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This document is a compilation of summaries of various articles from the British Journal of General Practice. The articles cover a range of topics related to primary care, including continuity of care for patients with mesothelioma, the use of longitudinal qualitative methods in asthma research, the management of chronic diseases in different patient populations, the attitudes of primary care professionals towards their title, suicide prevention in primary care, non-pharmacological interventions for dementia-related psychosis, healthcare access for Afghan refugees, inquiry-based stress reduction for obesity, non-pharmacological interventions for perinatal anxiety, and the impact of remote consulting in general practice. Each summary provides a brief overview of the background, aim, method, results, and conclusion of the respective article. The document provides a comprehensive collection of research studies in primary care, offering diverse perspectives and findings for library patrons conducting research on these topics. [Extracted from the article]

Background Older adults frequently attend the emergency department (ED) and experience high rates of adverse events following ED presentation. This randomised controlled trial evaluated the impact of early assessment and intervention by a dedicated team of health and social care professionals (HSCPs) in the ED on the quality, safety, and clinical effectiveness of care of older adults in the ED. Methods and findings This single-site randomised controlled trial included a sample of 353 patients aged [greater than or equal to]65 years (mean age = 79.6, SD = 7.01; 59.2% female) who presented with lower urgency complaints to the ED a university hospital in the Mid-West region of Ireland, during HSCP operational hours. The intervention consisted of early assessment and intervention carried out by a HSCP team comprising a senior medical social worker, senior occupational therapist, and senior physiotherapist. The primary outcome was ED length of stay. Secondary outcomes included rates of hospital admissions from the ED; hospital length of stay for admitted patients; patient satisfaction with index visit; ED revisits, mortality, nursing home admission, and unscheduled hospital admission at 30-day and 6-month follow-up; and patient functional status and quality of life (at index visit and follow-up). Demographic information included the patient's gender, age, marital status, residential status, mode of arrival to the ED, source of referral, index complaint, triage category, falls, and hospitalisation history. Participants in the intervention group (n = 176) experienced a significantly shorter ED stay than the control group (n = 177) (6.4 versus 12.1 median hours, p < 0.001). Other significant differences (intervention versus control) included lower rates of hospital admissions from the ED (19.3% versus 55.9%, p < 0.001), higher levels of satisfaction with the ED visit (p = 0.008), better function at 30-day (p = 0.01) and 6-month follow-up (p = 0.03), better mobility (p = 0.02 at 30 days), and better self-care (p = 0.03 at 30 days; p = 0.009 at 6 months). No differences at follow-up were observed in terms of ED re-presentation or hospital admission. Study limitations include the inability to blind patients or ED staff to allocation due to the nature of the intervention, and a focus on early assessment and intervention in the ED rather than care integration following discharge. Conclusions Early assessment and intervention by a dedicated ED-based HSCP team reduced ED length of stay and the risk of hospital admissions among older adults, as well as improving patient satisfaction. Our findings support the effectiveness of an interdisciplinary model of care for key ED outcomes. Trial registration ClinicalTrials.gov NCT03739515; registered on 12 November 2018., Author(s): Marica Cassarino 1,2, Katie Robinson 1, Dominic Trépel 3,Íde O'Shaughnessy 4, Eimear Smalle 4, Stephen White 4, Collette Devlin 1, Rosie Quinn 5, Fiona Boland 6, Marie E. Ward [...]

Background: General practice is well situated to promote physical activity (PA), but with PA levels declining after 45 years of age, often those who are most likely to benefit from interventions tend to be the least likely recruited to participate in research.Aims and Rationale: The aim of this study was to investigate recruitment and reporting of participant demographics in PA trials for adults aged 45 years and above. Specific objectives were: (i) to examine the reporting of demographics of participants; (ii) to investigate the strategies used to recruit these participants; and, (iii) to examine the efficiency of recruitment strategies.Methods: Seven databases were searched, including: PubMed, CINAHL, the Cochrane Library Register of Controlled Trials, Embase, Scopus, PsycINFO, and Web of Science. Only randomized control trials involving adults 45 years old or older recruited through primary care were included. The PRISMA framework for systematic review was followed, which involved 2 researchers independently conducting title, abstract, and full article screening. Tools for data extraction and synthesis were adapted from previous work on inclusivity in recruitment.Results: The searches retrieved 3,491 studies of which 12 were included for review. Sample size of the studies ranged from 31 to 1,366, with a total of 6,042 participants of which 57% were female. Of 101 participating practices, 1 was reported as rural. Reporting of recruitment lacked detail-only 6 studies outlined how practices were recruited. 11/12 studies involved a database or chart review to identify participants that met the inclusion criteria, followed by a letter of invitation sent to those people. The studies with higher recruitment efficiency ratios each employed more than 1 recruitment strategy, e.g. opportunistic invitations and telephone calls.Conclusion: This systematic review has presented deficits in the reporting of both demographics and recruitment. Future research should aim for a standardized approach to reporting. [ABSTRACT FROM AUTHOR]

Background: As prevalence of multimorbidity and polypharmacy rise, health care systems must respond to these challenges. Data is needed from general practice regarding the impact of age, number of chronic illnesses and medications on specific metrics of healthcare utilisation. Methods: This was a retrospective study of general practices in a university-affiliated education and research network, consisting of 72 practices. Records from a random sample of 100 patients aged 50 years and over who attended each participating practice in the previous two years were analysed. Through manual record searching, data were collected on patient demographics, number of chronic illnesses and medications, numbers of attendances to the general practitioner (GP), practice nurse, home visits and referrals to a hospital doctor. Attendance and referral rates were expressed per person-years for each demographic variable and the ratio of attendance to referral rate was also calculated. Results: Of the 72 practices invited to participate, 68 (94%) accepted, providing complete data on a total of 6603 patients' records and 89,667 consultations with the GP or practice nurse; 50.1% of patients had been referred to hospital in the previous two years. The attendance rate to general practice was 4.94 per person per year and the referral rate to the hospital was 0.6 per person per year, giving a ratio of over eight attendances for every referral. Increasing age, number of chronic illnesses and number of medications were associated with increased attendance rates to the GP and practice nurse and home visits but did not significantly increase the ratio of attendance to referral rate. Discussion: As age, morbidity and number of medications rise, so too do all types of consultations in general practice. However, the rate of referral remains relatively stable. General practice must be supported to provide person centred care to an ageing population with rising rates of multi-morbidity and polypharmacy. [ABSTRACT FROM AUTHOR]

Background: Longitudinal integrated clerkships (LICs) are a relatively new model of clinical medical education, whereby students participate in patient care over time and develop relationships with those patients', their clinicians, and other health care staff involved in the care of those patients. It has been called 'relationship-based education' but, to date, no review has investigated the development and impact of these central relationships within this curricula model. Aims: The aim of this study is to review the literature pertaining to relationships in LICs, specifically to understand how they come about and how they affect learning. Methods: The search strategy systematically explored PubMed, ERIC (EBSCO) and Academic Search Complete, using key words and MESH terms. Original research published in peer-reviewed journals between January 2007 and August 2020 that were written in the English language were included in the review. Results: After applying set inclusion and exclusion criteria, 43 studies were included in this review. A qualitative thematic analysis was undertaken, and results were synthesised narratively. Four distinct categories were identified: defining relationships in LICs, developing relationships in LICs, relationship maintenance and multi-stakeholder impact. Conclusions: The longitudinal integrated clerkship model of clinical education facilitates the development of meaningful triangular relationships between student, clinical teacher and patient, which are the central drivers of successful learning within the context of an LIC. These relationships are nested in a set of important supporting relationships involving other supervisors, the medical school and university, the practice clinical and administrative team and peers. [ABSTRACT FROM AUTHOR]

Background: Longitudinal integrated clerkships (LICs) are an innovation in medical education that are often successfully implemented in general practice contexts. The aim of this study was to explore the experiences and perspectives of general practitioner (GP)-tutors on the impact of LICs on their practices, patients and the wider community. Methods: GPs affiliated with the University of Limerick School of Medicine- LIC were invited to participate in in-depth interviews. Semi-structured interviews were conducted in person and over the phone and were based on a topic guide. The guide and approach to analysis were informed by symbiosis in medical education as a conceptual lens. Data were recorded, transcribed and analysed using an inductive thematic approach. Results: Twenty-two GPs participated. Two main themes were identified from interviews: 'roles and relationships' and 'patient-centred physicians'. Five subthemes were identified which were: 'GP-role model', 'community of learning', and 'mentorship', 'student doctors' and 'serving the community'. Conclusion: LICs have the potential to develop more patient-centred future doctors, who have a greater understanding of how medicine is practised in the community. The LIC model appears to have a positive impact on all stakeholders but their success hinges on having adequate support for GPs and resourcing for the practices. [ABSTRACT FROM AUTHOR]