General Practice trainees

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Research outputs from General Practice trainees based at the RD&E


Recent Submissions

Now showing 1 - 3 of 3
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    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.
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    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.
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    Books: ABC of Clinical Reasoning: Sound and Rational Decision Making.
    (Royal College of General Practitioners, 2017-03) Norris, Ben