Judy Cantrill

Managing demand: transfer of management of self limiting conditions from general practice to community pharmacies

The management of patients who visit general practitioners for acute, self limiting, health problems is a widespread concern for the workload of general practitioners.1 Although nurses and pharmacists receive government support for providing treatment for self limiting conditions,2 patients exempt from prescription charges are not necessarily motivated, or do not have the resources, to obtain care from other sources. 3 4 This increases the workload for general practitioners in areas with high percentages of exempt patients. We examined how referring patients with self limiting conditions directly to a community pharmacist would affect general practitioners workload.nnView this table:nnTransfer rates for presenting conditions, and intervention outcomes, in patients who were offered management by community pharmacy. Values are numbers (percentage) unless otherwise specifiednnnnAll patients seeking general practice appointments or telephone prescriptions for 12 conditions at one general medical practice were offered a consultation with a community pharmacist at one of eight community pharmacies serving that practice.5 The …

Can in‐depth research interviews have a ‘therapeutic’ effect for participants?

Objective The studys objective was to explore whether there was any discernible ‘therapeutic’ effect upon participants after an in‐depth research interview, which focused upon their experiences of hypertension and its management.

Patients' and general practitioners' views of what constitutes appropriate hypertension management.

Objectives: To explore how patients and general practitioners (GPs) construct the concept of appropriateness in the context of hypertension management. Method: Q-methodology was used. The study involved 120 patients and 12 GPs ranking 42 statements according to their degree of agreement or disagreement when considering appropriate hypertension management. The statements, comprising both clinical and non-clinical attributes, were developed from a qualitative study. Factor analysis of the data, using PQMethod computer software, determined if any patterns were discernible. Results: Patients (n = 92) and GPs (n = 10) exclusively clustered to six factors (factor loadings ≥ 0.5, P <0.01), which accounted for 77% of the total variance. The findings indicated that patients and GPs consider appropriate hypertension management in different ways. The GPs indicated that they considered non-pharmacological measures highly important, whereas 72% of patients were ambivalent. The patients clustered to five appropriateness factors, which varied in the degree of involvement patients had, or wished to have, in their hypertension management. Of these five, two were chosen by 73 patients. Conclusion: GPs views differ from those of patients and there is variation between patients, which has important implications for patient-centred care. Further application of Q-methodology to explore patients views of appropriateness of other medical conditions would be valuable.

Treatment of Paget's disease of bone

readily and it has been confirmed that where abnormalities existed opticians did not fail to detect them. It is, however, an assumption to conclude that an optician is therefore better able to examine a retina. It is true that they are trained in fundoscopy, but any abnormality that might be found beyond their experience of the normal must be referred to the general practitioner, who in turn is likely to refer the patient to the hospital eye service. It is our experience that most of these referrals are for lesions which are of no clinical importance and it is exceptionally rare for diabetes to be detected by the observation of retinopathy in a person who is otherwise not known to be suffering from the disease. It is perhaps regrettable that many diabetic patients receive their only eye examination by the optician, even though most will also be under the care of the general practitioner or a physician. General practitioners do express anxiety about their ability to detect retinopathy; however, it is not difficult for a doctor to acquire the necessary techniques and apply them routinely. As general practitioners become increasingly aware of the need to detect diabetic retinopathy many are improving their own fundoscopy techniques, and many large practices are ensuring that at least one partner obtains and continues to enjoy sufficient experience in the examination of the retina so that fundoscopy is no more of a worry than measuring blood pressure or listening to changes in heart sounds. It would also be helpful if physicians caring for diabetics routinely dilate their pupils and examine their fundi. Very many do not. Ophthalmic opticians provide a valuable service in testing for glasses, and they may play a part in routine testing of intraocular pressure. However, mixing the commercial aspect of selling glasses with the primary care of patients has led many ophthalmologists to express concern that the screening of diabetics may expand into the market place. Dr Yudkin presents a compelling case for the screening ofdiabetic retinas, but let this be done by doctors and not by ophthalmic opticians. The discussion which has been engendered by the proposal to charge people for an eye test by opticians should serve to highlight the problem of screening of diabetics and to encourage doctors to take upon themselves this responsibility.