GPs are basically family doctors who execute medical checkups with grownups and kids. They as well offer generic advice to sick people and occasionally refer them to narrowed doctors should a grievous illness happen.

Medical Docs

Medical physicians commonly specialize in a particular discipline to offer sick people more elaborated help than a GP. For instance, an oncologist acts principally with cancer sick people, while a woman’s doctor deals principally with women’s health.

Pros and Cons of GPs

GPs frequently have a thorough medical record of the family and can precisely appraise the correct sicknesses grounded on this knowledge. They as well provide the constancy of having a chief doc to visit when emergencies come up. A disfavor is that they may not offer differentiated care to sick people.

Pros and Cons of Medical Docs

For sick people whose particular illnesses can’t always be dealt by GPs, they can visit a health doctor. A disfavour is that medical doctors may not have the patients’ medical records pronto available.

Findings from the 2008 severe seasonal AR survey of more than 400 GPs and 500 AR patients revealed that two-thirds (65%) of GPs remarked that their biggest concern in treating severe seasonal AR patients was symptom breakthrough. Likewise, over two-fifths (42%) of patients surveyed rated their symptoms to be worse in 2008 compared to 2007 with almost one-in-three (29%) patients’ saying they were still experiencing symptoms last summer despite regular treatment from their GP. Patients also rated long-term efficacy of their current treatment and reliance on multiple therapies as two further issues of concern.

Despite this concern among patients GPs are not taking action with two-thirds (65%) not referring any of their severe seasonal AR patients who could benefit from advanced management, even when they were aware that local secondary care allergy services were available in their area.

“GPs can successfully manage patients with seasonal allergic rhinitis. However more severe patients will still experience symptom breakthrough and can be held as virtual prisoners in their home during the pollen season; affecting not only them but their whole family. For these patients, GPs should consider referral to a GPwSI or a specialist centre in order to access advanced treatments such as immunotherapy which can help symptom control and improve patient quality of life,” said Dr. Dermot Ryan, GP from Loughborough, Clinical Research Fellow, Department of General practice and Primary Care, University of Aberdeen.

The study also found that over half of GPs in the UK (53.1%) had seen as many as 20 severe seasonal AR patients during 2008’s pollen season. This figure shows a marked increase on current approximations which suggest that each GP in the UK will see an average of 1.53 severe seasonal allergic rhinitis patients.2,3

26% of adults suffer from AR in the UK, 4 typically suffering from symptoms such as a runny or blocked nose, frequent sneezing, itchy or watery eyes and an itchy throat, mouth, nose and ears5. These symptoms affect sleep, concentration and productivity at work or school.6,7 People with severe seasonal AR experience further deleterious symptoms and a worsening of co-existing conditions such as asthma.8

Despite an increasing number of severe seasonal AR patients presenting to their GP, there are still improvements to be made in the management of these patients. BSACI guidelines underpin allergy referral, highlighting that patients should be referred if uncontrolled on conventional therapies.8

Secondary care offers GPs an advanced management option for their patients with severe allergy. Management programmes such as immunotherapy offer an effective approach in tackling allergy, addressing the underlying cause of the disease instead of patients relying on antihistimanines and nasal sprays which only address the symptoms of their condition.9 Immunotherapy may also provide sustained treatment prevention and reduce long-term reliance on these rescue medications.9 However, GPs are relatively unaware of these advanced management options with 80% of GPs from the survey not aware of the benefits of immunotherapy.

Health professionals should take an active role in referring appropriate patients and can locate specialist local allergy services through visiting whttp://www.bsaci.org.uk

The 2008 severe seasonal AR survey was sponsored by ALK-Abelló Ltd.

About ALK-Abelló

ALK-Abelló is a research-based pharmaceutical company and a world leader in allergen specific immunotherapy with more than 80 years of experience in allergy treatment and diagnostics. Headquartered in Hørsholm, Denmark the company employs more than 1,200 employees worldwide. http://www.alk-abello.com

References

1. Calderon M A, Birk A.O, Andersen J S et al. Prolonged preseasonal treatment phase with Grazax sublingual immunotherapy increases clinical efficacy. Allergy 2007: 62: 958-961

2. White P, Smith H, Baker N et al. Symptom control in patients with hay fever in UK general practice: how well are we doing and is there a need for allergen immunotherapy? Clin Exp Allergy 1998; 28: 266-270.

3. Number of GPs in the UK. Royal College of General Practioners: Patient information factsheet. Accessed: 16 October 2008; http://https://www.rcgp.org.uk/patient_information/what_is_general_practice.aspx

4. Bauchau V and Durham SR. Prevalence and rate of diagnosis of allergic rhinitis in Europe. Eur Respir J 2004;24:758-64.

5. NHS Direct. Patient Information Leaftlet: Hay fever. Accessed: 16 October 2008; http://cks.library.nhs.uk/patient_information_leaflet/hay_fever

6. Crystal-Peters J, Crown WH, Goetzel RZ et al. The cost of productivity losses associated with allergic rhinitis. Am J Manag Care 2000;6(3):373-8.

7. Walker S, Kahn-Wasti S, Fletcher M et al. Seasonal allergic rhinitis is associated with a detrimental effect on examination performance in United Kingdom teenagers: case-control study. J Allergy Clin Immunol 2007 Aug;120(2):381-7.

8. Scadding G.K et al. BSACI guidelines for the management of allergic and non-allergic rhinitis. Clinical and Experimental Allergy 2008; 38: 19-4. (BSACI Guidelines)

9. Bousquet J et al. WHO Position paper: Allergen immunotherapy: therapeutic vaccines for allergic diseases. J Allergy Clin Immunol 1998; 102: 558-562.

ALK-Abelló

The study pooled 41 trials with a robust outcome standard of a semi-structured interview to assess depression. The researchers found that GPs were able to recognize about half of people who had clinical depression. For a typical GP trying to spot depression in an urban practice and seeing 100 cases over two days, there would be 20 true cases of depression. The GP would correctly diagnose 10 people as depressed but miss about the same number with depression. Of the remaining 80 non-depressed patients, he/she would be likely to over-diagnose 15 people (around 20%) and correctly reassure a further 65 (around 80%). In a rural setting, false positives per 100 cases would outnumber true positives by around three to one (17 vs 5). At a national level where 78% of the population see their GP over the course of a year, about 12% would be suffering from clinical depression and about half of those cases would be picked up; of the remaining 66% of the population who are not depressed and consult their GP, up to 12% would be at risk being misdiagnosed as depressed if GPs relied upon a single clinical assessment.

In asking why GPs have difficulty diagnosing depression, the authors say that since only 1 in 5 people have depression this ‘low’ rate lends itself to higher rates of false positives. Also, more severe cases of depression are diagnosed more reliably than less severe forms. A third factor-the short appointments most people have at a GP surgery-could also contribute, since they might be inhibited from fully discussing their problems. The authors say GPs must be prepared to ask anyone in difficulty about depression. If clinicians evaluated people who might have symptoms of depression over two appointments instead of one, the authors calculate the overall diagnostic accuracy of GPs would increase to 90%.

The authors say: “Our results should not be interpreted as a criticism of GPs for failing to diagnose depression but rather a call for better understanding of the problems that non-specialists face. No data suggest that GPs do worse than other non-psychiatric medical colleagues.”

They conclude: “Because one-off brief assessments only facilitate identification of about half of those with depression, we suggest that additional consultation time should be available for those likely to have depression. Repeated assessments by the GP or other professional in a collaborative model with a case manager might help to reduce diagnostic errors and improve overall quality of care.”

In an accompanying Comment, Professor Peter Tyrer, Head of Department of Psychological Medicine, Imperial College London, UK, says: “If the diagnosis of depression cannot be agreed satisfactorily by the best minds in psychiatry, why should we expect the general practitioner to be a reliable assessor of the condition?”

He concludes: “It would be better to enhance the treatments available for common mental disorders in primary care. This intervention [psychosocial intervention for depression] is effective, but does cost more and will have to compete with other priorities. In the meantime, one can only hope that the new revisions of the International Classification of Diseases and the Diagnostic and Statistical Manual of Mental Disorders revise the nosology* of mood disorders in such a way that the current labels can be cast into oblivion.”

Link to article

Source
The Lancet

These results follow recent QOF performance data (2007/8 results) which showed that 98.9% of points were gained for the cholesterol indicator CHD 08 (% of CHD patients with ≤5mmol/L total cholesterol2).3 However, in order to gain full points, only 70% of patients in a practice are required to reach the indicator.2 According to QOF figures, 82.5% of patients reached indicator CHD 08.3 The 17.5% of patients who did not reach the indicator are in addition to those patients who were excluded from the calculations from the start due to exception reporting (a mean of 8.96% of patients in England for CHD 084).5

Dr Stewart Findlay, Treasurer of the Primary Care Cardiovascular Society and GP in Bishop Auckland, County Durham commented, “While performance against the current CHD 08 indicator is high, it is important to look behind the top line figure. We are still failing approximately a quarter of our patients against the current standard and many more if we look to achieve the lower levels suggested by NICE. Standards can still be raised in cholesterol management and incentives should be retained and strengthened within QOF to ensure that this happens.”

Treating patients to lower cholesterol levels recommended by NICE

The survey also revealed a wide gap between what the GPs consider best practice lipid management and how they say they manage patients on a day-to-day basis.1 In an ‘ideal world’, 81% of GPs believe that best practice lipid management for type 2 diabetes is treatment to <4mmol/L total cholesterol and/or <2mmol/L LDL-cholesterol,1 in line with NICE guidelines.6 However, just 44% say that they typically treat type 2 diabetes patients to these levels in everyday practice, with the resources they have available.1

The results were similar for treatment of secondary prevention patients, with 79% of GPs questioned saying they believe that in an ‘ideal world’ best practice lipid management is treatment to <4mmol/L total cholesterol and/or <2mmol/L LDL-cholesterol,1 again in line with NICE guidelines.7 Yet only 37% say that they typically treat secondary prevention patients to these targets in everyday practice, with the resources they have available.1 Overall, only 8% of GPs questioned believed that patients at high risk of cardiovascular disease (secondary prevention, type 2 diabetes, familial hypercholesterolaemia) currently have their lipids managed in line with NICE guidelines.1

Dr Findlay continued, “It is encouraging that GPs, who are at the forefront of lipid management, are aware of the NICE recommendations. However, they are still facing considerable challenges in getting these patients, who are at the highest cardiovascular risk, to the lower lipid levels that could further improve outcomes.”

Support from other healthcare professionals for lower lipid targets in QOF

The support for specific lower lipid targets in QOF was even higher across other types of healthcare professionals surveyed (which included nurses, cardiologists and diabetologists), with 84% of cardiologists and 89% of diabetologists believing there should be lower lipid indicators for type 2 diabetes.1 Furthermore 86% of cardiologists and 92% of diabetologists agree that there should be lower lipid indicators for secondary prevention.1 Among the practice nurses questioned, 91% and 82% believe there should be lower lipid indicators for type 2 diabetes and secondary prevention, respectively.1

Source
Merck Sharp & Dohme and Schering-Plough

RACGP President, Dr Chris Mitchell, said that the new RACGP musculoskeletal guidelines are significant because most current clinical guidelines available are consensus-based, agreed on by peers, rather than evidence-based and there is very limited information on juvenile idiopathic arthritis.

The first three of four guidelines cover osteoarthritis, rheumatoid arthritis and juvenile idiopathic arthritis and will be launched on Friday, 11 September. The guidelines are available for free download on the RACGP website at http://www.racgp.org.au/guidelines. The other guidelines on osteoporosis will be available on the RACGP website as soon as they become available.

Each guideline includes:

- Algorithms (diagnosis and management) that are designed to be reference tools during consultations
- Recommendations that provide a summary and grading of the available evidence

“These guidelines are a first for general practice in Australia. We are pleased to see that there has already been significant international interest in this important work,” Dr Mitchell said.

“The guidelines focus strongly on the early diagnosis and management because there is an opportunity within the first few months of disease onset to provide treatment that effectively limits structural damage and improves health outcomes.”

“Early and proper diagnosis is paramount in effectively managing severe forms of arthritis. We encourage GPs to actively use these step-by-step guidelines to ensure their patients have the opportunity of accessing suitable and timely treatments for their condition,” said Arthritis Australia’s CEO, Ainslie Cahill.

The RACGP has been working with expert working groups (general practitioner and other primary health care professionals) and a consultant appointed by the National Health Medical Research Council (NHMRC) to develop these four guidelines.

These guidelines are one of the first to use the NHMRC Evidence based Matrix (NHMRC additional levels of evidence and gradings of recommendations for developers of guidelines), which greatly assisted the grading of the recommendations.

This project has been funded by the Australian Government Department of Health and Ageing and the guidelines have been developed to the requirements of the NHMRC.

Source
RACGP

“As with many new technologies coming on line in the medical field, GPs are excited by the opportunities that will be provided by the Australian Synchrotron. We recognise the signal this investment sends of the government’s commitment to ensuring access to high quality medical technologies,” said Dr Chris Mitchell, RACGP President and rural GP.

“Unfortunately at this point in time the Australian Government has put on hold previous plans to allow access to more than $13 million in funding that would have provided for GPs to refer patients directly for Medicare rebate eligible MRI scans.

“The RACGP has long been concerned by this approach. General practice is on the frontline of delivering care in our communities and GPs are often the first point of contact that patients have with the health system. GPs are well trained and highly competent in using high quality, high technology diagnostic tools.

“The exclusion of GP access to MRI results in additional needless costs in our health system and presents barriers to patients accessing this technology that can play a key part in their care.

“The RACGP wants to see the Australian Government adopt an approach that benefits our patients and respects the training, skills and experience of Australia’s highly competent GPs.”

About the RACGP

The Royal Australian College of General Practitioners (RACGP) is responsible for maintaining standards for quality clinical practice, education and training, and research in Australian general practice. The RACGP represents the majority of Australia’s urban and rural general practitioners.

Source
Royal Australian College of General Practitioners

Dr David Bailey, Chairman of the BMA’s GP Committee in Wales says: “BMA Cymru Wales completely supports Wales’ Chief Medical Officer and the Welsh Assembly Government in their decision to opt out of the National Pandemic Flu service. I strongly believe that patients want diagnoses of whatever their illness may be, made by clinicians, not call centres.

“GPs in Wales are adequately equipped to manage swine flu. Yes, myself and colleagues have in previous weeks been working harder, but we have just proved how we can step up to the mark when necessary and that we can deliver and will continue to deliver extremely good levels of patient care.

“The general public does have a part to play in helping to contain the spread of swine flu for the coming winter months, by self-caring if their symptoms do not seem to be too severe. The majority of healthy people can manage the virus themselves, without the need to see their GP, as is the case with other seasonal flu viruses.”

Source
The British Medical Association Cymru Wales

GPs are struggling to provide the quality of care for children with eczema currently recommended by two of the UK’s most prestigious medical bodies: the National Institute of Health and Clinical Excellence (NICE)1 and the Primary Care Dermatology Society/British Association of Dermatologists (PCDS/BAD).2 Almost 90% of GPs recently surveyed reported that they had only limited or insufficient time available to give comprehensive treatment advice, and to demonstrate how to apply critical first-line treatments such as emollients.3 The nation-wide survey of 200 GPs was commissioned by Stiefel Laboratories, the makers of Oilatum, who believe that poor compliance to eczema treatment is responsible for much of the ongoing misery endured by eczema sufferers.

The GP survey also revealed that parents are rarely given written information on how to treat their child’s eczema, and that a lack of parent education is thought to be one of the main reasons why emollient therapies are not always used correctly.3 These results agree with those reported in an earlier survey of over 300 members of the National Eczema Society, which found that more than one-third of parents had never received any information from their GPs that had helped them manage their child’s condition.4

What do the eczema guidelines say?

UK eczema guidelines1,2 set out the basic requirements for the management of childhood eczema by primary care teams. In both sets of guidelines, the first-line recommended treatment is complete emollient therapy (CET), including continual and liberal use of emollient creams, ointments, bath oils and soap substitutes. GPs and nurses are advised to take an holistic approach to managing the condition, and are offered specific guidance on CET including:

- Educating the parent/child on the optimal use of emollient therapies; providing details of applications and quantities and, ideally, demonstrating how and when to use them

- Recommending the use of both bath emollients and emollient creams

- Prescribing sufficient quantities of emollient creams, with recommended amounts for a child in the range of 250-500 g per week

- Informing the parent/child that emollients should be used in larger amounts and more often than other treatments – ideally applied at least 3-4-times a day

- Providing written information as a back-up.

Unfortunately, the results from the GP survey suggest that these recommendations are not being followed in all primary care practices. Only 6% of GPs who participated said they always gave parents written information on how to treat their child’s eczema, nearly half admitted they never demonstrated how to apply emollient creams, and over 60% recommended less than the ideal quantity of emollient creams per week. Not surprisingly, when questioned about why emollient therapies are not always used properly, the GPs surveyed said the most likely causes were a lack of education about how to use them, and them not being applied often enough.

Margaret Cox from the National Eczema Society comment’s, ‘we know from the calls we receive to our helpline that many eczema sufferers are unhappy with the advice they receive from their doctor. I understand that GPs are under increasing pressure and time restraints. However, as the primary health professional the majority of eczema sufferers will first consult about their condition, GP’s are in a perfect position to offer crucial advice that could really make a difference to the lives of sufferers’.

Margaret says that new research suggesting that eczema cases seen by GP’s almost doubled in a four year period, means it’s more vital than ever before that GP’s consider the value of the information they give their patients. She comments ‘GP’s should ensure the time they do have available to spend with eczema suffers should be used to explain the fundamental aspects of treating the condition. From experience, just a few minutes spent to educate and demonstrate how to use emollient treatments effectively and to explain things like the importance of bathing with an emollient bath additive rather than using soaps and detergents can really make a difference to the physical and emotional impact of the condition.

References

1. National Institute for Health and Clinical Excellence (NICE). Atopic eczema in children. NICE Clinical Guideline 57. Issue date: December 2007.

2. Primary Care Dermatology Society & British Association of Dermatologists. Guidelines on the Management of Atopic Eczema 2003. Available on-line at: http://www.bad.org.uk.

3. Survey commissioned by Stiefel Laboratories questioning 200 GPs to investigate the current treatment of eczema. February 2009 GP omnibus survey by Opinion Health.

4. Nationwide survey of childhood eczema by Oilatum® Junior in association with the National Eczema Society. August 2008. Details available at from nikki@spinkpr.com or tel 01444 484888.

Source
National Eczema Society

Higher risk people – including pregnant women, chronic disease sufferers, Indigenous Australians, and frontline health workers – will have priority for vaccination in the initial phase of the rollout, but others will not be precluded should there be an opportunity to vaccinate them early.

The national pandemic influenza vaccine campaign was launched in Perth this morning and the first supplies of the swine flu vaccine are available in general practices around the country from today.

Dr Pesce said the AMA welcomes the Government’s recognition of the role of Australia’s GPs at the front and centre of the vaccine campaign.

“GPs have the best knowledge of an individual’s overall health history, and people trust their GP,” Dr Pesce said.

“The AMA encourages people to get vaccinated and not to take any chances,” Dr Pesce said.

“While not all general practices will be supplying the vaccine, people should contact their regular GP to get advice on when and where to be vaccinated at the earliest opportunity.”

Children under the age of 10 should not be vaccinated at this stage. Clinical trials of a vaccine suitable for people under 10 are continuing.

Dr Pesce said the Government, the AMA and the community fully appreciate the contribution being made by

GPs all around Australia to making this vital public health initiative a success.

“The AMA and other medical groups worked closely with the Government, the Commonwealth Department of Health and Ageing (DoHA), and the Chief Medical Officer on the rollout of the national pandemic influenza vaccination campaign,” Dr Pesce said.

“We all agreed that there are compelling clinical reasons for rolling out the vaccine now in Australia and we all agreed that general practice would be the key to a safe and effective rollout of the vaccine right across the country.”

Source
Australian Medical Association

“Recent research is predicting that one in seven Australians will have type 2 diabetes by 2050,” said RACGP president, Dr Chris Mitchell.

“With their knowledge and skill in delivering preventive health care strategies and educating those at risk of diabetes, GPs will be key players in avoiding a national health crisis,” said Dr Mitchell.

“GPs provide cradle-to-grave care and consult with more than 85% of Australians annually. There is no group better equipped to provide solutions and we welcome the excellent work Diabetes Australia is doing to raise community awareness of this looming crisis. It is crucial that the RACGP continues to work with such specialist organizations in the delivery of preventive health care,” said Dr Mitchell.

“Patients need to be aware that their GP is an expert when it comes to discussing lifestyle changes that can prevent diabetes and that they can provide management support to those who have already developed the condition.”

The role of GPs in encouraging people at risk of developing type 2 diabetes to take up the Life! Course http://www.diabeteslife.org.au is central to the World Diabetes Day message. The aim of the course is to educate the community about the condition and the risk factors which can contribute to developing diabetes.

The RACGP’s Guidelines for preventive activities in general practice recommends that patients should be screened for diabetes every 3 years from 45 years of age using the Australian Type 2 Diabetes Risk Assessment Tool. Aboriginal and Torres Strait Islander people should be screened from 18 years of age. See RACGP, Diabetes Management in General Practice guidelines with Diabetes Australia http://www.racgp.org.au/guidelines/diabetes.

Source
Royal Australian College of General Practitioners