General Practice trainees
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Research outputs from General Practice trainees based at the RD&E
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Item Ideas, concerns, expectations, and effects on life (ICEE) in GP consultations: an observational study using video-recorded UK consultations(Royal College of General Practitioners, 2023-09-01) Edwards, P. J.; Sellers, G. M.; Leach, I.; Holt, L.; Ridd, M. J.; Payne, R. A.; Barnes, R. K.BACKGROUND: Eliciting patients' ideas, concerns, expectations, and whether a problem has an 'effect' on their life (ICEE), is a widely recommended communication technique. However, it is not known how frequently ICEE components are raised in UK GP consultations. AIM: To assess the frequency of ICEE in routine GP consultations with adult patients and explore variables associated with ICEE. DESIGN & SETTING: An observational study was undertaken. It involved secondary analysis of a pre-existing archive of video-recorded, face-to-face GP consultations in the UK. METHOD: Observational coding of 92 consultations took place. Associations were assessed using binomial and ordered logistic regression. RESULTS: Most consultations included at least one ICEE component (90.2%). The most common ICEE component per consultation was patient ideas (79.3%), followed by concerns (55.4%), expectations (51.1%), and then effects on life (42.4%). For all ICEE components patients more commonly initiated the ICEE dialogue, and in only three consultations (3.3%) did GPs directly ask patients about their expectations. Problems that were acute (odds ratio [OR] 2.98, 95% confidence interval [CI] = 1.36 to 6.53, P = 0.007) or assessed by GPs aged ≥50 years (OR 2.10, 95% CI = 1.07 to 4.13, P = 0.030) were associated with more ICEE components. Problems assessed later in the consultation (OR 0.60 per problem order increase, 95% CI = 0.41 to 0.87, P = 0.007) by patients aged ≥75 years (OR 0.40, 95% CI = 0.16 to 0.98, P = 0.046) and from the most deprived cohort (OR 0.39, 95% CI = 0.17 to 0.92, P = 0.032) were associated with fewer ICEE components. Patient ideas were associated with more patients being 'very satisfied' post-consultation (OR 10.74, 95% CI = 1.60 to 72.0, P = 0.014) and the opposite was true of concerns (OR 0.14, 95% CI = 0.02 to 0.86, P = 0.034). CONCLUSION: ICEE components were associated with patient satisfaction and demographic variables. Further research is required to assess if the way ICEE are communicated affects these associations and other potential confounders.Item Clinical judgement of GPs for the diagnosis of dementia: a diagnostic test accuracy study(Royal College of General Practitioners, 2021-07-27) Creavin, S. T.; Haworth, J.; Fish, M.; Cullum, S.; Bayer, A.; Purdy, S.; Ben-Shlomo, Y.BACKGROUND: GPs often report using clinical judgement to diagnose dementia. AIM: Investigate the accuracy of GPs' clinical judgement for the diagnosis of dementia. DESIGN & SETTING: Diagnostic test accuracy study, recruiting from 21 practices around Bristol. METHOD: The clinical judgement of the treating GP (index test) was based on the information immediately available at their initial consultation with a person aged over 70 years who had cognitive symptoms. The reference standard was an assessment by a specialist clinician, based on a standardised clinical examination and made according to ICD-10 criteria for dementia. RESULTS: 240 people were recruited, with a median age of 80 years (IQR 75-84 years), of whom 126 (53%) were men and 132 (55%) had dementia. The median duration of symptoms was 24 months (IQR 12-36 months) and the median ACE-III score was 75 (IQR 65-87). GP clinical judgement had sensitivity 56% (95% CI 47% to 65%) and specificity 89% (95% CI 81% to 94%). Positive likelihood ratio was higher in people aged 70-79 years (6.5, 95% CI 2.9-15) compared to people aged ?80 years (3.6, 95% CI 1.7-7.6), and in women (10.4, 95% CI 3.4-31.7) compared to men (3.2, 95% CI 1.7-6.2), whereas the negative likelihood ratio was similar in all groups. CONCLUSION: A GP clinical judgement of dementia is specific, but confirmatory testing is needed to exclude dementia in symptomatic people who GPs judge as not having dementia.Item Books: ABC of Clinical Reasoning: Sound and Rational Decision Making.(Royal College of General Practitioners, 2017-03) Norris, Ben