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General Practice Setting (general + practice_setting)
Selected AbstractsAn economic evaluation of atenolol vs. captopril in patients with Type 2 diabetes (UKPDS 54)DIABETIC MEDICINE, Issue 6 2001A. Gray Abstract Aims To compare the net cost of a tight blood pressure control policy with an angiotensin converting enzyme inhibitor (captopril) or , blocker (atenolol) in patients with Type 2 diabetes. Design A cost-effectiveness analysis based on outcomes and resources used in a randomized controlled trial and assumptions regarding the use of these therapies in a general practice setting. Setting Twenty United Kingdom Prospective Diabetes Study Hospital-based clinics in England, Scotland and Northern Ireland. Subjects Hypertensive patients (n= 758) with Type 2 diabetes (mean age 56 years, mean blood pressure 159/94 mmHg), 400 of whom were allocated to the angiotensin converting enzyme inhibitor captopril and 358 to the , blocker atenolol. Main outcome measures Life expectancy and mean cost per patient. Results There was no statistically significant difference in life expectancy between groups. The cost per patient over the trial period was £6485 in the captopril group, compared with £5550 in the atenolol group, an average cost difference of £935 (95% confidence interval £188, £1682). This 14% reduction arose partly because of lower drug prices, and also because of significantly fewer and shorter hospitalizations in the atenolol group, and despite higher antidiabetic drug costs in the atenolol group. Conclusions Treatment of hypertensive patients with Type 2 diabetes using atenolol or captopril was equally effective. However, total costs were significantly lower in the atenolol group. Diabet. Med. 18, 438,444 (2001) [source] Randomization in psychiatric intervention research in the general practice settingINTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 3 2000CM Van Der Feltz-Cornelis Faculty of Medicine Abstract Most studies of psychiatric interventions in general practice settings conform only in part to the requirements of randomization, placebo control and blinding as formulated by the Cochrane Collaboration. It is possible, nonetheless, to develop experimental research designs that are sufficiently near to this standard. These must deal with certain methodological issues specific to psychiatric research. This article discusses scientific standards of psychiatric research with special consideration of interventions in general practice settings. These issues are accompanied by concrete examples and suggestions on how to confront the problems. In psychiatric intervention research, equivalence studies with single-blind outcome assessment, a tested and ethically justified method, are generally used in place of placebo-controlled studies. The article also examines randomization procedures in greater depth. Randomization can be applied across trial subjects or across doctors' practices. Practical consequences of randomizing across subjects, and specific implementations of it such as crossover and pre-post designs in general practice settings, are clarified. Overall, a research design using randomization across doctors' practices is judged preferable to one that randomizes across trial subjects. One potential problem is that the control group may become too small, especially when considerable effects are expected from the intervention being studied. One might consider making the control condition smaller in the first place, or, if indicated on ethical grounds, performing an intermediate analysis and then breaking off the study as soon as a statistically significant effect has been demonstrated. Multilevel statistical techniques offer new opportunities for analysis within such designs. Copyright © 2000 Whurr Publishers Ltd. [source] Brief Intervention for Female Heavy Drinkers in Routine General Practice: A 3-Year Randomized, Controlled StudyALCOHOLISM, Issue 11 2000Mauri Aalto Background: Today, heavy drinking is a common health hazard among women. The evidence in favor of providing some kind of brief intervention to reduce drinking is quite convincing. However, we do not know if intervention works in a natural environment of routine health care. The purpose of this study was to evaluate the effectiveness of long-lasting, brief alcohol intervention counseling for women in a routine general practice setting. Methods: In five primary care outpatient clinics in a Finnish town, 118 female early-phase heavy drinkers who consulted their general practitioners for various reasons were given brief alcohol intervention counseling. Intervention groups A (n= 40) and B (n= 38) were offered seven and three brief intervention sessions, respectively, over a 3-yr period. The control group C (n= 40) was advised to reduce drinking at baseline. Main outcome measures were self-reported weekly alcohol consumption, carbohydrate-deficient transferrin, mean corpuscular volume (MCV), aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyltransferase. Results: Depending on the outcome measure and the study group, clinically meaningful reduction of drinking was found in 27% to 75% of the heavy drinkers. Within all the groups, MCV significantly decreased. However, there were no statistically significant differences between study groups A, B, and C in the mean changes between the beginning and endpoint in the main outcome measures. Conclusions: The present study indicated that minimal advice, as offered to group C, was associated with reduced drinking as much as the brief intervention, as offered to groups A and B, given over a 3-yr period. Furthermore, in the routine setting of the general practice office, the effectiveness of the brief intervention may not be as good as in special research conditions. The factors possibly reducing the effectiveness in a routine setting are unknown. Thus, different methods of implementing brief intervention need to be evaluated to find better ways to support general practice personnel in their efforts to help heavy-drinking female patients to reduce their drinking. [source] Partner violence prevalence among women attending a Maori health provider clinicAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 2 2007Jane Koziol-McLain Abstract Objective: To determine partner violence rates among women attending a general practice in Aotearoa, New Zealand. Methods: This descriptive study was conducted in a hauora (Maori health provider general practice clinic) in one South Auckland community. Non-acute, English-speaking women who entered the huaora during 30 randomly selected clinic sessions in a five-week period in 2003 were eligible to participate. Research assistants (RAs) verbally administered a structured, brief questionnaire that included a partner violence screen (past 12 months), assessment of high danger risk, and lifetime prevalence. Of 148 women approached, 109 participated. Participants generally self-identified as Maori (74%) or New Zealand European (18%) and ranged in age from 17 to 82 years (mean 38.8). Results: Twenty-three per cent (95% CI 15,31) of women screened positive for partner violence. Among the 25 women who screened positive, six (24%) had one or more high danger risk factors and 24 (96%) reported one or more children living in the household. Seventy-eight per cent (95% CI 70,86) of women reported a history of partner violence. Conclusions: In this sample of mostly Maori women, direct partner violence questioning in a general practice setting yielded a high disclosure rate. Three out of four women disclosed violence by a partner; nearly one out of four disclosed violence by a partner in the past year. Implications: Healthcare providers have the opportunity to identify and provide services to women and their children experiencing partner violence. Health care providers and the health care system also have a responsibility to join with the community in calling for non-tolerance of family violence. [source] Modelling nursing activities: electronic patient records and their discontentsNURSING INQUIRY, Issue 1 2000Els Goorman Modelling nursing activities: electronic patient records and their discontents A fully integrated and operating EPR in a clinical setting is hard to find: most applications can be found in outpatient or general practice settings or in isolated hospital wards. In clinical work practice problems with the electronic patient record (EPR) are frequent. These problems are at least partially due to the models of health care work embedded in EPRs. In this paper we will argue that these problems are at least partially due to the models of health care work embedded in current EPRs. We suggest that these models often contain projections of nurses' and doctors' work as it should be performed on the ward, rather than depicting how work is actually performed. We draw upon sociological insights to elucidate the fluid and pragmatic nature of healthcare work and give recommendations for the development of an empirically based EPR, which can support the work of nurses and other health care providers. We argue that these issues are of great importance to the nursing profession, since the EPR will help define the worksettings of the future. Since it is a tool that will impact the development of the nursing profession, nurses have and should have a stake in its development. [source] | ||||||||||