Attitudes On The Role Of Nutrition In GP Training

Aim Nutrition is the leading cause of chronic disease globally, yet it is unknown how much nutritional education GP trainees receive. The aim is to identify GP trainee attitudes to nutrition and compare with the programme directors who deliver this training. Methods A multicentre online survey questionnaire of 542 GP trainees in Ireland and 63 programme directors over 2 weeks in September 2019. ANOVA analysis was used to determine if there was an agreement between programme directors and trainees. Results 13 GP training schemes participated, with 93 trainees (16%) and 9 (14%) programme directors answering the survey. There was consensus and agreement between trainees and programme directors for the following; it is the role of the GP to promote a healthy diet; there are barriers to optimal nutritional management; there would be interest in further education. ANOVA analysis found that there was agreement from directors and trainees in the assertion that nutritional education to date is not adequate. Discussion There is an agreement between GP trainees and their programme directors that the nutritional educational component of GP training is an unmet need. This study highlights the need for an improvement in nutritional education to maximise the management of chronic disease in Irish general practice.

The use of psychotherapeutic interventions by primary care GPs in Ireland in the treatment of their methadone patients: a grounded theory study

BACKGROUND

The methadone protocol placed responsibility on general practitioners (GPs) for the methadone treatment of stabilised drug-addicted patients. The protocol emphasised a medico-pharmacological model with minor reference to psychotherapeutic treatment.

AIM

This qualitative study investigated how primary care GPs in Ireland use psychotherapeutic interventions in the treatment of methadone patients.

METHOD

A grounded theory methodology was used.

FINDINGS

There is a wide variation in the beliefs and knowledge of methadone-prescribing GPs regarding the efficacy of psychotherapeutic interventions for patients on methadone maintenance. GPs do not formally integrate psychotherapeutic interventions into methadone patient treatment. Accessing psychotherapeutic services raises concerns for GPs in terms of availability, location and quality. Primary care GPs who offer methadone maintenance view opiate abuse as a health issue similar to other such issues within their community. They take a holistic view of their methadone patient and, without formal guidelines, develop individual approaches to the use of psychotherapeutic interventions. The absence of a framework for the use of psychotherapeutic interventions in primary care methadone treatment in Ireland militates against the development of a basis for improving practice.

What has happened to people affected by thalidomide 50 years on?

INTRODUCTION

There have been reports of thalidomide-affected people suffering a deterioration in their disability over time [1, 2]. This study assessed changes in disabilities among thalidomide-affected people in the Irish population.

METHODS

A questionnaire, assessing musculo-skeletal health, quality-of-life, general health and illness intrusiveness was sent to 26 people affected by thalidomide in the Republic of Ireland.

RESULTS

Seventeen (65%) responded. Six (35%) respondents were not working as a result of their disability. Eleven (65%) reported a worsening of their disability over time, with nine of them reporting the deterioration as moderate to severe. The impact of this decline was measured by respondents in terms of ability to perform daily tasks, emotional health and finances (due to extra costs related to clothing, transport, housing alterations and heating).

CONCLUSION

There is a need to continually review the physical, psychological and social needs of thalidomide survivors in order to ensure optimum care is made available.

There's a hole in the bucket: an analysis of the impact of the medical card review process on patient entitlement to free health care

In 2001 the frequency of reviewing medical-card eligibility was increased. This study assessed the impact of this policy change on patient entitlement to free health care. Data on reasons for patient removal from a GP's General Medical Services (GMS) list during a two and a half year period was analysed. During this period, 1489 (89% CI 87-91%) patients from the practice list were removed for non-return of review forms. Forty patients randomly selected from patients deleted from the list in 2006 were interviewed. Sixty percent said they had not received a review form and 91% (CI 82-100%) believed they were entitled to a medical card. In the period without medical card cover, cost prevented 11% (CI 1-21%) of those who felt they were eligible from accessing medical care while 26% (CI 12-40%) paid 'out-of-pocket'. This study shows that a bureaucratic policy change has negatively affected access to health care.

Timing of strangulation in adult hernias

This retrospective study aimed to determine why the incidence of strangulated hernias in adults remains high. Seventy-nine patients presented with clinical evidence of hernia strangulation which required urgent surgery during the period 1979-87. Forty-six patients (58 per cent) had noted a hernia present for at least 1 month before strangulation: 18 (23 per cent) had not reported it to their family doctor, 19 (24 per cent) were known by family practitioners or non-surgical medical personnel to have a hernia but had not been referred for surgical opinion, and nine (11 per cent) had been previously assessed surgically with a view to elective repair. Of these nine, five were considered unfit, three were on waiting lists for operation and one had refused surgery. Thirty-two patients (40 per cent) presented primarily with strangulation within days of developing a hernia. The duration of hernia before strangulation in one patient was unknown. Although an unavoidable number of patients will continue to present with strangulation within days of developing a hernia, the overall incidence could be significantly reduced by greater public awareness of the risks of hernia strangulation and by a policy of immediate patient referral and prompt elective repair.