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  1. Article ; Online: GP views on strategies to cope with increasing workload: a qualitative interview study.

    Fisher, Rebecca Fr / Croxson, Caroline Hd / Ashdown, Helen F / Hobbs, Fd Richard

    The British journal of general practice : the journal of the Royal College of General Practitioners

    2017  Volume 67, Issue 655, Page(s) e148–e156

    Abstract: Background: The existence of a crisis in primary care in the UK is in little doubt. GP morale and job satisfaction are low, and workload is increasing. In this challenging context, finding ways for GPs to manage that workload is imperative.: Aim: To ... ...

    Abstract Background: The existence of a crisis in primary care in the UK is in little doubt. GP morale and job satisfaction are low, and workload is increasing. In this challenging context, finding ways for GPs to manage that workload is imperative.
    Aim: To explore what existing or potential strategies are described by GPs for dealing with their workload, and their views on the relative merits of each.
    Design and setting: Semi-structured, qualitative interviews with GPs working within NHS England.
    Method: All GPs working within NHS England were eligible. Of those who responded to advertisements, a maximum-variation sample was selected and interviewed until data saturation was reached. Data were analysed thematically.
    Results: Responses were received from 171 GPs, and, from these, 34 were included in the study. Four main themes emerged for workload management: patient-level, GP-level, practice-level, and systems-level strategies. A need for patients to take greater responsibility for self-management was clear, but many felt that GPs should not be responsible for this education. Increased delegation of tasks was felt to be key to managing workload, with innovative use of allied healthcare professionals and extended roles for non-clinical staff suggested. Telephone triage was a commonly used tool for managing workload, although not all participants found this helpful.
    Conclusion: This in-depth qualitative study demonstrates an encouraging resilience among GPs. They are proactively trying to manage workload, often using innovative local strategies. GPs do not feel that they can do this alone, however, and called repeatedly for increased recruitment and more investment in primary care.
    MeSH term(s) Adaptation, Psychological ; Attitude of Health Personnel ; General Practitioners/psychology ; Humans ; Job Satisfaction ; Personnel Loyalty ; Primary Health Care/organization & administration ; Qualitative Research ; State Medicine/organization & administration ; United Kingdom ; Workload/psychology ; Workload/statistics & numerical data
    Language English
    Publishing date 2017-01-16
    Publishing country England
    Document type Journal Article
    ZDB-ID 1043148-2
    ISSN 1478-5242 ; 0035-8797 ; 0960-1643
    ISSN (online) 1478-5242
    ISSN 0035-8797 ; 0960-1643
    DOI 10.3399/bjgp17X688861
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Out-of-hours primary care use at the end of life: a descriptive study.

    Fisher, Rebecca Fr / Lasserson, Daniel / Hayward, Gail

    The British journal of general practice : the journal of the Royal College of General Practitioners

    2016  Volume 66, Issue 650, Page(s) e654–60

    Abstract: Background: Out-of-hours (OOH) primary care services are integral to the care of patients at end of life. Little is known about the OOH service usage of patients with palliative care needs.: Aim: To describe patterns of usage of patients presenting ... ...

    Abstract Background: Out-of-hours (OOH) primary care services are integral to the care of patients at end of life. Little is known about the OOH service usage of patients with palliative care needs.
    Aim: To describe patterns of usage of patients presenting to an OOH service and coded as 'palliative'.
    Design and setting: A descriptive study of data from the Oxfordshire OOH service.
    Method: A database of all patient contacts with the Oxfordshire OOH service from a 4-year period (June 2010-August 2014) was used to extract demographic and service usage data for all contacts to which clinicians had applied a 'palliative' code. Observed differences in demographic features between palliative and non-palliative contacts were tested using logistic regression.
    Results: Out of a total of 496 931 contacts, there were 6045 contacts coded palliative; those 'palliative' contacts provided care to 3760 patients. Patients contacting the OOH service with palliative care needs did so predominantly during weekend daytime periods, and over a third had more than one contact. Patients were predictably older than the average population, but contacts coded as 'palliative' were relatively less deprived than contacts to the OOH service for all causes, even after adjusting for age and sex.
    Conclusion: The current 'one-size-fits-most' model of OOH primary care may not allow for the specific needs of patients at the end of life. Wider analysis of palliative patient flow through urgent care services is needed to identify whether healthcare access at the end of life is inequitable, as well as the capacity requirements of a community-based service that can provide high-quality end-of-life care.
    MeSH term(s) After-Hours Care/standards ; After-Hours Care/utilization ; Aged ; Aged, 80 and over ; Chronic Disease/therapy ; England ; Female ; Health Services Accessibility/statistics & numerical data ; Humans ; Male ; Needs Assessment ; Palliative Care/standards ; Palliative Care/utilization ; Primary Health Care/standards ; Primary Health Care/utilization ; Qualitative Research
    Language English
    Publishing date 2016-09
    Publishing country England
    Document type Journal Article
    ZDB-ID 1043148-2
    ISSN 1478-5242 ; 0035-8797 ; 0960-1643
    ISSN (online) 1478-5242
    ISSN 0035-8797 ; 0960-1643
    DOI 10.3399/bjgp16X686137
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Feasibility of a 4-Week Manual Therapy and Exercise Intervention on Posture and Function in Community-Dwelling Older Adults: A Pilot Study.

    Hughes, Lynne C / Galloway, Rebecca V / Fisher, Steve R

    Journal of geriatric physical therapy (2001)

    2022  Volume 46, Issue 3, Page(s) 151–160

    Abstract: ... Go (TUG), 5 times sit-to-stand (5XSTS), Functional Reach (FR), 2-minute walk test (2MWT), and Patient ... time was found. Univariate analysis of each dependent variable showed significance except for FR ...

    Abstract Background and purpose: Thoracic hyperkyphosis is a common condition that progresses with aging and has been associated with impaired functional performance, increased risk of falls, and even mortality. Previous studies to improve posture primarily used exercise for durations of 3 months or longer. The purpose of this pilot study was to examine the feasibility of a manual therapy intervention in community-dwelling older adults over a 4-week time frame that is comparable to the typical clinical setting, to test the appropriateness and procedures for the measurement of posture and function in the older population with hyperkyphosis, and to collect preliminary data to describe change in posture and function measures.
    Methods: Twenty-four participants with hyperkyphosis or forward head posture were recruited, and 22 participants completed this pilot study. Feasibility was measured based on attendance, tolerance, safety, and retention. Issues with measurement procedures were recorded. The intervention included manual therapy and exercise 3 times a week for 4 weeks to target spinal and peripheral joint stiffness, muscle lengthening, and muscle activation. Outcomes included height, kyphotic index (KI), Block Test, Acromion to Table (ATT), Timed Up and Go (TUG), 5 times sit-to-stand (5XSTS), Functional Reach (FR), 2-minute walk test (2MWT), and Patient-Specific Functional Scale (PSFS). Data collected at visits 1, 6, and 12 were analyzed using 1-way repeated-measures multivariate analysis of variance.
    Results and discussion: Measurement and intervention protocols were found to be feasible. A significant effect for the aggregate dependent variables change over time was found. Univariate analysis of each dependent variable showed significance except for FR. All postural measures (height, KI, Block Test, and ATT) significantly improved statistically. The KI and ATT exceed the minimal detectable change for clinical significance. Function showed statistical improvements in the TUG, 5XSTS, 2MWT, and PSFS. Clinical significance was reached with the PSFS. Seven of 9 measures showed a statistically significant change in just 2 weeks.
    Conclusions: This pilot study suggests that manual therapy and exercise applied to older adults shows promise for improvement in measures of posture and functional performance in a clinically feasible 4-week time frame.
    MeSH term(s) Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Exercise Therapy/methods ; Feasibility Studies ; Independent Living ; Kyphosis/physiopathology ; Kyphosis/therapy ; Musculoskeletal Manipulations ; Physical Functional Performance ; Pilot Projects ; Posture/physiology ; Treatment Outcome
    Language English
    Publishing date 2022-08-05
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2250801-6
    ISSN 2152-0895 ; 1539-8412
    ISSN (online) 2152-0895
    ISSN 1539-8412
    DOI 10.1519/JPT.0000000000000360
    Database MEDical Literature Analysis and Retrieval System OnLINE

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