Diagnostic strategies should always take into consideration the setting in which they are administered. The predictive value, positive or negative of a clinical sign or diagnostic test has a ...different weight in family medicine than in the hospital setting. Many tests have not been formally evaluated in primary care; unfortunately, very often low prevalence settings are used to conduct screening in these populations, and often result in unrealistically high prevalence estimates for chronic disease and these results are then used to conclude that General Practitioners are not good at detecting diseases. In primary care, the prevalence and incidence of disease differs from what appears in the hospital setting, and severe disease occurs less frequently in general practice than in hospital because there is no preventive selection. This requires a specific probability-based decision-making process, based by the knowledge of patients and the community. In primary care, the diagnostic strategy should begin with complaints and symptoms and address uncertainty and complexity, using step-by-step strategies, including watchful waiting, presumptive symptomatic treatment, and focusing on low-tech strategies.
Differentiating mild cognitive impairment (MCI) from subjective cognitive decline (SCD) is important because of the higher progression rate to dementia for MCI and when considering future ...disease-modifying drugs that will have treatment indications at the MCI stage.
We examined if the two most widely-used cognitive tests, the Mini-Mental State Examination (MMSE) and clock-drawing test (CDT), and a test of attention/executive function (AQT) accurately can differentiate MCI from SCD.
We included 466 consecutively recruited non-demented patients with cognitive complaints from the BioFINDER study who had been referred to memory clinics, predominantly from primary care. They were classified as MCI (n = 258) or SCD (n = 208) after thorough neuropsychological assessments. The accuracy of MMSE, CDT, and AQT for identifying MCI was examined both in training and validation samples and in the whole population.
As a single test, MMSE had the highest accuracy (sensitivity 73%, specificity 60%). The best combination of two tests was MMSE < 27 points or AQT > 91 seconds (sensitivity 56%, specificity 78%), but in logistic regression models, their AUC (0.76) was not significantly better than MMSE alone (AUC 0.75). CDT and AQT performed significantly worse (AUC 0.71; p < 0.001-0.05); otherwise no differences were seen between any combination of two or three tests.
Neither single nor combinations of tests could differentiate MCI from SCD with adequately high accuracy. There is a great need to further develop, validate, and implement accurate screening-tests for primary care to improve accurate identification of MCI among individuals that seek medical care due to cognitive symptoms.
The Mediterranean dietary pattern is a well-established protective factor against cardiovascular disease (CVD). However, very often it is not sufficient and, in the treatment of dyslipidaemia in ...patients with high cardiovascular risk, we often need to add 3-hydroxy- 3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins). Liver toxicity is a known but rare side effect of statins, and cross-reactivity among the different statins in the susceptibility to liver injury has not been defined. Here we report a case of atorvastatin-induced hepatitis, partially relapsed after rosuvastatin assumption, in a patient tolerant to simvastatin.
Social prescribing (SP) is a patient pathway by which healthcare professionals connect patients with other sources of support, groups, or activities within their community. The awareness, practice, ...and perception of SP among GPs across Europe remains unclear.
To explore the awareness, practice, and perception of GPs on SP in the WONCA Europe region.
An anonymous, cross-sectional online survey was distributed through a snowballing system, mailing lists, and at three international conferences in 2022/2023 to explore GPs' awareness, practice, and perception of SP. The questionnaire in English contained 21 open and closed questions.
Of the 208 participating GPs from 33 countries, 116 (56%) previously heard of 'social prescribing' and 66 (32%) regularly referred patients to community activities through a formal system. These 66 GPs reported different funding sources and varied activities, with an average of four activities and physical exercise being the most prevalent. Among them, 25 (38%) knew about national or local SP awareness campaigns. Of these 25, 17 (68%) agreed that SP increases their job satisfaction and 21 (84%) agreed that it has a positive impact on their patients. Variations in SP awareness and referral practice were evident across and within countries.
Despite disparities in awareness and referral practice as well as a diversity of activities and funding sources, most GPs who actively referred patients and were informed about SP campaigns agreed that SP positively impacts them and their patients.
Italian Primary Care System has been modelled after the NHS in UK and was established in 1978. In 2000 Italy's healthcare system was regarded, by a World Health Organization's ranking, as the 2nd ...best in the world after France;since then, the performance has constantly decreased mainly because ofthe austerity policy. This austerity policy is notjustified by the Official OECD figures which show that Italian Health Care expenditures are below the average in OECD Countries. Quality outcomes almost always show a clear North-South divide in almost all health care sectors. Responsibility for health care is now shared between the central government and 19 regions and 2 autonomous provinces (Trento and Bolzano), which traditionally differ a lot in terms ofeconomic development, per capita income, demography and culture. Disparities can be found in almost any area of health care provision, in health policy making, health care expenditure, quality of health care, public satisfaction and health care services organization. The pros ofthe Italian Primary Care System are the continuity of care and the universalism; the cons are the crippling bureaucracy, the workload, the lack of basic social benefits for GPs such as subsidized sick leaves and the lack of University Department of Primary Care and finally the absence of any perspective of professional development in the Academic field.
Abstract
Introduction
To reduce inappropriate polypharmacy, deprescribing should be part of patients’ regular care. Yet deprescribing is difficult to implement, as shown in several studies. ...Understanding patients’ attitudes towards deprescribing at the individual and country level may reveal effective ways to involve older adults in decisions about medications and help to implement deprescribing in primary care settings. In this study we aim to investigate older adults’ perceptions and views on deprescribing in different European countries. Specific objectives are to investigate the patients’ willingness to have medications deprescribed by medication type and to have herbal or dietary supplements reduced or stopped, the role of the Patient Typology (on medication perspectives), and the impact of the patient-GP relationship in these decisions.
Methods and analysis
This cross-sectional survey study has two parts: Part A and Part B. Data collection for Part A will take place in nine countries, in which per country 10 GPs will recruit 10 older patients (≥65 years old) each (
n
= 900). Part B will be conducted in Switzerland only, in which an additional 35 GPs will recruit five patients each and respond to a questionnaire themselves, with questions about the patients’ medications, their willingness to deprescribe those, and their patient-provider relationship. For both Part A and part B, a questionnaire will be used to assess the willingness of older patients with polypharmacy to have medications deprescribed and other relevant information. For Part B, this same questionnaire will have additional questions on the use of herbal and dietary supplements.
Discussion
The international study design will allow comparisons of patient perspectives on deprescribing from different countries. We will collect information about willingness to have medications deprescribed by medication type and regarding herbal and dietary supplements, which adds important information to the literature on patients’ preferences. In addition, GPs in Switzerland will also be surveyed, allowing us to compare GPs’ and patients’ views and preferences on stopping or reducing specific medications. Our findings will help to understand patients’ attitudes towards deprescribing, contributing to improvements in the design and implementation of deprescribing interventions that are better tailored to patients’ preferences.
Investigates guideline use amongst general practitioners (GP) from 26 European countries and from Brazil, Israel and New Zealand, regarding best management of hypertension in frail oldest-old (>80 ...years of age). Examines if guideline use relates to different decisions when managing hypertension in frail oldest-old. Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.
PDF
