Tag Archives: Child & Adolescent mental health

Top 10 most read BJGP research articles published in 2016

16Jan_Top10_research_2015_BJGP_smThese are the top 10 most read research articles based on full text downloads from bjgp.org in 2016.

1. Overdiagnosis of asthma in children in primary care: a retrospective analysis. 
http://bjgp.org/content/66/644/e152

Overdiagnosis of childhood asthma is common in primary care, leading to unnecessary treatment, disease burden, and impact on quality of life. However, only in a small percentage of children is a diagnosis of asthma confirmed by lung function tests.

2. Telephone triage systems in UK general practice: analysis of consultation duration during the index day in a pragmatic randomised controlled trial. 
http://bjgp.org/content/66/644/e214

Telephone triage is not associated with a reduction in overall clinician contact time during the index day. Nurse-led triage is associated with a reduction in GP contact time but with an overall increase in clinician contact time. Individual practices may wish to interpret the findings in the context of the available skill mix of clinicians.

3. Primary care clinician antibiotic prescribing decisions in consultations for children with RTIs: a qualitative interview study.
http://bjgp.org/content/66/644/e207

Prognostic uncertainty remains an important driver of health care professionals’ antibiotic prescribing. Experience and training in recognising severe respiratory tract infections (RTIs), together with more evidence to help professionals identify the children at risk of future illness deterioration, may support identification of the children most and least likely to benefit from antibiotics.

4. Continuity of care in primary care and association with survival in older people: a 17-year prospective cohort study.
http://bjgp.org/content/66/649/e531

This study demonstrates that low continuity of care in general practice is associated with a higher risk of mortality, strengthening the case for encouragement of continuity of care.

5. Nursery sickness policies and their influence on prescribing for conjunctivitis: audit and questionnaire survey.
http://bjgp.org/content/66/650/e674

Most of the childcare providers’ sickness policies contain requirements that are inconsistent with Public Health England guidance. The requirements of childcare sickness policies are likely to be resulting in unnecessary primary care consultations and thousands of prescriptions for antibiotics with little demonstrable clinical or public health benefit.

6. Unrecognised bipolar disorder among UK primary care patients prescribed antidepressants: an observational study.
http://bjgp.org/content/66/643/e71

Among people aged 16–40 years prescribed antidepressants in primary care for depression or anxiety, there is a substantial proportion with unrecognised bipolar disorder. When seeing patients with depression or anxiety disorder, particularly when they are young or not doing well, clinicians should review the life history for evidence of unrecognised bipolar disorder. Some clinicians might find the Mood Disorder Questionnaire to be a useful supplement to non-standardised questioning.

7. Identifying depression among adolescents using three key questions: a validation study in primary care.
http://bjgp.org/content/66/643/e65

Depression in teenagers can have serious consequences and the incidence seems to be increasing. Three short questions, suitable for use in general practice, are useful for identifying depression in adolescents in primary health care.

8. Barriers to effective management of type 2 diabetes in primary care: qualitative systematic review.
http://bjgp.org/content/66/643/e114

Although resources are important, many barriers to improving care are amenable to behaviour change strategies. Improvement strategies need to account for differences between clinical targets and consider tailored rather than ‘one size fits all’ approaches. Training targeting knowledge is necessary but insufficient to bring about major change; approaches to improve diabetes care need to delineate roles and responsibilities, and address clinicians’ skills and emotions around treatment intensification and facilitation of patient behaviour change.

9. Comparison of brief interventions in primary care on smoking and excessive alcohol consumption: a population survey in England.
http://bjgp.org/content/66/642/e1

Whereas approximately half of smokers in England visiting their GP in the past year report having received advice on cessation, less than 10% of those who drink excessively report having received advice on their alcohol consumption.

10. Molluscum contagiosum and associations with atopic eczema in children: a retrospective longitudinal study in primary care.
http://bjgp.org/content/66/642/e53

Consultations for molluscum contagiosum in primary care are common, especially in 1–9-year-olds, but they declined significantly during the decade under study. A primary care diagnosis of atopic eczema is associated with an increased risk of a subsequent primary care diagnosis of molluscum contagiosum.

 

Child & Adolescent Mental Health Problems – Twitter Journal Club

img_4397Carrie Ladd is a part time NHS GP, a spare time RCGP Clinical Fellow in Perinatal Mental Health and a full time mum… doing overtime! You can find her on Twitter @LaddCar and she has a website.

On Sunday 28th November, Dr Lucy Pocock and I co-hosted a session of the Twitter based journal club #gpjc to discuss one of the emerging priority areas of General Practice – Child and Young People’s Mental Health. The BJGP paper we discussed was a systematic review of primary care practitioner’s perceptions to barriers in managing these problems. All contributors seemed to agree that GPs are seeing more and more cases of mental health problems in adolescents but there was some debate as to whether this piece taught us anything new about the challenges we face in supporting these young people.screen-shot-2016-12-05-at-14-36-21

The themes identified in this review as ‘barriers’ were familiar to those joining the discussion and they are in common with most other mental health sub-specialities. Fear of judgement or stigma may limit disclosure, concerns over confidentiality may limit discussion and lack of referral options locally may restrict what help is available. This review also highlighted a lack of confidence in GPs themselves recognising childhood mental health problems and this may prove a springboard piece of work to address this unmet need in the near future.

This was a large systematic review covering 4151 articles in initial stages with 43 being looked at in detail – 30 quantitative and 13 qualitative. The articles were from a range of countries and one of the points in our discussion questioned whether this undermined or strengthened the validity of the results. Although Australia and Ireland could be seen to have similar health systems/ socioeconomic factors to the UK, perhaps South Africa and Puerto Rico less so? Also many of these studies were not specifically GPs but paediatrics as well which is important to be aware of.

In the final section of the discussion, we looked at how we can mitigate these barriers and collaboration seemed a key theme. Several people suggested better lines of communication with our mental health colleagues. Quarterly MDTs between psychiatry/CMHT & the GP practice, Psychiatry colleagues spending a day a week in General Practice is being done in one innovative GP surgery. In another great example of collaborative working, a specialist eating disorder therapist is based in a predominantly University Population Bristol based GP practice.

Finally, close of discussion included signposting to the RCGP Mental Health Toolkit which is available free, open access to all and mention of Young Minds and MindEd resources which are well worth a look up if new to you. The conversation continued after the scheduled hour and the 10 minute consultation model was cast aside as not fit for purpose when a patient comes to talk about mental health problems with longer appointments welcomed by the #gpjc group.

It is clear that from the GPs who joined the discussions on Sunday, this is an area of general practice we could do better, and we need to galvanise interest and support for a society wide movement to raise awareness and prompt further investment in Child and Young People’s Mental Health services.

If you haven’t popped over on a Sunday evening, check out @GPjournalclub for their monthly discussion group – see you there.