Bmc Fam Pract
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Randomized Controlled Trial Multicenter Study
The value of an embedded qualitative study in a trial of a second antidepressant for people who had not responded to one antidepressant: understanding the perspectives of patients and general practitioners.
Depression is the leading cause of disability worldwide, and is a major contributor to the overall global burden of disease. The number of prescriptions for antidepressants has risen dramatically in recent years yet up to 50% of patients who are treated for depression with antidepressants do not report feeling better as a result of treatment, and do not show the desired improvement on depression measures. We report a qualitative study embedded in a trial of second antidepressant for people who had not responded to one antidepressant, exploring the acceptability of a combination of antidepressants from the perspectives of both patients and practitioners, together with experiences of participating in a clinical trial. ⋯ Exploring reasons for declining to participate in a trial of a second antidepressant in people who had not responded to one antidepressant suggests that people who are already taking one antidepressant may be reluctant to take a second, being wary of possible side-effects, but also being unconvinced of the logic behind such a combination. In addition, people describe being in a state of equilibrium and reluctant to make a change, reflecting that this equilibrium is 'hard-won' and they are unwilling to risk disturbing this. This makes some people reluctant to enrol in a clinical trial. Understanding a patient's view on medication is important for GPs when discussing antidepressants.
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Multicenter Study
Potential correlates of burnout among general practitioners and residents in Hungary: the significant role of gender, age, dependant care and experience.
Burnout is increasingly prevalent among general practitioners (GPs) in Hungary, which may lead to functional impairment and, subsequently, to poor quality of patient care. However, little is known about potential predictors of burnout among GPs. The aim of this study was to explore psychosocial correlates of burnout among GPs and residents in Hungary. ⋯ We identified specific socio-demographic and work-related correlates of burnout, which may guide the development of specific and effective organizational decisions to attenuate occupational stress and subsequent burnout as well as functional impairment among GPs, and thus, may improve the quality of patient care.
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Multicenter Study
Development and use of an index for measuring implementation of a weight management program in children in primary care clinics in Texas.
The Texas Childhood Obesity Research Demonstration study was an integrated, systems-oriented intervention that incorporated primary and secondary obesity prevention approaches targeting multiple sectors, including primary care clinics, to address childhood obesity. The primary care clinic component included the American Academy of Pediatrics' Next Steps weight management counseling materials that support brief healthy lifestyle-focused visits. The current study describes the methodology and assesses the implementation of the Next Steps program in the participating primary care clinics, as well as the association of implementation with enrollment of children with overweight and obesity in the secondary prevention intervention. ⋯ The development of an index using process evaluation measures can be used to assess the implementation and evaluation of provider-based obesity prevention tools in primary care clinics.
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By screening and modifying risk factors, stroke incidence can be reduced. Clinical guidelines states that primary prevention of stroke is a responsibility and task of primary health care, but research shows that this not always the case. The aim of the study was to explore and describe what characterizes GPs' reasoning around risk screening and primary prevention among persons at risk for stroke in primary health care. ⋯ There is a need for a more proactive, transparent and systematic approach in the distribution of GPs' time and reimbursement of prevention in primary health care. The findings suggest, by developing new methods and approaches such as digital clinical decision-making tools and by implementing inter-professional team-work, the quality of the primary prevention of stroke could be improved.
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Multicenter Study
Development of the Japanese version of the general practice assessment questionnaire: measurement of patient experience and testing of data quality.
Physicians' interpersonal performance is critical in medical practice, especially primary care practice. The General Practice Assessment Questionnaire (GPAQ) was developed in the United Kingdom to evaluate the quality of primary care from the viewpoint of patients. This questionnaire highlights the evaluation of interpersonal skills and interactions between physicians and patients. Though several other tools also exist to evaluate primary care quality, the GPAQ has several distinctive evaluation items, covering receptionists, access to primary care, and enablement (patients' understanding of self-care and of their own health after consultation). Our purpose was to develop and validate a Japanese version of the GPAQ. ⋯ The Japanese version of the GPAQ was acceptable, reliable, and valid. This could be a useful instrument to evaluate key areas of primary care performance in Japan, particularly physicians' communication skills. Further work is required to evaluate its utility in urban areas.