Tag Archives: telephone triage

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.

 

Yonder: Rosacea, youth mental health, diagnosing arthritis and telephone triage

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.

Rosacea
Rosacea is a common, chronic skin condition in adults. As it predominantly affects the face, it has the potential to cause significant psychological and social distress. The internet has provided opportunities for patients to access information as well as interact with peers and experts. A US research team recently analysed posts on an online rosacea support forum to obtain insights into patients’ educational needs.1 They found that patients primarily sought advice about treatments, triggers, diet, and skin care. Perhaps unsurprisingly, there were also a large number of queries about the efficacy and adverse effects of therapies.

The authors suggest that doctors should make more attempts to include patients in their rosacea care and suggest that one way of doing this is to have them take pictures to track progress and keep a diary of potential triggers. They also suggest that proactively providing resources could help reduce confusion about the disease and treatments.

Youth mental health
Youth mental health is increasingly recognised as a priority area in health systems around the world. In particular, there has recently been an increased focus on early intervention and an Irish research team recently sought to examine the role of the GP in providing early treatment in this population.2

They combined a national survey of GPs with interviews of both health professionals and young people. They found that GPs were largely unsatisfied with their postgraduate training in child mental health and substance misuse. Access to services and youth workers were cited as key facilitators to improve care. Much like in the NHS, it seems an increase in funding for mental health services is also acutely needed in the Irish health system.

Diagnosing arthritis
Progress in rheumatoid arthritis management in recent years has meant that starting treatment early is more important than ever. However, this naturally relies on early identification and a Dutch rheumatology team recently examined the signs, symptoms, and investigations that GPs use in the diagnosis of inflammatory arthritis, analysing medical records.3 They used records from 16 practices and found 126 patients with new diagnoses of inflammatory arthritis. Information about classic inflammatory symptoms (pain, swelling, warmth, redness, reduced function) was frequently documented but items that they record as being routinely checked in secondary care (morning stiffness, family history and squeeze-test) were rarely used. In the UK, the increasing use of referral proformas with checklists may already have mostly ameliorated this issue.

Telephone triage
Practices are increasingly using telephone triage to manage patient flow but there are many unanswered questions about its effectiveness and safety. In the Netherlands, telephone triage in the daytime is done by practice assistants who generally have followed an intermediate vocational medical education of 3 years. A recent Dutch study sought to examine the adequacy of this triage, conducting a web-based survey asking practice assistants to assess the required type of care of written case scenarios with varying health problems and levels of urgency.4 They found that the required care was assessed adequately in 63.6% of cases, was over-estimated in 19.3%, and under-estimated in 17.1% and predictably, more experienced assistants and assistants with fixed daily work meetings with the GP performed better.

The authors conclude that telephone triage by general practice assistants is efficient, but potentially unsafe in highly urgent cases and suggest improved training is the key solution. As for NHS general practice, it seems increasingly likely that there will be more multidisciplinary working in years to come and this paper provides some insights into the kind of challenges (and opportunities) this may bring.

REFERENCES
1. Alinia  H, Moradi Tuchayi  S, Farhangian  ME, et al. (2016) Rosacea patients seeking advice: Qualitative analysis of patients’ posts on a rosacea support forum. J Dermatolog Treat 27(2):99–102.

2. Leahy  D, Schaffalitzky  E, Saunders  J, et al. (2015) Role of the general practitioner in providing early intervention for youth mental health: a mixed methods investigation. Early Interv Psychiatry doi:10.1111/eip.12303.

3. Newsum  EC, de Waal  MW, van Steenbergen  HW, et al. (2016) How do general practitioners identify inflammatory arthritis? A cohort analysis of Dutch general practitioner electronic medical records. Rheumatology (Oxford) pii:kev432.

4. Smits  M, Hanssen  S, Huibers  L, Giesen  P (2016) Telephone triage in general practices: A written case scenario study in the Netherlands. Scand J Prim Health Care 19:1–10.

GP Journal Club – Sunday 20th March 2016 at 20:00 GMT

The next GP Journal Club will be discussing the BJGP paper:

Telephone triage systems in UK general practice: analysis of consultation duration during the index day in a pragmatic randomised controlled trial by Holt et al. 

You can download it here.

Suggested questions include:

1) What do you think of the selection of consultation duration as the outcome?
2) Any thoughts on the study design?
3) Does the fact that only same-day consultations are triaged change the results?
4) Are the data collection methods reliable?
5) Has this paper changed your views on phone triage?

Feel free to suggest questions – via Twitter or leave them in the comments box below.