Family practice
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Approaches to improving the quality of health care recognize the need for systems and cultures that facilitate optimal care. Interpersonal relationships and dynamics are a key factor in transforming a system to one that can achieve quality. The Quality in Family Practice (QIFP) program encompasses clinical and practice management using a comprehensive tool of family practice indicators. ⋯ The program resulted in perceived changes to relationships, teamwork and morale. Addressing issues of leadership, role clarity, empowerment, flattening of hierarchy and teamwork may go a long way in establishing and maintaining a quality culture.
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Review Meta Analysis
Effectiveness of oseltamivir in adults: a meta-analysis of published and unpublished clinical trials.
Oseltamivir is widely used for the treatment of influenza. Previous systematic reviews suggest that they reduce complications, but had significant methodologic limitations. ⋯ There is no evidence that oseltamivir reduces the likelihood of hospitalization, pneumonia or the combined outcome of pneumonia, otitis media and sinusitis in the ITT population.
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Comparative Study
Comparing measures of multimorbidity to predict outcomes in primary care: a cross sectional study.
An increasing proportion of people are living with multiple health conditions, or 'multimorbidity'. Measures of multimorbidity are useful in studies of interventions in primary care to take account of confounding due to differences in case-mix. ⋯ The number of prescribed drugs is the most powerful measure for predicting future consultations and the second most powerful measure for predicting mortality. It may have potential as a simple proxy measure of multimorbidity in primary care.
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Advance care planning (ACP) has been gaining prominence for its perceived benefits for patients in enhancing patient autonomy and ensuring high-quality end-of-life-care. Moreover, it has been postulated that ACP has positive effects on families and health professionals and their relationship with the patient. However, there is a paucity of studies examining the views of GPs on this issue. ⋯ Our study highlights the importance that GPs place on the link between ACP and the patient's interpersonal context. This has implications on how ACP is conducted in primary care settings that are considerably different from other care settings in their emphasis on continuity of care and long-term nature of relationships.
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Promotion of self-care for persistent back pain and other long-term conditions has become a central component in health care policy in the UK, and general practitioners face increasing demands to support patients' self-care efforts. Gaining insight into patients' views may facilitate support. ⋯ Self-care for back pain is contextualized by the individual's capacity to self-care and preferences for support. Doubt over the ability of GPs to provide support for self-care may mean that those who have specific needs are reticent to seek help. The role of self-care in the management of back pain should be discussed openly at the consultation level, and GPs may be well placed to signpost patients and provide guidance on the safety of specific self-care activities.