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Monica Fletcher

Publications and source records attributed to Monica Fletcher.

8 recordsLinked to original sources

International Primary Care Respiratory Group (IPCRG) Guidelines: diagnosis of respiratory diseases in primary care.

This Diagnosis paper constitutes the second of the IPCRG Guideline papers on the management of chronic respiratory diseases in primary care. Primary care health professionals are usually the first point of contact for patients who can present a wide range of initial symptoms which may or may not constitute their first presentation of a chronic disease such as asthma, COPD, or rhinitis. This paper is focussed upon the early identification and diagnosis of chronic respiratory diseases in primary care. It uses a symptom-based approach, and includes original questionnaires and diagnostic guides to help the primary care clinician proceed systematically through the diagnostic process.

Adult↗

General practitioners with a special clinical interest: a model for improving respiratory disease management.

Health care technology is continuously moving forward with great advances in all fields of medicine. The way in which health care is delivered has been stuck in a primary care/secondary care model, which is failing to meet patients' needs. Existing structures are inefficient because they do not maximise use of skills. A new way of delivering services is proposed using an intermediate level specialist--a general practitioner with a special clinical interest (GPSCI), to increase access at a location close to the patient while giving support to the wider primary health community. We explore how the role of GPSCI might work using the field of respiratory medicine as an exemplar. The concept is transferable to other therapeutic areas.

Family Practice↗

Ethnic variations in UK asthma frequency, morbidity, and health-service use: a systematic review and meta-analysis.

BACKGROUND: The frequency of asthma varies between countries, and may also vary between ethnic groups in more geographically confined areas. We sought evidence of such ethnic variations in the UK for asthma frequency, morbidity, and health-services use, and to understand possible reasons for any differences. METHODS: We searched MEDLINE, EMBASE, CINAHL, PSYCHInfo, PREMEDLINE, HEALTHSTAR, Cambridge Register of Conference Abstracts, the Dissertation and Thesis Database, and the National Registry of Research. Additionally, we searched the bibliographies of reports identified and websites of health authorities, and contacted experts in this discipline. Our main outcomes were comparisons of asthma rate, morbidity, and health-services use. We did meta-analyses using random-effects models. FINDINGS: 13 studies contained relevant data. All prevalence studies were of children and showed that south Asian children had a lower frequency of symptoms suggestive of asthma compared with black and white children (pooled rate of history of wheeze in the previous 12 months: south Asians 9.6% [95%CI 8.0-11.2%], black people 16.2% [12.8-19.6%], white people 14.6% [11.5-17.8%]). The pooled frequency of clinician-diagnosed asthma in children followed a similar pattern (south Asians 7.6% [3.7-11.4%], black people 15.0% [3.5-26.5%], white people 10.6% [4.6-16.7%]. However, relative to white people, the risk of admission for asthma in children and adults was higher for south Asians (odds ratio 2.9 [2.4-3.4]) and black people (2.1 [1.8-2.5]). INTERPRETATION: The differences in admission are not explained by differences in asthma frequency between groups; they could relate to ethnic variations in asthma severity, differences in health-seeking behaviour, or difficulties in accessing high-quality primary care services.

Asia, Southeastern↗

Efficacy versus the costs of asthma management in primary care.

Nurses have gained increasing recognition over the past few years for their role in managing patients' respiratory care. The responsibility for many decisions, specifically treatment choice, are consequently now driven by this key group. The forthcoming general medical services contract, combined with the introduction of both formulary and supplementary nurse prescribing in the past two years, is likely to lead to a growing role for nurses in asthma prescribing. It is therefore crucial for nurses to gain an awareness of cost-effective prescribing and develop a close working relationship with prescribers in primary care trusts (PCTs).

Asthma↗

Guidelines for improving care in respiratory disease in the UK.

More than eight million people in the UK have respiratory conditions and one in four people die from them. We appear to be facing a major paradox with regard to the management of respiratory disease in the UK. Although we have a wide range of diagnostic tests and effective treatments at our disposal, we do not appear to be making any impact on the morbidity and mortality of respiratory disease. Respiratory disease needs to be moved onto the 'must do' agenda.

Age Distribution↗

Strategy and implications of managing long-term illness.

As the U.K. population is growing and living longer, inevitably there will be an increase in the number of people living with chronic illnesses. This article discusses the issues around managing chronic disease, highlighting current policy and implications for nurses and nursing practice.

Case Management↗