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[PMID]:29462143
[Au] Autor:Bucholc M; O'Kane M; Ashe S; Wong-Lin K
[Ad] Endereço:Intelligent Systems Research Centre, University of Ulster, Magee Campus, Londonderry, Northern Ireland, United Kingdom.
[Ti] Título:Prescriptive variability of drugs by general practitioners.
[So] Source:PLoS One;13(2):e0189599, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Prescription drug spending is growing faster than any other sector of healthcare. However, very little is known about patterns of prescribing and cost of prescribing between general practices. In this study, we examined variation in prescription rates and prescription costs through time for 55 GP surgeries in Northern Ireland Western Health and Social Care Trust. Temporal changes in variability of prescribing rates and costs were assessed using the Mann-Kendall test. Outlier practices contributing to between practice variation in prescribing rates were identified with the interquartile range outlier detection method. The relationship between rates and cost of prescribing was explored with Spearman's statistics. The differences in variability and mean number of prescribing rates associated with the practice setting and socioeconomic deprivation were tested using t-test and F-test respectively. The largest between-practice difference in prescribing rates was observed for Apr-Jun 2015, with the number of prescriptions ranging from 3.34 to 8.36 per patient. We showed that practices with outlier prescribing rates greatly contributed to between-practice variability. The largest difference in prescribing costs was reported for Apr-Jun 2014, with the prescription cost per patient ranging from £26.4 to £64.5. In addition, the temporal changes in variability of prescribing rates and costs were shown to undergo an upward trend. We demonstrated that practice setting and socio-economic deprivation accounted for some of the between-practice variation in prescribing. Rural practices had higher between practice variability than urban practices at all time points. Practices situated in more deprived areas had higher prescribing rates but lower variability than those located in less deprived areas. Further analysis is recommended to assess if variation in prescribing can be explained by demographic characteristics of patient population and practice features. Identification of other factors contributing to prescribing variability can help us better address potential inappropriateness of prescribing.
[Mh] Termos MeSH primário: Prescrições de Medicamentos
Clínicos Gerais
[Mh] Termos MeSH secundário: Medicina Estatal
Reino Unido
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180221
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0189599


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[PMID]:29292924
[Au] Autor:Nyhlén L; Modig S
[Ad] Endereço:SUS Primärvård/ VO Omkretsen - Lomma vårdcentral Lomma, Sweden SUS Primärvård/ VO Omkretsen - Lomma vårdcentral Lomma, Sweden.
[Ti] Título:Tidsbrist största hindret för att utföra basal läke­medelsgenomgång - Enkätstudie till primärvårdsläkare i Region Skåne..
[So] Source:Lakartidningen;114, 2017 Nov 09.
[Is] ISSN:1652-7518
[Cp] País de publicação:Sweden
[La] Idioma:swe
[Ab] Resumo:Clinical medication reviews can be useful in improving pharmacotherapy for elderly. This study aimed to investigate the view and knowledge of clinical medication reviews among primary care physicians in order to identify perceived barriers and facilitating factors. Data were collected via a questionnaire given to primary care physicians in southern Sweden. Eight out of ten of the respondents were familiar with the concept of clinical medication review, and four out of ten of these, used the method on a regular basis. Lack of time was identified as the greatest impeding factor. Although necessary for a medication review, medication reconciliation was often lacking. Regardless of the theoretical knowledge of medications which are potentially inappropriate for elderly, the respondents still perceived difficulties in decisions made for the individual patient. Further education about medication reviews should be offered to primary care physicians, irrespective of time in the profession.
[Mh] Termos MeSH primário: Reconciliação de Medicamentos
Médicos de Atenção Primária
[Mh] Termos MeSH secundário: Adulto
Idoso
Atitude do Pessoal de Saúde
Competência Clínica
Feminino
Clínicos Gerais
Seres Humanos
Masculino
Reconciliação de Medicamentos/métodos
Reconciliação de Medicamentos/normas
Reconciliação de Medicamentos/utilização
Meia-Idade
Médicos de Família
Inquéritos e Questionários
Suécia
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180103
[St] Status:MEDLINE


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[PMID]:29206820
[Au] Autor:Rojas-Dosal JA
[Ad] Endereço:Presidente del Comité Normativo Nacional de Medicina General (CONAMEGE), México.
[Ti] Título:[General practitioner certification].
[Ti] Título:Certificación del médico general..
[So] Source:Gac Med Mex;153(6):651-652, 2017 Nov-Dec.
[Is] ISSN:0016-3813
[Cp] País de publicação:Mexico
[La] Idioma:spa
[Ab] Resumo:La regulación de la profesión médica es un proceso antiguo en nuestro país. Desde los tiempos del virreinato existía el Real Tribunal del Protomedicato, que tenía como función examinar a los médicos, cirujanos y boticarios para ser autorizados a ejercer su profesión; con el tiempo, esta función se fue relegando en otras estructuras administrativas que se fueron modificando, pero que la mantuvieron en vigor.
[Mh] Termos MeSH primário: Certificação
Clínicos Gerais/normas
[Mh] Termos MeSH secundário: Seres Humanos
México
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171206
[St] Status:MEDLINE
[do] DOI:10.24875/GMM.17003809


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[PMID]:29370178
[Au] Autor:Devillers L; Sicsic J; Delbarre A; Le Bel J; Ferrat E; Saint Lary O
[Ad] Endereço:Department of Family Medicine, Faculty of Health Sciences Simone Veil, University Versailles Saint-Quentin en Yvelines (UVSQ), Montigny-le-Bretonneux, France.
[Ti] Título:General Practitioner trainers prescribe fewer antibiotics in primary care: Evidence from France.
[So] Source:PLoS One;13(1):e0190522, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: Antibiotic prescription is a central public health issue. Overall, 90% of antibiotic prescriptions are delivered to patients in ambulatory care, and a substantial proportion of these prescriptions could be avoided. General Practitioner (GP) trainers are similar to other GPs in terms of sociodemographic and medical activities, but they may have different prescription patterns. Our aim was to compare the antibiotic prescribing rates between GP trainers and non-trainers. METHODS: This observational cross-sectional study was conducted on administrative data claims from the French National Health Insurance. The antibiotic prescribing rate was calculated. The main independent variable was the training status of the GPs. Prescribing rates were adjusted for the various GPs' characteristics (gender, age, location of the practice, number of visits per GP and the case-mix) in a multiple linear regression analysis. RESULTS: Between June 2014 and July 2015 the prescribing patterns of 860 GPs were analysed, among which 102 were GP trainers (12%). Over the year 363,580 patients were prescribed an antibiotic out of 3,499,248 visits for 1,299,308 patients seen over the year thus representing around 27.5% of patients. In the multivariate analyses, being a trainer resulted in a significant difference of 6.62 percentage points (IC 95%: [-8.55; -4.69]; p<0.001) in antibiotic prescriptions comparing to being a non-trainer, corresponding to a relative reduction of 23.4%. CONCLUSION: These findings highlight the role of GP trainers in antibiotic prescriptions. By prescribing fewer antibiotics and influencing the next generations of GPs, the human and economic burden of antibiotics could be reduced.
[Mh] Termos MeSH primário: Antibacterianos/uso terapêutico
Revisão de Uso de Medicamentos
Clínicos Gerais
Atenção Primária à Saúde/organização & administração
[Mh] Termos MeSH secundário: Estudos Transversais
Feminino
França
Seres Humanos
Masculino
Meia-Idade
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Anti-Bacterial Agents)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180126
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0190522


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[PMID]:29385155
[Au] Autor:Dumesnil H; Apostolidis T; Verger P
[Ad] Endereço:Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.
[Ti] Título:Opinions of general practitioners about psychotherapy and their relationships with mental health professionals in the management of major depression: A qualitative survey.
[So] Source:PLoS One;13(1):e0190565, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: French general practitioners (GPs) refer their patients with major depression to psychiatrists or for psychotherapy at particularly low rates. OBJECTIVES: This qualitative study aims to explore general practitioners' (GP) opinions about psychotherapy, their relationships with mental health professionals, their perceptions of their role and that of psychiatrists in treating depression, and the relations between these factors and the GPs' strategies for managing depression. METHODS: In 2011, in-depth interviews based on a semi-structured interview guide were conducted with 32 GPs practicing in southeastern France. Verbatim transcripts were examined by analyzing their thematic content. RESULTS: We identified three profiles of physicians according to their opinions and practices about treatment strategies for depression: pro-pharmacological treatment, pro-psychotherapy and those with mixed practices. Most participants considered their relationships with psychiatrists unsatisfactory, would like more and better collaboration with them and shared the same concept of management in general practice. This concept was based both on the values and principles of practice shared by GPs and on their strong differentiation of their management practices from those of psychiatrists. CONCLUSION: Several attitudes and values common to GPs might contribute to their low rate of referrals for psychotherapy in France: strong occupational identity, substantial variations in GPs' attitudes and practices regarding depression treatment strategies, representations sometimes unfavorable toward psychiatrists. Actions to develop a common culture and improve cooperation between GPs and psychiatrists are essential. They include systems of collaborative care and the development of interdisciplinary training common to GPs and psychiatrists practicing in the same area.
[Mh] Termos MeSH primário: Atitude do Pessoal de Saúde
Transtorno Depressivo Maior/terapia
Clínicos Gerais/psicologia
Relações Interprofissionais
Psicoterapia
[Mh] Termos MeSH secundário: Seres Humanos
Pesquisa Qualitativa
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180221
[Lr] Data última revisão:
180221
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0190565


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[PMID]:29363514
[Au] Autor:Roberts S
[Ad] Endereço:Leeds Teaching Hospitals and Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds LS2 9NL, UK.
[Ti] Título:Physician associates: different from but complementary to general practitioners.
[So] Source:BMJ;360:k244, 2018 01 23.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Clínicos Gerais
Médicos de Família
[Mh] Termos MeSH secundário: Terapias Complementares
Seres Humanos
Assistentes Médicos
[Pt] Tipo de publicação:LETTER; COMMENT
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180212
[Lr] Data última revisão:
180212
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180125
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.k244


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[PMID]:29267362
[Au] Autor:Liu Y; Chen C; Jin G; Zhao Y; Chen L; Du J; Lu X
[Ad] Endereço:Department of General Practice, School of General Practice and Continuing Education, Capital Medical University, Beijing, P.R. China.
[Ti] Título:Reasons for encounter and health problems managed by general practitioners in the rural areas of Beijing, China: A cross-sectional study.
[So] Source:PLoS One;12(12):e0190036, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: The purpose of this study was to describe the patients' reasons for encounter (RFE) and health problems managed by general practitioners (GPs) in the rural areas of Beijing to provide evidences for health services planning and GPs training. METHODS: This study was conducted at 14 community health service centers (CHSCs) in 6 suburban districts of Beijing, using a multistage sampling method. A total of 100 GPs was selected from the study sites. A self-designed data collection form was developed on the basis of Subjective-Objective-Assessment-Plan (SOAP), including patient characteristics, RFEs, health problems, interventions, and consultation length. Each GP recorded and coded their 100 consecutive patients' RFEs and health problems with the International Classification of Primary Care, 2nd version (ICPC-2). Descriptive statistics were employed to describe the distribution of RFE and health problems. Student t-test and analysis of variance were used to compare the differences of mean number of RFE or health problems per encounter by patient characteristics. RESULTS: A total of 10,000 patient encounters with 13,705 RFEs and 15,460 health problems were recorded. The RFEs and health problems were mainly distributed in respiratory, circulatory, musculoskeletal, endocrine, metabolic and nutritional, and digestive systems. Cough and hypertension were the most common RFE and health problem, respectively. With increased ages, the mean number of RFEs decreased and the mean number of health problems increased. Patients with Beijing medical insurance had less RFEs and more health problems than those in other cities (p<0.001). Patients who had visited the CHSC previously and signed contracts with the GP team had more health problems than those who had not (p<0.001). CONCLUSIONS: These findings present a view of patients' demands and work contents of GPs in Beijing rural areas and can provide reference for health services planning and GPs training.
[Mh] Termos MeSH primário: Clínicos Gerais
Serviços de Saúde Rural/organização & administração
População Rural
[Mh] Termos MeSH secundário: Adulto
Estudos Transversais
Feminino
Seres Humanos
Masculino
Meia-Idade
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180116
[Lr] Data última revisão:
180116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171222
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0190036


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[PMID]:28455347
[Au] Autor:Limb M
[Ad] Endereço:London.
[Ti] Título:Still no "credible plan" to increase GP numbers, say MPs.
[So] Source:BMJ;357:j2098, 2017 04 28.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Clínicos Gerais/provisão & distribuição
Reforma dos Serviços de Saúde
Seleção de Pessoal/organização & administração
[Mh] Termos MeSH secundário: Necessidades e Demandas de Serviços de Saúde
Seres Humanos
Motivação
Reino Unido
[Pt] Tipo de publicação:NEWS
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180101
[Lr] Data última revisão:
180101
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170430
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.j2098


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[PMID]:27772558
[Au] Autor:Konnopka A; König HH; Kaufmann C; Egger N; Wild B; Szecsenyi J; Herzog W; Schellberg D; Schaefert R
[Ad] Endereço:Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Germany. Electronic address: a.konnopka@uke.de.
[Ti] Título:Cost-utility of a specific collaborative group intervention for patients with functional somatic syndromes.
[So] Source:J Psychosom Res;90:43-50, 2016 11.
[Is] ISSN:1879-1360
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Collaborative group intervention (CGI) in patients with functional somatic syndromes (FSS) has been shown to improve mental quality of life. OBJECTIVE: To analyse incremental cost-utility of CGI compared to enhanced medical care in patients with FSS. METHODS: An economic evaluation alongside a cluster-randomised controlled trial was performed. 35 general practitioners (GPs) recruited 300 FSS patients. Patients in the CGI arm were offered 10 group sessions within 3months and 2 booster sessions 6 and 12months after baseline. Costs were assessed via questionnaire. Quality adjusted life years (QALYs) were calculated using the SF-6D index, derived from the 36-item short-form health survey (SF-36). We calculated patients' net-monetary-benefit (NMB), estimated the treatment effect via regression, and generated cost-effectiveness acceptability curves. RESULTS: Using intention-to-treat analysis, total costs during the 12-month study period were 5777EUR in the intervention, and 6858EUR in the control group. Controlling for possible confounders, we found a small, but significant positive intervention effect on QALYs (+0.017; p=0.019) and an insignificant cost saving resulting from a cost-increase in the control group (-10.5%; p=0.278). NMB regression showed that the probability of CGI to be cost-effective was 69% for a willingness to pay (WTP) of 0EUR/QALY, increased to 92% for a WTP of 50,000EUR/QALY and reached the level of 95% at a WTP of 70,375EUR/QALY. Subgroup analyses yielded that CGI was only cost-effective in severe somatic symptom severity (PHQ-15≥15). CONCLUSION: CGI has a high probability to be a cost-effective treatment for FSS, in particular for patients with severe somatic symptom severity.
[Mh] Termos MeSH primário: Comportamento Cooperativo
Análise Custo-Benefício/métodos
Intervenção Médica Precoce/economia
Clínicos Gerais/economia
Sintomas Inexplicáveis
Qualidade de Vida
[Mh] Termos MeSH secundário: Adulto
Intervenção Médica Precoce/métodos
Feminino
Custos de Cuidados de Saúde
Seres Humanos
Masculino
Meia-Idade
Qualidade de Vida/psicologia
Anos de Vida Ajustados por Qualidade de Vida
Inquéritos e Questionários
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; PRAGMATIC CLINICAL TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171229
[Lr] Data última revisão:
171229
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE


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[PMID]:27778366
[Au] Autor:Selinger CP; Carbery I; Warren V; Rehman AF; Williams CJ; Mumtaz S; Bholah H; Sood R; Gracie DJ; Hamlin PJ; Ford AC
[Ad] Endereço:Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
[Ti] Título:The relationship between different information sources and disease-related patient knowledge and anxiety in patients with inflammatory bowel disease.
[So] Source:Aliment Pharmacol Ther;45(1):63-74, 2017 01.
[Is] ISSN:1365-2036
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Patient education forms a cornerstone of management of inflammatory bowel disease (IBD). The Internet has opened new avenues for information gathering. AIM: To determine the relationship between different information sources and patient knowledge and anxiety in patients with IBD. METHODS: The use of information sources in patients with IBD was examined via questionnaire. Anxiety was assessed with the hospital anxiety and depression scale and disease-related patient knowledge with the Crohn's and colitis knowledge score questionnaires. Associations between these outcomes and demographics, disease-related factors, and use of different information sources were analysed using linear regression analysis. RESULTS: Of 307 patients (165 Crohn's disease, 142 ulcerative colitis) 60.6% were female. Participants used the hospital IBD team (82.3%), official leaflets (59.5%), and official websites (53.5%) most frequently in contrast to alternative health websites (9%). University education (P < 0.001), use of immunosuppressants (P = 0.025), Crohn's and Colitis UK membership (P = 0.001), frequent use of the hospital IBD team (P = 0.032), and frequent use of official information websites (P = 0.005) were associated with higher disease-related patient knowledge. Female sex (P = 0.004), clinically active disease (P < 0.001), frequent use of general practitioners (P = 0.014), alternative health websites (homoeopathy, nutritionists, etc.) (P = 0.004) and random links (P = 0.016) were independently associated with higher anxiety. CONCLUSIONS: Different patient information sources are associated with better knowledge or worse anxiety levels. Face-to-face education and written information materials remain the first line of patient education. Patients should be guided towards official information websites and warned about the association between the use of alternative health websites or random links and anxiety.
[Mh] Termos MeSH primário: Ansiedade/psicologia
Conhecimentos, Atitudes e Prática em Saúde
Doenças Inflamatórias Intestinais/psicologia
Internet/utilização
Folhetos
Educação de Pacientes como Assunto/métodos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Ansiedade/diagnóstico
Ansiedade/terapia
Estudos Transversais
Feminino
Clínicos Gerais/utilização
Seres Humanos
Doenças Inflamatórias Intestinais/diagnóstico
Doenças Inflamatórias Intestinais/terapia
Masculino
Meia-Idade
Relações Médico-Paciente
Inquéritos e Questionários
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1708
[Cu] Atualização por classe:171220
[Lr] Data última revisão:
171220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE
[do] DOI:10.1111/apt.13831



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