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Section Editors' highlights

New Content ItemWelcome to the BMC Family Practice Section Editors' highlights page. Here, the Section Editors have chosen recent papers published in their section of the journal that are of particular importance or interest to highlight to a wider audience.

A changing landscape: how do GPs cope with uncertainty in diagnosis?

Chosen by:  Norbert Donner-Banzhoff

The incidence of acute coronary syndromes has been declining in developed countries, but people consult more often than before for chest pain. Other aetiologies than coronary heart disease therefore become more frequent. How do GPs cope with this change? This qualitative study among Flemish and Dutch GPs shows that clinical judgment is still the key for responsible decisions. They see only a limited the role for technology to reduce the inevitably high uncertainty.

Did shared decisions about treatment help people recover faster?

Chosen by:  Chris Burton

This was a well designed trial of adding shared decision making about treatment to the primary care management of acute back pain. Did shared decisions about treatment help people recover faster? No; while the study fell short of its recruitment targets, there were no differences in outcome between patients who went through a shared decision process and those that didn't. As is so often the case, the informative part of a complex intervention study comes in thinking about why it didn't work. In the discussion, the authors draw attention to the tension between implementing guidelines on treatment and implementing guidelines on shared decision making and they point out that other aspects of communication (such as creating positive expectations for recovery) may be more important in situations like dealing with acute back pain.

How do patients and clinicians view the challenges of patient safety?

Chosen by:  Carolyn Chew-Graham

Multimorbidity (the presence of two or more long-term conditions) is an increasing challenge for people with the conditions (in terms of illness and treatment burdens) and for health care professionals in health services today.  Ensuring patient safety is vital, but often considered only when failure occurs.  This paper reports a triangulation of data obtained from interviews with patients and carers, observation of consultations and electronic health records. Data from six cases are presented in the Results section.  The authors suggest that patient safety work places a further burden on patients and clinicians, and point to a tension between the desirability of  minimally disruptive medicine versus safety risks, possibly associated with what authors describe as ‘under’ or ‘over’ consultation. The authors highlight that whilst clinician-patient communication is important, the systems in which care takes place are important as well.

How does heart failure affect mortality in patients with COPD?

Chosen by:  Christos Lionis

I have chosen this paper by Kaszuba, et al since it addresses two chronic diseases that are both frequent and less-recognised in clinical practice, namely heart failure and chronic obstructive pulmonary disease (COPD), while it reports the important impact of heart failure on mortality in patients with COPD.  Multimorbidity has been recognized as an important and challenging subject in primary health care (PHC), while COPD and heart failure are included among the frequent chronic conditions that seek care from PHC. This observational study reports a large register-based prospective cohort study from Sweden and its key message is that heart failure has an important impact on mortality in patients with COPD. The study concluded that the mortality in patients with COPD and co-existing heart failure was strongly associated with age, male sex and other co-morbidities.

Which chronic disease management interventions have shown benefits for both professionals and patients?

Chosen by:  Cindy L.K. Lam

Addressing chronic disease is a major challenge for healthcare systems around the world. Primary care is uniquely situated to play a key role in both prevention and treatment of chronic conditions. There is growing literature on chronic disease management in primary care, and this systematic review addresses the need to understand which interventions are effective, for whom and in what context. Self-management support interventions, which were the most common, had the highest frequency of improvement, while other types of interventions showed limited benefits in specific contexts. This study highlighted the need for more and better self-management education as well as the need for increased research into other interventions to improve chronic disease management.

What determines whether patients with schizophrenia visit a GP?

Chosen by:  Mark Harris

The physical health of patients with severe mental illness is recognised as an important priority for health systems around the world.  This observational, cross-sectional study in Spain uses a multilevel modelling to explore factors associated with GP visits.  This identified not only patient factors but also health service characteristics and organisational factors that increased or decreased the likelihood of GP use by this vulnerable population.