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Biomedical subjects

Martyn R Partridge

Publications and source records attributed to Martyn R Partridge.

13 recordsLinked to original sources
PubMed2006

Use of an open access spirometry service by general practitioners.

AIMS: To understand better which patients with which diagnoses or suspected diagnoses are referred for spirometry in primary care, and to assess whether all such referrals are appropriate. METHODS: 200 consecutive patient referrals to an open access spirometry service from ten local general practices were evaluated by perusing the request forms, and analysis of the spirometry results and the report sent to the general practitioner (GP). RESULTS: 51% of all referrals had suspected or stated COPD, but airway obstruction was demonstrated in only 53% of cases. A minority had a degree of reversibility which suggested an additional asthma component at least. Airway obstruction was rarely demonstrated in patients referred with stated or suspected asthma. 117 patients were referred with stated or suspected airway disease but had no evidence of airway narrowing on testing. 14.5% of these had an unexpected small lung (restrictive) disorder. Six of these had a BMI of more than 30. CONCLUSION: Most referrals with stated or suspected COPD were highly appropriate since spirometry is required in order to establish the correct diagnosis. Referral of patients with suspected asthma is less likely to be helpful, and a period of home peak flow monitoring may be more useful. Restrictive disorders can be confused with airway disorders, and obesity may be underestimated as a cause of breathlessness.

Family Practice↗
PubMed2006

Attitudes and actions of asthma patients on regular maintenance therapy: the INSPIRE study.

BACKGROUND: This study examined the attitudes and actions of 3415 physician-recruited adults aged > or = 16 years with asthma in eleven countries who were prescribed regular maintenance therapy with inhaled corticosteroids or inhaled corticosteroids plus long-acting beta2-agonists. METHODS: Structured interviews were conducted to assess medication use, asthma control, and patients' ability to recognise and self-manage worsening asthma. RESULTS: Despite being prescribed regular maintenance therapy, 74% of patients used short-acting beta2-agonists daily and 51% were classified by the Asthma Control Questionnaire as having uncontrolled asthma. Even patients with well-controlled asthma reported an average of 6 worsenings/year. The mean period from the onset to the peak symptoms of a worsening was 5.1 days. Although most patients recognised the early signs of worsenings, the most common response was to increase short-acting beta2-agonist use; inhaled corticosteroids were increased to a lesser extent at the peak of a worsening. CONCLUSION: Previous studies of this nature have also reported considerable patient morbidity, but in those studies approximately three-quarters of patients were not receiving regular maintenance therapy and not all had a physician-confirmed diagnosis of asthma. This study shows that patients with asthma receiving regular maintenance therapy still have high levels of inadequately controlled asthma. The study also shows that patients recognise deteriorating asthma control and adjust their medication during episodes of worsening. However, they often adjust treatment in an inappropriate manner, which represents a window of missed opportunity.

Administration, Inhalation↗
PubMed2006

How useful are post consultation letters to patients?

BACKGROUND: As part of the NHS plan it was suggested that all patients receive copies of letters sent to their General Practitioner following outpatient consultations. The former Secretary of State for Health extended this proposal, suggesting that patients have a specific letter to themselves after a hospital consultation. METHODS: The aim of this study was to send cardiorespiratory patients attending Charing Cross Hospital, a copy of the letter sent to their G.P. plus a specific letter to themselves and to assess the usefulness and comprehensibility of each. The letters were analysed for dictation time, Flesch Reading Ease Score, Flesch-Kincaid Grade Level and word count. Eighty-four out of 105 sequential patients (80%) consented and were sent both types of letter after their attendance. Patients returned both letters circling any items they did not understand and stated a preference for the GP letter, patient letter, or both. The patients' GPs were subsequently also asked for their views on each letter. RESULTS: GP letters took significantly longer to dictate than patient letters. The Flesch Reading Ease Score was significantly higher in the patient letters, indicating that the patient letters were easier to read. The GP letters were significantly longer than the patient letters and patients were significantly more likely to circle more items in the GP letters (p < 0.001). The content of letters is sometimes inaccurate. Thirty-six out of 62 patients (58%) would like to receive both letters, 13/62 (21.6%) would prefer the GP letter and 13/62 (20%) wanted only the patient letter. 45 GPs replied (62.5%), 28/45 (62.5%) wanted the GP letter, 14 GPs (31.1%) wanted both letters and 3/45 (6.7%) wanted the patient letter only. General themes concerned insufficient clinical details and the GPs preferred the structure of the letters written to them. CONCLUSION: Patients appreciate copies of the letter being sent to their GP but comprehension is less good than with a shorter letter written especially to the patient. More attention needs to be paid to making letters to GPs simpler to read without losing the structure and detail liked by GPs. A compromise might be to dictate the letter in front of the patient and to provide a speciality-specific glossary to accompany each letter.

Ambulatory Care↗
PubMed2006

Implementing practice guidelines: a workshop on guidelines dissemination and implementation with a focus on asthma and COPD.

The present supplement summarizes the proceedings of the symposium "Implementing practice guidelines: A workshop on guidelines dissemination and implementation with a focus on asthma and COPD", which took place in Quebec City, Quebec, from April 14 to 16, 2005. This international symposium was a joint initiative of the Laval University Office of Continuing Medical Education (Bureau de la Formation Médicale Continue), the Canadian Thoracic Society and the Canadian Network for Asthma Care, and was supported by many other organizations and by industrial partners. The objectives of this meeting were to examine the optimal implementation of practice guidelines, review current initiatives for the implementation of asthma and chronic obstructive pulmonary disease (COPD) guidelines in Canada and in the rest of the world, and develop an optimal strategy for future guideline implementation. An impressive group of scientists, physicians and other health care providers, as well as policy makers and representatives of patients' associations, the pharmaceutical industry, research and health networks, and communications specialists, conveyed their perspectives on how to achieve these goals. This important event provided a unique opportunity for all participants to discuss key issues in improving the care of patients with asthma and COPD. These two diseases are responsible for an enormous human and socioeconomic burden around the world. Many reports have indicated that current evidence-based guidelines are underused by physicians and others, and that there are many barriers to an effective translation of recommendations into day-to-day care. There is therefore a need to develop more effective ways to communicate key information to both caregivers and patients, and to promote appropriate health behaviours. This symposium contributed to the initiation of what could become the "Canadian Asthma and COPD Campaign", aimed at improving care and, hence, the quality of life of those suffering from these diseases. It is hoped that this event will be followed by other meetings that focus on how to improve the transfer of key recommendations from evidence-based guidelines into current care, and how to stimulate research to accomplish this.

Asthma↗
PubMed2006

Patient understanding, detection, and experience of COPD exacerbations: an observational, interview-based study.

STUDY OBJECTIVES: This study was conducted to gain insight into patients' comprehension, recognition, and experience of exacerbations of COPD, and to explore the patient burden associated with these events. DESIGN: A qualitative, multinational, cross-sectional, interview-based study. SETTING: Patients' homes. PATIENTS: Patients (n = 125) with predominantly moderate-to-very severe COPD (age > or = 50 years; with two or more exacerbations during the previous year). INTERVENTIONS: Patients underwent a 1-h face-to-face interview with a trained interviewer. MEASUREMENTS AND RESULTS: During the preceding year, patients experienced a mean +/- SD of 4.6 +/- 5.4 exacerbations, after which 19.2% (n = 24) believed they had not fully recovered. Although commonly used by physicians, only 1.6% (n = 2) of patients understood the term exacerbation, preferring to use simpler terms, such as chest infection (16.0%; n = 20) or crisis (16.0%; n = 20) instead. Approximately two thirds of patients stated that they were aware of when an exacerbation was imminent and, in most cases, patients recounted that symptoms were consistent from one exacerbation to another. Some patients (32.8%; n = 41), however, reported no recognizable warning signs. At the onset of an exacerbation, 32.8% of patients (n = 41) stated that they reacted by self-administering their medication. Some patients spontaneously mentioned a fear of dying (12.0%; n = 15) or suffocating (9.6%; n = 12) during exacerbations, and effects on activities, mood, and personal/family relationships were frequently reported. Physicians tended to underestimate the psychological impact of exacerbations compared with patient reports. CONCLUSIONS: This study shows that patients with frequent exacerbations have a poor understanding of the term exacerbation. Patient recollections suggest that exacerbation profiles vary enormously between patients but that symptoms/warning signs are fairly consistent within individuals, and are generally recognizable. Exacerbations appear to have a significant impact on patient well-being, including psychological well-being, and this may be underestimated by physicians.

Activities of Daily Living↗
PubMed2005

Do medical outpatients want 'out of hours' clinics?

BACKGROUND: Patient choice is a major theme in current healthcare delivery. Little is known about patients' wishes regarding the timing of medical outpatient clinics. METHODS: A questionnaire survey of 300 sequential patients attending cardiac and respiratory clinics to determine patients preferences for out of hours and weekend outpatient clinics. (Out of hours defined as a clinic after 5 pm on Mon - Fri) RESULTS: Two hundred and 64 patients completed the survey of which 165 (62.5%) wanted either an out of hours clinics or a weekend clinic. Sixty four (38.8%) specifically stated that this was because of work commitments but for many others, the reasons given were easy to justify. CONCLUSION: Current provision for outpatient consultation may not be convenient for many patients with heart and lung disease. A fuller evaluation of the cost and benefits of more flexible clinic hours is now needed.

Adult↗
PubMed2005

The asthma consultation: what is important?

Sufficient time and effective communication are the main requirements in an ideal asthma consultation. One way of using limited time effectively is for patients to be offered more information prior to the consultation. Physician-patient communication during the consultation may be improved by patients receiving, in advance, pertinent information related to their appointment and leaflets may be used to encourage patients to list any questions, fears or concerns prior to the consultation. Directing patients to appropriate internet sites may also facilitate information transfer. Time is frequently wasted when patients fail to attend their consultation. Sending a reminder letter or phoning to remind patients of their appointment has been shown to significantly reduce non-attendance rates. During the consultation, time can be used more effectively by ensuring that patients understand their treatment regimens, by improving communication between the doctor and patient and by organising asthma services in a manner acceptable to patients; this includes avoiding delays, having a doctor that listens and seeing the same doctor on each occasion. After the consultation, advice given to patients should be reinforced as studies suggest that patients' ability to recall information given to them may influence patient adherence and patient satisfaction. The whole professional team should be involved in order to manage better limited time effectively and information given to patients should be reinforced, either by post-consultation leaflet/letter or via telephone or email. Most importantly, correct performance of the inhalation manoeuvre should be regularly checked, patients should be taught and trained how to manage their own condition and should be offered convenient follow-up options, all of which should improve patient satisfaction and compliance.

Asthma↗
PubMed2004

An assessment of the feasibility of telephone and email consultation in a chest clinic.

One hundred and sixty-four consecutive patients attending a busy respiratory outpatient service were asked how acceptable was the concept of alternating face to face consultation with consultation by either telephone or email. The patients were then assessed as to their suitability for such non-traditional methods of consultation. Thirty patients (18.3%) were not agreeable to other forms of consultation and five could not speak English. One hundred and thirty-three (84%) had a suitable daytime telephone number for consultation purposes, but only 34 (21%) had email access, with this being commoner in the younger ages. One hundred and five patients were not thought to be suitable for alternative methods of consultation because of: the severity of their condition, the difficulty of assessing it over the telephone, or because they needed to attend the hospital for investigations. However, even in a clinic where the policy was already to return as many patients as possible to the care of their primary care physicians, and in a clinic where much work was already shared with respiratory nurse specialists, over one-third of patients were thought to be suitable for alternating face to face with telephone consultation. The diagnoses in those cases included asthma, suspected obstructive sleep apnoea, chronic obstructive pulmonary disease (COPD), unexplained cough, and some patients with respiratory malignancy being visited at home by the palliative medicine services. However, for those with asthma and for those awaiting results of investigations especially, use of telephone consultation appears to be an acceptable and convenient way of reducing the pressure upon time available for face to face consultations.

Computer Literacy↗
PubMed2002

Strengthening asthma education to enhance disease control.

This article focuses on reducing the barriers to effectively applying what is known about asthma patient education. One barrier to effective asthma control in individuals and populations is failure to recognize the range of influences on patients trying to manage their disease, including actions of family, clinicians, friends and neighbors, work or school mates, and significant people and organizations in the wider social environment. Another deterrent is failing to assist patients in developing their self-regulation skills. Other barriers are the lack of attention to the patients' asthma management goals (as opposed to clinical objectives) and overlooking signs that indicate follow-up education is needed. Five actions taken by health-care professionals could significantly enhance the effectiveness of asthma education: (1) make messages to patients and core skills taught consistent with national asthma guidelines; (2) focus on developing the patient's ability to self-regulate; (3) develop comprehensive plans for treatment and education that assign clinicians to appropriate educative roles; (4) use clinician communication techniques demonstrated to enhance asthma management by patients; and (5) ensure that all providers of education are themselves trained to achieve actions 1 to 4.

Asthma↗
PubMedDate not supplied

Writing to patients.

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Attitude of Health Personnel↗