Family Practice - Advance Access

Frequent consulting and multiple morbidity: a qualitative comparison of 'high' and 'low' consulters of GPs

Townsend, A., Wyke, S., Hunt, K. — 2008-04-30

Background. Frequent consulting is associated with multiple and complex social and health conditions. It is not known how the impact of multiple conditions, the ability to self-manage and patient perception of the GP consultation combines to influence consulting frequency.

Objective. To investigate reasons for frequent consultation among people with multiple morbidity but contrasting consulting rates.

Methods. Qualitative study with in-depth interviews in the west of Scotland. Participants were 23 men and women aged about 50 years with four or more chronic illnesses; 11 reported consulting seven or more times in the last year [the frequent consulters (FCs)] and 12, three or fewer times [the less frequent consulters (LFCs)]. The main outcome measures were the participants’ accounts of their symptoms, self-management strategies and reasons for consulting a GP.

Results. All participants used multiple self-management strategies. FCs described: more disruptive symptoms, which were resistant to self-management strategies; less access to fewer treatments and resources and more medical monitoring, for unstable conditions and drug regimens. The LFCs reported: less severe and more containable symptoms; accessing more efficacious self-management strategies and infrequent GP monitoring for stable conditions and routine drug regimens. All participants conveyed consulting as a ‘last resort’. However, the GP was seen as ‘ally’, for the FCs, and as ‘innocent bystander’, for the LFCs.

Conclusions. This qualitative investigation into the combined significance of multiple morbidities and self-management on the GP consultation suggests that current models of self-management might have limited potential to reduce utilization rates among this vulnerable group. Severity of symptoms, stability of condition and complexity of drug regimens combine to influence the availability of effective resources and influence frequency of GP consultations.

Routine glutamic acid decarboxylase autoantibody (GADA) testing: patients' perspective

Davies, H, Mannan, S., Brophy, S, Williams, R — 2008-04-28

Background. Latent autoimmune diabetes in adults (LADA) is a form of type 1 diabetes which in the UK is often diagnosed and treated as type 2 diabetes (T2D). People with LADA show slow progression to insulin dependence and can be distinguished from T2D by blood tests for glutamic acid decarboxylase autoantibodies (GADA).

Aims. This study explores the views and experiences of patients who are newly diagnosed with LADA, with particular reference to (i) routine GADA testing; (ii) whether this diagnosis has any influence on the self-management of their diabetes; and (iii) the information needs of patients newly diagnosed with LADA.

Methods. Ten consecutive patients newly diagnosed with LADA (GADA positive) were invited to participate in individual qualitative semi-structured interviews. Their views and experiences were analysed into codes and categories, using a constant comparative method.

Findings. Participants supported routine GADA testing in all patients with diabetes because the provision of a correct diagnosis has an empowering effect on patients, as it encourages the consideration of treatment options early on in the condition. Participants preferred to rely on future Hba_1c levels and their doctor's opinion to determine a change in treatment to insulin. Some participants had difficulty distinguishing between the different types of diabetes, including LADA. Others needed to ask questions about LADA in addition to written information.

Conclusions. Participants were supportive of routine GADA testing, would prefer not to start insulin immediately following a diagnosis of LADA and needed to discuss treatment options with health professionals who were knowledgeable on LADA.

Reporting of research data by GPs: a cautionary tale for primary care researchers

Gormley, G., Connolly, D., Catney, D., Freeman, L., Murray, L. J, Gavin, A. — 2008-04-28

Background. Given the importance of community-based research, there is a need to ensure the quality of data obtained from such studies. However, research has been considered a low priority for most GPs.

Objectives. To assess the quality of data reported by GPs in a large community-based study.

Methods. Men were recruited as part of a population-based study on prostate-specific antigen (PSA) testing. Those with elevated initial PSA levels in the mid-1990s and no investigation in the intervening period were invited for repeat PSA testing. The GP of each included man was contacted and asked to report basic clinical information. Trained data extractors independently reviewed each man's GP medical notes and recorded data relating to prostate problems. Data provided by GPs were rematched with data extracted from medical notes.

Results. A total of 758 men with 379 GPs were included. In all, 366 (96.6%) GPs agreed to participate. Of 698 men suitable for follow-up, GP and note review data were available in 505 (72.3%) cases (287 GPs). Overall, 245 (85.4%) GPs provided completely accurate data. Male GPs, compared to female GPs, were found to have a higher level of inaccurate reporting (P = 0.008).

Conclusions. We found that when GPs were asked to record basic clinical information, for the purposes of a primary care-based study, there was a significant level of inaccurate reporting. The results from our study confirm the importance of quality control in primary care research, especially in studies that involve GPs' reporting data.