagnosis, localization of the disease, extraintestinal manifestations or family history on IBD were documented. Age-adjusted incidence rates are presented with 95% Poisson confidence intervals (CIs), based on the European standard population. In total, 286 newly diagnosed patients with IBD were reported in this region, 168 patients suffering from Crohn's disease (CD), 105 patients with ulcerative colitis. Age-standardized incidence rates were 11.0/10(5) (95% CI: 9.1-11.6) for IBD, 6.6/10(5) (95% CI: 5.6-7.7) for CD and 3.9/10(5) (95% CI: 3.2-4.7) for ulcerative colitis. Peak incidences were found in the age interval of 16-24 years for both diseases, predominantly for CD. Age at first diagnosis was lower, extraintestinal manifestations and a positive family history on IBD were more common in patients with CD. The incidence rate in IBD seems to be stable in Germany as compared with previously reported data, as is the remarkable predominance of CD. Prospective follow-up studies will be based on this incidence cohort.

Direct medical costs of monitoring and treating patients with Takayasu arteritis in Italy.

The study provides the first overall estimate of the costs of Takayasu arteritis (TA) monitoring and treatment in Italy and highlights the differences in cost components across defined subgroups of patients. We estimated resource consumption and direct costs from the Italian National Health Service perspective. We conducted a multicenter, prospective study in 12 medical departments. All the 67 patients recruited met the American College of Rheumatology 1990 criteria for the classification of TA and were followed up for 1 year. For the purpose of analysis they were divided into two groups: "active TA" (patients who had taken at least one drug specific for TA treatment, i.e., corticosteroids and/or cytotoxics), and "inactive TA" (all the remaining patients). The average cost per year was Euro 4,079. Patients with active TA (Euro 5,055) had a significantly higher mean cost per year than those with inactive TA (Euro 1,328). In particular, significant differences were found for costs in general practitioner consultations, laboratory tests, and hospital admissions. These findings suggest that patients not only experience more complications requiring hospital admissions but also see general practitioners more often during the active stage of the disease, presumably in order to obtain a prescription for laboratory tests.

Medication reviews in the community: results of a randomized, controlled effectiveness trial

To examine the effectiveness of a multidisciplinary service model delivering medication review to patients at risk of medication misadventure in the community. The study was carried out in three Australian states; Queensland, New South Wales and Western Australia, and conducted as a randomized, controlled effectiveness trial with the general practitioner (GP) as the unit of randomization. In total, 92 GPs, 53 pharmacists and 400 patients enrolled in the study. The multidisciplinary service model consisted of GP education, patient home visits, pharmacist medication reviews, primary healthcare team conferences, GP implementation of action plans in consultation with patients, and follow-up surgery visits for monitoring. Effectiveness was assessed using the four clinical value compass domains of (i) functional status, (ii) clinical outcomes, (iii) satisfaction and (iv) costs. The domains of functional status (assessed by the health-related quality of life measure SF-36 subscales) and clinical outcomes (as assessed by adverse drug events (ADEs), number of GP visits, hospital services and severity of illness) were measured at baseline and endpoint. Satisfaction was measured by success in implementation and by participant satisfaction at endpoint, and costs (as assessed using medication and healthcare service costs, less intervention costs) were measured preintervention and during the trial. In addition, process evaluation was conducted for intervention patients, in which problems and recommendations from the medication reviews were described. The model was successfully implemented with 92% of intervention GPs suggesting that the model had improved the care of participating patients, a view shared by 94% of pharmacists. In addition, positive trends in clinical outcomes (ADEs and severity of illness) and costs (an ongoing trend towards reduction in healthcare service costs) were evident, although the trial was limited to a 6-month intervention time. No differences between intervention and control groups were identified for the health-related quality of life domain. The cost-effectiveness ratio for the intervention based on cost savings, reduced adverse events and improved health outcomes was small. The most common problems identified in the medication reviews were potential adverse drug reactions, suboptimal monitoring and adherence/lack of concordance issues. In total, 54.4% of recommendations were enacted, and 23.9% were implemented precisely as recommended in the medication review. Follow-up evaluation showed that 70.9% of actions had a positive outcome, 15.7% no effect and 3.7% had a negative outcome. Most studies emphasize efficacy and the best achievable clinical outcomes rather than whether an intervention will be effective in practice. The current trial showed that three of the four domains in the clinical value compass showed trends of improvement or were indeed improved in the relatively short follow-up period of the trial, suggesting that a service based on this model could achieve similar benefits in practice. A domiciliary medication review programme similar to this model has now been implemented into national Australian practice, where GPs and pharmacists are reimbursed by the Australian government for the provision of these services.

The first general practitioner hospital in The Netherlands: towards a new form of integrated care?

Objective To describe the types of patients admitted to the first Dutch general practitioner (GP) hospital, their health-related quality of life and its substitute function.Design A prospective observational study.Setting The remaining 20-bed ward of a former district general hospital west of Amsterdam; a region with 62 000 inhabitants and 26 GPs.Subjects All patients admitted during the 12 months between 1 June 1999 and 1 June 2000.Main outcome measures Patients’ health-related quality of life (Medical Outcome Study 36-item Short Form Health Survey, Groningen Activities Restriction Scale), GPs assessments of severity of illness (DUSOI/WONCA Severity of Illness Checklist) and alternative modes of care.Results In total, 218 admissions were recorded divided into 3 bed categories: GP beds (n=131), rehabilitation beds (n=62) and nursing home beds (n=25). The mean age of all patients was 76 years. Main reasons for admission were immobilization due to trauma at home (GP beds), rehabilitation from surgery (rehabilitation beds) and stroke (nursing home beds). Overall, patients showed a poor health-related quality of life on admission. If the GP beds had not been available, the GPs estimated that the admissions would have been almost equally divided among home care, nursing home and hospital care. The severity of the diagnosis on admission of the ‘hospital-care group’ appeared to be significantly higher than the other care groups.Conclusion The GP hospital appears to provide a valuable alternative to home care, nursing home care and hospital care, especially for elderly patients with a poor health-related quality of life who are in need of short medical and nursing care.