Aust Fam Physician
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General practices are required to have flexible systems to accommodate urgent appointments. Not all patients requesting a same day appointment receive one. There is scant research detailing how requests for same day appointments are managed. Our study examined this issue from the perspective of practice staff. ⋯ Practice policies must make clear roles and responsibilities for all staff managing patient appointments. Aspects of clinic policies and practices could be reviewed to reduce medicolegal risk and additional workload caused by non-medically urgent needs.
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Opioids have a critical, time-limited role in our management of acute and terminal pain and an open-ended role in our management of opioid dependency. They also have a use in the management of chronic non-cancer pain. ⋯ For chronic non-cancer pain, the evidence base for the long-term use of opiates is mediocre, with weak support for minimal improvements in pain measures and little or no evidence for functional restoration. Much research and professional education in this field has been underwritten by commercial interests. Escalating the prescribing of opioids has been repeatedly linked to a myriad of individual and public harms, including overdose deaths. Many patients on long-term opioids may never be able to taper off them, despite their associated toxicities and lack of efficacy. Prescribers need familiarity with good opioid care practices for evidence-based indications. Outside these areas, in chronic non-cancer pain, the general practitioner needs to use time and diligence to implement risk mitigation strategies. However, if a GP believes chronic non-cancer pain management requires opioids, prescribing must be both selective and cautious to allow patients to maintain, or regain, control of their pain management.
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Chronic pain is a common presentation to general practice. ⋯ The mind, emotions and attention play an important role in the experience of pain. In patients with chronic pain, stress, fear and depression can amplify the perception of pain. Mind-body approaches act to change a person's mental or emotional state or utilise physical movement to train attention or produce mental relaxation. They are occasionally used as a sole treatment, but more commonly as adjuncts to other therapies. Mind-body approaches include progressive muscle relaxation, meditation, laughter, mindfulness based approaches, hypnosis, guided imagery, yoga, biofeedback and cognitive behavioural therapy. Studies have shown that mind-body approaches can be effective in various conditions associated with chronic pain, however levels of evidence vary. Group delivered courses with healthcare professional input may have more beneficial effects than individual therapy. General practitioners are well placed to recommend or learn and provide a range of mind-body approaches to improve outcomes for patients with chronic pain.
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The prevalence of Helicobacter pylori is thought to be about 40% in developed countries. However, rates are difficult to determine due to many cases being asymptomatic. ⋯ Migraine is the most common cause of recurrent headaches in children. Previous reports have suggested a possible association between H. pylori infection and migraine. In the case study presented, H. pylori infection may have been associated with the child's recurrent headaches. Further research is required to confirm these anecdotal findings and to provide guidance for clinicians on whether recurrent headache in childhood is an indication for testing for H. pylori infection with a (13)C-urea breath test and, if necessary, treatment with triple therapy.
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Maximising the effectiveness of your appointment system in general practice has the potential to connect patients and clinicians for timely care and create a sustainable working environment. ⋯ Five common appointment strategies have emerged through the work of the Australian Primary Care Collaboratives: open access, book on the day, supersaturate, carve out and advanced access systems. All these systems have advantages and disadvantages and may suit different practices depending on their contexts and populations. It is helpful to measure how effective the current practice approach is in dealing with delay and delivering satisfaction. Specific approaches such as 'appointment golf' and 'jeopardy doctor' may help improve system functioning. Practices should make intentional choices about their appointment system to meet the needs of their patients, staff and clinicians.