Family practice
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General practitioners' perceptions of low back pain (LBP) patients were investigated through a series of in-depth semi-structured interviews, as part of a wider study which also investigated patient perceptions. An exhaustive analysis of the interview transcripts revealed six principal ways in which GPs distinguished between different patients as a means of deciding how to treat them. This differentiation, on the basis of patient characteristics, is the major focus for the resulting discussion and conclusions, and is used as a way of exploring more effective strategies for the future.
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The objective was to analyse clinical and non-clinical factors associated with the receipt of a prescription for a benzodiazepine among general practice patients. A survey of 110 consecutive patient encounters (consultations) as recorded by a representative sample of general practitioners in inner urban, outer urban and rural settings was designed. A total of 286 general practitioners took part during 1991-2. 31,256 patients (10,683 male; 34%) were surveyed and the odds of receiving a benzodiazepine script measured. ⋯ There is a need to educate doctors about the non-drug management of insomnia. The stereotype of the doctor over-prescribing a benzodiazepine without an appropriate problem/diagnosis should be questioned. On the other hand, there is concern that patient age continues to be associated with a prescription of these medications, when all other clinical and non-clinical factors are taken into account.
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Review Comparative Study
Frequent attenders of Finnish public primary health care: sociodemographic characteristics and physical morbidity.
In this article results of a Finnish study on frequent attender patients of public primary health care are reported. These patients (n = 96) were compared with other patients (n = 466) attending the same surgeries. ⋯ The results indicate that many frequent attender patients complaints form a complicated network departing from different levels (physical, psychological and social). The implications of the findings are discussed.
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Case note data were obtained for 186 elderly primary care attenders who also completed the 15 item Geriatric Depression Scale (GDS15). The presence or absence in the case notes of a current or past diagnosis of depression, of current treatment of depression, and of a number of clinical features of depression were noted. Case notes were also rated for the presence or absence of contraindications to the use of tricyclic antidepressants (TCAs) and to serotonin-specific reuptake inhibitors (SSRIs). ⋯ The former was significantly associated with GDS caseness (P < 0.05). Twenty-four patients (13%) were currently on antidepressants, 19 of them receiving adequate doses (equivalent to at least 75 mg of amitriptyline). Current antidepressant treatment was not associated with GDS 'caseness'.(ABSTRACT TRUNCATED AT 250 WORDS)
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Review
The role of social support in the pathogenesis of coronary heart disease. A literature review.
A possible effect of social support on the pathogenesis of coronary heart disease (CHD) would have practical implications, especially from a general practitioner's point of view. This paper reviews studies on the relationship between social support and CHD/CHD risk factors. ⋯ This conclusion is supported by several investigations indicating that social support is capable of moderating potentially harmful negative emotions and the potentially harmful cardiovascular response to psychological challenge. However, a lack of control with personality factors in most of the studies makes this conclusion uncertain.