The British journal of general practice : the journal of the Royal College of General Practitioners
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Review
Review of 39 years of randomized controlled trials in the British Journal of General Practice.
Randomized controlled trials are being used increasingly to evaluate the effectiveness of health care interventions, including those in primary care. ⋯ Some imaginative solutions to the logistic difficulties of conducting randomized trials in general practice were noted. These may serve as an incentive to those undertaking such studies in the future.
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Against a background of concern over the costs of the cervical screening programme in the United Kingdom, increased precision in targeting groups at high risk of having an abnormal cervical smear offers a means of increasing efficiency. Previous papers have described the development of a risk scoring system and its feasibility and reliability in primary care. ⋯ Given the ease with which risk status can be ascertained (a risk score could not be calculated for only 23 of 3661 women) and the magnitude of difference in risk, the risk scoring system appears to have potential for assisting the targeting of screening resources. Studies of risk perception and behaviour, and ultimately a randomized controlled trial, are required to assess the effectiveness and cost effectiveness of risk targeting.
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Increasing numbers of long-term mentally ill people now live in the community, many of whom lose contact with psychiatric services and come to depend on general practitioners for medical care. However, it has been suggested that general practitioners may be unaware of some of these patients and their needs. ⋯ These findings suggest that patients in long-term contact with specialist services cannot be taken as representative of the whole population with long-term mental illness. General practitioners could use their frequent contacts with long-term mentally ill people to play a greater role in monitoring the mental state and drug treatment of this group.
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A screening clinic for Bangladeshi families was established in order to improve the health care provided by one general practice to its Bangladeshi patients. ⋯ This clinic provides a model which could be adapted for use with other ethnic or 'hard-to-reach' groups. It may also prove an effective way of screening all families in general practice.
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Attendance at health checks of patients already registered with a general practitioner is known to be poor, with those in need least likely to attend. Little is known of the efficacy of such checks for newly registered patients. ⋯ Attendance at registration health checks at these practices was poor and non-attenders tended to be more socially deprived than attenders and had relatively unhealthy lifestyles. Although the health checks increased the attenders' motivation to alter smoking and drinking habits, inviting all new patients to a health check would appear to result in poor targeting of health promotion resources and may widen inequalities in health.