General practice at the cutting edge of information technology, or failing to keep pace?

Delaney, Brendan

doi:10.3399/bjgp10x483869

Cited by 8 publications

(6 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Psychometric properties of the PHQ-9, PHQ-2+ have been well studied in clinical populations generally; [10] amongst patients with diabetes; [11] and in Aboriginal and Torres Strait Islander populations [11-13]. The psychological distress domain (K-5) - a modified version of the Kessler Psychological Distress Scale-10 (K-10) has been used in survey settings in Australia amongst Indigenous adults [14].…”

Section: Introductionmentioning

confidence: 99%

Do competing demands of physical illness in type 2 diabetes influence depression screening, documentation and management in primary care: a cross-sectional analytic study in Aboriginal and Torres Strait Islander primary health care settings

Schierhout

Nagel

et al. 2013

Int J Ment Health Syst

View full text Add to dashboard Cite

BackgroundRelatively little is known about how depression amongst people with chronic illness is identified and managed in diverse primary health care settings. We evaluated the role of complex physical needs in influencing current practice of depression screening, documentation and antidepressant prescriptions during a 12-month period, among adults with Type 2 diabetes attending Aboriginal and Torres Strait Islander primary care health centres in Australia.MethodsWe analysed clinical audit data from 44 health centres participating in a continuous quality improvement initiative, using previously reported standard sampling and data extraction protocols. Eligible patients were those with Type 2 diabetes with health centre attendance within the past 12 months. We compared current practice in depression screening, documentation and antidepressant prescription between patients with different disease severity and co-morbidity. We used random effects multiple logistic regression models to adjust for potential confounders and for clustering by health centre.ResultsAmong the 1174 patients with diabetes included, median time since diagnosis was 7 years, 19% of patients had a co-existing diagnosis of Ischaemic Heart Disease and 1/3 had renal disease. Some 70% of patients had HbAc1>7.0%; 65% had cholesterol >4.0 mmol1-1 and 64% had blood pressure>130/80 mmHg. Documentation of screening for depression and of diagnosed depression were low overall (5% and 6% respectively) and lower for patients with renal disease (Adjusted odds ratio [AOR] 0.21; 95% confidence interval [CI] 0.14 to 0.31 and AOR 0.34; 95% CI 0.15 to 0.75), and for those with poorly controlled disease (HbA1c>7.00 (AOR 0.40; 95% CI 0.23 to 0.68 and AOR 0.51; 95% CI 0.30 to 84)). Screening for depression was lower for those on pharmaceutical treatment for glycaemic control compared to those not on such treatment. Antidepressant prescription was not associated with level of diabetes control or disease severity.ConclusionsBackground levels of depression screening and documentation were low overall and significantly lower for patients with greater disease severity. Strategies to improve depression care for vulnerable populations are urgently required. An important first step in the Australian Indigenous primary care context is to identify and address barriers to the use of current clinical guidelines for depression screening and care.

show abstract

Section: Introductionmentioning

confidence: 99%

Do competing demands of physical illness in type 2 diabetes influence depression screening, documentation and management in primary care: a cross-sectional analytic study in Aboriginal and Torres Strait Islander primary health care settings

Schierhout

Nagel

et al. 2013

Int J Ment Health Syst

View full text Add to dashboard Cite

show abstract

“…In the Netherlands and the US, practice-based research networks provide continuous high-quality observational data for health services research, but are also expected to serve as a platform for clinical trials [12,13]. The UK-led European TRANSFoRm project aims to interlink and extend existing databases of electronic patient records, and to provide electronic support to practice networks in order to facilitate clinical trials and comparative effectiveness research in primary care [14,15]. Usually, practice-based research networks cooperate closely with specific coordinating centres, often academic departments for general practice, or specific, publicly funded research institutes for primary health care research.…”

Section: Introductionmentioning

confidence: 99%

General practice-based clinical trials in Germany - a problem analysis

Hummers-Pradier¹,

Bleidorn

Schmiemann

et al. 2012

Trials

View full text Add to dashboard Cite

BackgroundIn Germany, clinical trials and comparative effectiveness studies in primary care are still very rare, while their usefulness has been recognised in many other countries. A network of researchers from German academic general practice has explored the reasons for this discrepancy.MethodsBased on a comprehensive literature review and expert group discussions, problem analyses as well as structural and procedural prerequisites for a better implementation of clinical trials in German primary care are presented.ResultsIn Germany, basic biomedical science and technology is more reputed than clinical or health services research. Clinical trials are funded by industry or a single national programme, which is highly competitive, specialist-dominated, exclusive of pilot studies, and usually favours innovation rather than comparative effectiveness studies. Academic general practice is still not fully implemented, and existing departments are small. Most general practitioners (GPs) work in a market-based, competitive setting of small private practices, with a high case load. They have no protected time or funding for research, and mostly no research training or experience. Good Clinical Practice (GCP) training is compulsory for participation in clinical trials. The group defined three work packages to be addressed regarding clinical trials in German general practice: (1) problem analysis, and definition of (2) structural prerequisites and (3) procedural prerequisites. Structural prerequisites comprise specific support facilities for general practice-based research networks that could provide practices with a point of contact. Procedural prerequisites consist, for example, of a summary of specific relevant key measures, for example on a web platform. The platform should contain standard operating procedures (SOPs), templates, checklists and other supporting materials for researchers.ConclusionAll in all, our problem analyses revealed that a substantial number of barriers contribute to the low implementation of clinical research in German general practice. Some issues are deeply rooted in Germany’s market-based healthcare and academic systems and traditions. However, new developments may facilitate change: recent developments in the German research landscape are encouraging.

show abstract

“…General Practice is one of the professions that in the last years have been affected more deeply by a process of continuous digitization of its documentand communication-related tasks (Benson, 2002;Delaney, 2010;Dobrev et al, 2008;Purves, 1996). The Electronic Medical Record (EMR) is the main tool at the centre of this process of digitization, and therefore it has so far received the interest of hundreds of scholarly studies aimed at understanding the nature of its role in changing medical work, e.g., (Hassey, 2001;Hippisley-Cox, 2003;Porcheret et al, 2004;Treweek, 2003).…”

Section: Motivations and Backgroundmentioning

confidence: 99%

Electronic Records for General Practice - Where we Are, Where we should Head to Improve Them

Cabitza

Zotti²,

Misericordia³

2014

Proceedings of the International Conference on Health Informatics

View full text Add to dashboard Cite

General practice at the cutting edge of information technology, or failing to keep pace?

Cited by 8 publications

References 8 publications

Do competing demands of physical illness in type 2 diabetes influence depression screening, documentation and management in primary care: a cross-sectional analytic study in Aboriginal and Torres Strait Islander primary health care settings

Do competing demands of physical illness in type 2 diabetes influence depression screening, documentation and management in primary care: a cross-sectional analytic study in Aboriginal and Torres Strait Islander primary health care settings

General practice-based clinical trials in Germany - a problem analysis

Electronic Records for General Practice - Where we Are, Where we should Head to Improve Them

Contact Info

Product

Resources

About