Essential Primary Care (eBook)

Andrew Blythe, Jessica Buchan (Herausgeber)

eBook Download: EPUB

2016
John Wiley & Sons (Verlag)
978-1-118-86759-4 (ISBN)

Infos

Essential Primary Care aims to provide undergraduate students with a comprehensive overview of the clinical problems encountered in primary care. It covers the structure of primary care in the UK, disease prevention and the management of common and important clinical presentations from infancy to old age. Case studies are used in every chapter to illustrate key learning points. The book provides practical advice on how to consult with patients, make sense of their symptoms, explain things to them, and manage their problems.
Essential Primary Care:
• Is structured in five sections:
 - The building blocks of primary care: its structure and connection with secondary care, the consultation, the process of making a diagnosis, prescribing, and ethical issues
 - Health promotion
 - Common and important presenting problems in roughly chronological order
 - Cancer
 - Death and palliative care
• Gives advice on how to phrase questions when consulting with patients and how to present information to patients
• Provides advice on how management extends to prescribing - often missing from current textbooks
• Contains case studies within each chapter which reflect the variety of primary care and provide top tips and advice for consulting with patients
• Supported by a companion website at www.wileyessential.com/primarycare featuring MCQs, EMQs, cases and OSCE checklists

Autor

Andrew Blythe is a General Practitioner at Gaywood House Surgery, Bristol, and Senior Teaching Fellow, University of Bristol. Jessica Buchan is a General Practitioner and a Teaching Fellow, University of Bristol.

Inhalt

contributors viii

Foreword ix

Preface x

How to use your textbook xi

About the companion website xii

Part 1: The key features of primary care

1 The structure and organisation of primary care 3
Andrew Blythe

2 The GP consultation 10
Jessica Buchan

3 Making a diagnosis 22
Barbara Laue

4 Prescribing 30
Andrew Blythe

5 The interface with secondary care 42
Sarah Jahfar

6 The everyday ethics of primary care 50
Trevor Thompson

Part 2: Healthy living and disease prevention

7 Behaviour change 59
Jessica Buchan

8 Alcohol and drug misuse 68
Andrew Blythe

9 Preventing cardiovascular disease 77
Andrew Blythe

10 Caring for people with learning disabilities 85
Andrew Blythe

Part 3: Common presenting problems

11 Tiredness 95
Andrew Blythe

Childhood

12 Child health in primary care 111
Jessica Buchan

13 Managing the feverish and ill child in primary care 120
Alastair Hay, Lucy Jenkins and Jessica Buchan

14 Managing common conditions in infancy 134
Jessica Buchan

15 Managing chronic conditions in childhood 139
Lucy Jenkins, Alastair Hay, Matthew Ridd and Jessica Buchan

16 Teenage and young?]adult health 147
Jessica Buchan and David Kessler

Early adulthood

17 Respiratory tract infections 157
Lucy Jenkins

18 Low back pain 163
Jessica Buchan

19 Heartburn and dyspepsia 170
Jessica Buchan

20 Diarrhoea and rectal bleeding 177
Andrew Blythe

21 Common skin conditions 184
Matthew Ridd

22 Headache 194
Andrew Blythe

23 Fits, faints and funny turns 201
Andrew Blythe

24 Depression, anxiety and self?]harm 210
David Kessler

25 Sexual health and dysuria 219
Lucy Jenkins

26 Menstrual problems, contraception and termination of pregnancy 231
Jessica Buchan

27 Pregnancy 241
Jessica Buchan

28 Domestic violence and abuse 254
Gene Feder

Middle and old age

29 Cardiovascular disease 265
Andrew Blythe

30 Breathlessness 275
Jessica Buchan

31 Joint pains and stiffness 287
Andrew Blythe

32 Urinary problems and prostate disease 294
Simon Thornton

33 The menopause 302
Jessica Buchan

34 Multimorbidity and polypharmacy 307
Polly Duncan and Andrew Blythe

35 Falls and fragility fractures 314
Andrew Blythe

36 Visual and hearing loss 322
Andrew Blythe

37 Dementia 331
Andrew Blythe

Part 4: Cancer

38 Spotting patients with cancer 343
Andrew Blythe

39 Looking after patients with cancer 352
Andrew Blythe

Part 5: Palliative care and death

40 Palliative care and death 361
Andrew Blythe

Index 371

Textauszug

CHAPTER 1
The structure and organisation of primary care

Andrew Blythe

GP and Senior Teaching Fellow, University of Bristol

Key topics

• What is primary care?
• Organisation of primary care in the UK
• What can be done in primary care?

Learning objectives

• Understand the benefits of a health service that is based on primary care.
• Understand the scope and limitations of primary care in the UK.
• Appreciate how primary care is evolving in the UK.

What is primary care?

Primary care is first-contact care provided by health care professionals to local populations. Primary care attempts to manage the health needs of individuals within these defined populations in a coordinated, comprehensive and continuous fashion from birth until death. Because patients present with unsorted problems, primary care health care professionals must be generalists who have an expert understanding of the causes of health and illness throughout a person’s life.

In many countries primary care provides the foundation upon which the rest of the country’s health system is built. This is certainly true in the UK. Everyone in the UK is entitled to register with a local general medical practitioner (GP). Once registered, the person is entitled to consult with a GP or nurse in the practice to which that GP belongs as often as they like. Most of the time, the GP is able to manage the patient’s problem within the primary care team. Sometimes, the GP needs to refer the patient to the next tier of the health service – secondary care – for further investigation and treatment. In so doing, the GP acts as a ‘gatekeeper’ to the rest of the National Health Service (NHS), ensuring appropriate use of more expensive secondary care services, which are normally based in hospital.

The importance of primary care

The importance of having a strong primary care sector in every country was highlighted by the World Health Organization (WHO) in 1978 at an international conference at Alma-Ata, in what is now known as Uzbekistan.1 The Alma-Ata declaration set out the aspiration of providing health for all by a primary care-led service. Here is its definition of primary care:

Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of selfreliance and self-determination. It forms an integral part both of the country’s health system, of which it is the central function and main focus, and of the overall social and economic development of the community. It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process.

Article VI, Alma-Ata Declaration, WHO, 19781

The aspirations of the Alma-Ata declaration have not yet been fully realised, but many countries are attempting to improve the health care that they offer their citizens by building a stronger base in primary care. China, for example, aims to train a further 300 000 GPs over the next 10 years, so that there will be 1 GP for every 3000–5000 people.2

The last 2 decades have seen the publication of a lot of evidence suggesting that countries which have a strong primary care sector have better health care outcomes. Professor Barbara Starfield, from the Johns Hopkins School of Public Health in the USA, published a seminal paper on this topic in 1994,3 in which she ranked developed countries according to their health care outcomes and the strength of their primary care services. Countries which had the most developed primary care services had the best health care outcomes. The USA, which had the least developed primary care system at the time, had the worst health care outcomes. In the same paper, Professor Starfield showed that the countries which spent the least per capita on health care were the countries which had the most developed systems of primary care.

A more recent analysis of data from 31 European countries4 has confirmed that health care outcomes are better in those countries which have a strong primary care base, as measured by the density of primary care providers and the quality of their environment. However, this analysis has not confirmed that these better outcomes are provided more cheaply. Today, countries in Europe which have well-developed primary care services tend to spend a larger proportion of their gross domestic product (GDP) on health than countries with less robust primary care services. According to the World Bank, in 1995 the UK spent 6.8% of its GDP on health; by 2012, it was spending 9.4%.5

Knowing the patient

In hospitals the diseases stay and the people come and go; in general practice, the people stay and the diseases come and go.

Iona Heath, Past President of the Royal College of General Practitioners6

One of the central features of primary care in the UK has been the relationship between the patient and ‘their GP’. Patients are registered with a GP for years (the mean is 11 years), and in this time GPs often get to know their patients well. GPs’ knowledge of their patients helps them with diagnosing and addressing the patients’ worries. When a new diagnosis is made, patients want to know why and how it has happened to them. Knowledge of the patient makes it easier for the GP to provide this explanation and help the patient chose the best plan of action.

In many instances knowing the person who has the disease is as important as knowing the disease that person had.

James McCormick7

Case study 1.1 may help to explain why knowledge of the patient is so important in primary care.

Case study 1.1

Stephen Stockman is a 60-year-old widower who works on the railways. He is on treatment for high blood pressure. Recently, he saw the practice nurse for a blood pressure check; it was high, so the nurse told him to consult his GP. Last week he also went to see his optician for a routine eye check and was told that he might need referral to the Eye Hospital because the appearance of the back of his right eye indicated that he might have glaucoma. He hasn’t noticed any change in his vision.

What finally prompts him to make an appointment with the doctor is neither of these things: it’s the fact that he has a cough that has gone on for 3 weeks. He could have made an appointment to see one of the other doctors in the practice a bit sooner, but he decides to wait for the next available appointment with his usual GP, Dr Jones. When he comes to the GP, he starts out by mentioning the cough.

How does the GP’s prior knowledge of this patient help to sort out these problems?

Dr Jones got to know Mr Stockman well when his wife was dying of lung cancer. Dr Jones made regular home visits to provide palliative care and issued the death certificate. Afterwards, she had a few consultations with Mr Stockman to support him through his bereavement. The GP established a strong, trusting relationship with Mr Stockman.

Knowing that his wife died of lung cancer, Dr Jones suspects Mr Stockman is worried that his cough is the first sign of cancer, so she takes particular care to check out this possibility.

Dr Jones holds the entire set of medical records for Mr Stockman, dating back to childhood. Dr Jones knows when Mr Stockman was diagnosed with hypertension and has records of the medication he has tried so far and the tablets he had to stop because of side effects. Thus, Dr Jones is in the best position to decide what new or additional tablet Mr Stockman could try to control his blood pressure better.

Amongst the medical records are all the consultant letters from visits to hospital. One of the letters is from a consultant whom Mr Stockman saw at the Eye Hospital 6 years ago. In this letter, the consultant describes the same appearance of the right fundus that the optician is describing now. The consultant had ruled out glaucoma. Mr Stockman had forgotten this.

Organisation of primary care in the UK

The UK has a national network of GP practices. All GP practices operate as independent small businesses that are subcontracted by the NHS to provide primary care services to specified geographical areas. There are restrictions on the number of practices in a given area. In many parts of the country, particularly in urban areas, there are several practices with overlapping boundaries. Therefore, many patients have a choice about which practice they register with. Members of a given household tend to be registered with the same practice, but this is not always the case. About 98% of the UK population is registered with a GP.

The GP workforce

The number of full time-equivalent GPs in the UK has grown very slowly in recent years, but the way in which they have been organised has changed quite rapidly. The number of single-handed practices continues to fall, as practices merge and grow. All...

Produkt-Details

• Erscheint lt. Verlag: 24.3.2016
• Reihe/Serie: Essentials
• Reihe/Serie: Essentials
• Reihe/Serie: Essentials
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Allgemeines / Lexika
• Themenwelt: Medizin / Pharmazie ► Gesundheitswesen
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Allgemeinmedizin
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Medizinethik
• Themenwelt: Studium ► Querschnittsbereiche ► Geschichte / Ethik der Medizin
• Themenwelt: Studium ► Querschnittsbereiche ► Prävention / Gesundheitsförderung
• Schlagworte: Allgemeinpraxis, hausärztliche Praxis • Allgemeinpraxis, hausärztliche Praxis • Cancer • Childhood • Consultation • Disease • general practice • General Practice/Family Practice • GP • Lifespan • <p>Primary care • Medical • medical education • Medical Science • Medizin • Medizinische Grundversorgung • Medizinstudium • old-age • palliative</p> • Student • Symptoms
• ISBN-10: 1-118-86759-9 / 1118867599
• ISBN-13: 978-1-118-86759-4 / 9781118867594