Tag Archives: diabetes

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. 

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. 

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.

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.

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.

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.

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.

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.

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.

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.

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.


Yonder: diabetes, orofacial pain, screening tests, and pharma

F1.largeAhmed Rashid is an academic clinical fellow in general practice at the University of Cambridge. He writes the regular monthly column “Yonder” in the BJGP: a diverse selection of primary care relevant research stories from beyond the mainstream biomedical literature. Twitter: @Dr_A_Rashid

You can download the PDF here at BJGP.org.

In recent years, improving care coordination and the interface between primary and secondary care have been particularly important targets for those designing diabetes services. A recent Australian study sought to investigate patients’ experiences of two GP-led integrated diabetes care services in Brisbane.1 They found that although patients listened to health professionals’ advice, the extent to which they were able to adopt it was determined unavoidably by their life circumstances. The various new relationships with different health professionals that resulted from the new service were another aspect that patients often found challenging to negotiate. The authors conclude that the flexible and personalised approach of a GP-led service can achieve good clinical outcomes and quality of life, although they emphasise the importance of preserving mutual trust between clinicians and patients in order to achieve this.

Orofacial pain
Pain in the face, mouth, and jaw is a common presentation to both medical and dental services and when it becomes persistent with no organic cause or trauma, it is labelled chronic orofacial pain (COFP). Although psychological treatments have been promising in clinical trials, they are not being widely used. In order to understand how a psychological approach may be better implemented in practice, a research team from Manchester interviewed patients with COFP as well as medical and dental practitioners.2 Although patients and clinicians recognised the importance of psychological factors as causes, they were largely focused on biomedical-management strategies. Dentists tended to view it as a non-dental problem, whereas GPs felt responsible to support patients using strategies adapted from other long-term conditions. The study suggests that improving the liaison between medical and dental services and increasing knowledge about the condition among GPs and dentists could help transform the care of this frustrating condition.

Screening tests
In recent years, there has been recognition from across the healthcare community that many clinical activities are ineffective and have the potential to cause physical and psychological harm. The Choosing Wisely campaign is an important part of the solution, highlighting ineffective tests and treatments that should be stopped or used less often. However, such strategies must include the views of patients and the public. A US team of researchers recently interviewed 50 individuals about what they thought of screening tests they’d been invited to take part in.3 Many participants could name no harms of screening and those that did, focused on harms of the screening test itself rather than those further along the management cascade. Benefits of screening, meanwhile, were easily identified and indeed, often overestimated. The study is a useful reminder that campaigns to save money or improve quality through disinvestment must focus on better communication with patients and the public.

Pharmaceutical industry interactions
The relationship between clinicians and the pharmaceutical industry has received considerable attention in the medical and lay press in recent years. Psychiatry has been a particularly high-profile discipline because of the nature of the drugs being prescribed. However, junior doctors in this specialty have yet to be investigated, prompting the European Federation of Psychiatric Trainees to survey trainee psychiatrists across 20 countries about their interactions with the pharmaceutical industry.4 The 62-item questionnaire was completed by over 1400 participants and demonstrated considerable variation across countries, with frequent interactions still taking place. The authors suggest creating alternative educational opportunities and specific training about the pharmaceutical industry to reduce the impact of industry marketing on psychiatric training. They also identify the importance of role models and encourage senior psychiatrists to reflect on the kind of examples they wish to set to their junior colleagues.

1. Burridge LH, Foster MM, Donald M, et al. (2015) Making sense of change: patients’ views of diabetes and GP-led integrated diabetes care. Health Expect doi:10.1111/hex.12331, [Epub ahead of print].
2. Peters S, Goldthorpe J, McElroy C, et al. (2015) Managing chronic orofacial pain: a qualitative study of patients’, doctors’, and dentists’ experiences. Br J Health Psychol doi:10.1111/bjhp.12141, [Epub ahead of print].
3. Sutkowi-Hemstreet A, Vu M, Harris R, et al. (Apr 14, 2015) Adult patients’ perspectives on the benefits and harms of overused screening tests: a qualitative study. J Gen Intern Med, [Epub ahead of print].
4. Riese F, Guloksuz S, Roventa C, et al. (2015) Pharmaceutical industry interactions of psychiatric trainees from 20 European countries. Eur Psychiatry 30(2):284–290.