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Reports of work absence usually come from self-report or company absence records; however, these records are limited to just one company. Electronic recording of sickness certification in primary care medical records may provide an alternative source of data, but its relation to other sources of sickness absence information is unknown. Comparing general practitioner electronic sickness certification records with self-reported work absence would enable the comparability of these electronic records to be established.
To investigate the comparability of electronic medical records of sickness certification in primary care, with self-reported work absence.
Analysis included 292 primary care low-back pain consulters who consented to medical record review. A within-group design was used to match electronic records of sickness certification with self-reported sickness absence.
Overall 95% of the electronic medical records of sickness certification matched with self-reported absences; 96% in employed consulters and 95% in unemployed consulters. In all, 94% of employed participants were a direct match, 2% a consistent match and 4% a mismatch. Including consistent matches increased matching to 97% in employed consulters and to 100% in unemployed consulters. Electronic records of sickness certification in general practice are a useful method of analysing sickness absence in the population, as they are comparable with other sources of data. Additionally, electronic records of sickness certification will allow the investigation of sickness absence where data from one company are too limited and self-report is not available or unreliable. To facilitate the use of electronic medical records of sickness certification, data need to be accurately recorded and evaluated or audited to ensure completeness and validity. Furthermore, methods should be developed to ensure straightforward linkage between sickness certification records and other data held on the electronic medical record.
Statistics from primary health care in Sweden, as well as from other Nordic countries, have been sparse. The electronic patient records (EPR) will be an increasingly important source of clinical information. The aim of this study was to investigate types of encounters, managed diseases and health problems, and characteristics of patients and general practitioners (GPs) in everyday general practice using EPR.
A multi-centre, cross-sectional database study of EPR in primary health care in Stockholm, Sweden. Twenty-six randomly selected GPs with 20 randomly selected encounters each. Main outcome measures were the number and distribution of diseases and health problems, age and gender of patients and GPs, and type of encounter.
The mean age of the patients was 51.2 years, 30.2% were aged 75 years or older, and 57.5% were women. The mean number of managed problems per encounter was 1.4. The most common specific diagnoses were essential hypertension (9.3% of the encounters) and acute upper respiratory infections (8.8%). Older patients had more health problems in each encounter (P = 0.000001). GPs differed regarding the characteristics of their patients, including sex, age and number of health problems managed at each encounter. The patients of different GPs differed regarding sex, age and number of health problems managed. Female and male patients had different diagnostic panoramas and they had a tendency to encounter a GP of the same sex (odds ratio 1.5, P = 0.053).
We found that two diagnoses (essential hypertension and acute upper respiratory infections), four diagnostic groups, women and the elderly are predominant. Female and male patients have different diagnostic panoramas and they have a tendency to encounter a GP of the same sex. GPs differ regarding the characteristics of their patients, including sex, age and number of health problems managed at each encounter.
Prison health care in England, including primary care, is now incorporated into the National Health Service; the impetus for the change is in part due to concern about standards of health care within prisons. The demographic characteristics and health status of patients within prisons are relatively well understood, as are the problems faced by health care professionals. Less is known about current health care provision.
To describe the organisation of primary health care and specialised services in prisons and compare services available to different types of prison.
A piloted questionnaire was sent to the governors of all prisons in England and Wales for completion by the health care manager.
Completed questionnaires were received from 122 (89%) of 138 prisons. The survey showed a low use of information technology (IT). Problems were reported with the recruitment and retention of general nurses in more than 50% of prisons. Prisoners in category A/B (higher security) prisons had available to them a greater range of health care services compared with those in other prisons. The results suggest that provision of services for chronic diseases and improvements in IT are needed. Problems with the recruitment and retention of general nurses need addressing. The reasons why lower-security prisoners are receiving a narrower range of specialised health care services compared with higher-security prisoners need justifying.
The research question for this study was: Are there within-group disparities in Hispanic women’s knowledge of heart attack and stroke symptomology?
Hispanics constitute the fastest growing group in the US and have surpassed other racial and ethnic groups to become the largest US minority. Hispanics make up about one-third of the US population, and hence are a group of significant interest for health care providers. Few studies have examined heart attack and stroke symptom awareness among adult Hispanic women, a group at high risk for delays in treatment. Research is needed to elucidate their knowledge of warning symptoms for these vascular events.
Behavioral Risk Factor Surveillance Survey data from states using the 2003–2005 Heart and Stroke module were examined by multivariate techniques. To maximize the representativeness of the sample, three years of survey data (2003–2005) were amalgamated into a single dataset. If a given state administered the Heart and Stroke module in multiple years, only the data from the most recent year were included in the merged dataset. In the final analysis, data from 23 states, one territory and the District of Columbia were included in the combined 2003–2005 database. The unweighted sample size for the population of interest for the years 2003–2005 was 3146. For analysis these data were weighted to represent 2 641 024 Hispanic women aged 18 years and older who answered questions about heart attack and stroke symptoms.
Adult Hispanic women earning low scores on the heart attack and stroke knowledge questions were more likely to have less than a high school education, be uninsured, live in a household with an annual income of <$35 000 and not have a primary care provider.
These results suggest that strategies to educate Hispanic women on signs and symptoms of heart attack and stroke might benefit from targeting women in these groups.
The purpose of this study was to investigate the circumstances of opioid prescription among general practitioners (GPs) in the UK.
Prescription of opioids for chronic pain, particularly non-malignant chronic pain, remains controversial. In the midst of this controversy, patterns of actual prescription and influences on these patterns are not well understood.
A mail survey was posted to 1192 GPs and it was returned by 414 (35.0%). The survey addressed the frequency and reluctance in GP prescription of opioids for chronic pain. It also sampled their attitudes and concerns about opioids, including their views on appropriateness and effectiveness, adverse effects and potential social pressures presumed to impact on prescribing.
Overall, 57.9% of GPs reported they sometimes, frequently, or always, prescribe strong opioids for chronic pain, which was of significantly lower frequency than for prescribing of weak opioids, non-steroidal anti-inflammatory drugs (NSAIDs) or tricyclic antidepressant medications. Similarly, 69.1% reported a reluctance to prescribe strong opioids for chronic non-malignant pain, which was a significantly greater reluctance than for cancer pain, for example. GPs who were men, younger, had fewer years experience and worked full time (as opposed to part time), were more likely to prescribe opioids. Practice guideline use was unrelated to prescribing but those with specialty training were more likely to prescribe. Interestingly, a majority of GPs (83.0%) felt that opioids are effective for chronic non-malignant pain; however, they worry about long-term commitment (such as managing dosing and repeat prescriptions), addiction and other adverse events.
Based on multivariate analyses, both frequency of prescribing and reluctance were predicted by a combination of concerns about effects on patient behaviour, professional competency concerns and degree of belief in opioids as an effective option. These results may suggest a need for additional GP training in the management of analgesics for chronic non-malignant pain.
To understand the experience of terminal care and health care access for Gypsy Travellers, to inform palliative and primary care service provision.
Little contemporary research of UK English Romany Gypsy Travellers is available. This ethnic group is often overlooked in ethnic minority health research.
Access to Gypsy Traveller communities was through non-health care channels and required the development of trust through repeated contact over time. English Romany Gypsy Travellers at two Traveller sites participated in face-to-face contacts. Data collection was through field observation and seven semistructured interviews with Gypsy Traveller women who had experience of caring for relatives who were dying. In addition, data were collected over two years through discussion in a members-only Gypsy and Traveller interest e-mail forum.
The culture of Gypsy Travellers is distinct but diverse. Hygiene is important as is discretion and sensitivity to the information requirements of the patient and family. Gypsy Travellers are aware that their mobility (voluntary or enforced) can negatively impact on health care. Home care for the terminally ill is often preferred to hospital care often due to poor understanding of their cultural and personal needs by health care professionals and due to an aversion to ‘bricks and mortar’. Care may be provided by the extended family. Palliative care provision should consider the needs of Gypsy Travellers including respect for their culture and support for caring at home.