The European journal of general practice
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Multicenter Study
Prescription of psychotropic medication in patients with type two diabetes mellitus: A multi-practice study from Ireland.
Background: Comorbid anxiety and depression and type two diabetes mellitus (T2DM) are commonly managed by General Practitioners (GPs). Objectives: To investigate the proportion of people with T2DM who are prescribed either antidepressant or benzodiazepine medications in general practice; to compare people with T2DM that have a prescription with those that do not in terms of patient characteristics, glycaemic control and healthcare utilization. Methods: Anonymized data was collected by GPs and senior medical students from electronic medical records of patients with T2DM in 34 Irish general practices affiliated with the University of Limerick Graduate Entry Medical School during the 2013/14 academic year. ⋯ Rates of poor glycaemic control were similar in those with and without a current prescription. Conclusion: Over one-fifth of people with T2DM in Irish general practice are prescribed an antidepressant or benzodiazepine medication. Prescription of these is associated with increased healthcare utilization but not poorer glycaemic control.
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Background: Psychosocial factors such as depressive symptoms should be considered when assessing cardiovascular (CV) risk. Depressive symptoms are suggested to be associated with poor perception of one's health, i.e. self-rated health (SRH). Thus, assessing SRH could be a practical tool in CV risk prediction. ⋯ Among those with poor or fair SRH, the prevalence of depressive symptoms was 36% and associated with perception of physical health. Conclusion: Poor SRH is associated with depressive symptoms and impaired perceived physical health. Assessing SRH might be useful for detecting possible depressive symptoms in patients in CV risk management and diabetes care.
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Despite growing access to effective therapies, asthma control still needs improvement. Many non-drug factors, such as allergens, air pollutants and stress also affect asthma control and patient quality of life, but an overview of the effectiveness of non-drug interventions on asthma control was lacking. ⋯ Twenty-six interventions were effective in asthma control. Simultaneously combining several action plans, each focusing on different aspects of asthma management, seems most likely to be effective.
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The effectiveness of any national healthcare system is highly correlated with the strength of primary care within that system. A strong research basis is essential for a firm and vibrant primary care system. General practitioners (GPs) are at the centre of most primary care systems. ⋯ Members of the GP research community see the clear need for both national and international primary care research networks to facilitate appropriate RCB interventions. These interventions should be multifaceted, responding to needs at different levels and tailored to the context where they are to be implemented.
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Leaders are needed to address healthcare changes essential for implementation of integrated primary care. What kind of leadership this needs, which professionals should fulfil this role and how these leaders can be supported remains unclear. ⋯ Good quality research on clinical leadership in integrated primary care is scarce. More profound knowledge is needed about leadership skills, required for integrated-care implementation, and leadership support aimed at developing these skills.