The effect of virtual specialist conferences between endocrinologists and general practitioners about type 2 diabetes: study protocol for a pragmatic randomized superiority trial.

BACKGROUND: To support the primary care sector in delivering high-quality type 2 diabetes (T2D), literature reviews emphasize the need for implementing models of collaboration that in a simple and effective way facilitate clinical dialogue between general practitioners (GPs) and endocrinologists. The overall aim of the project is to evaluate if virtual specialist conferences between GPs and endocrinologists about patients living with T2D is clinically effective and improves diabetes competences and organization in general practice in comparison to usual practice. METHODS: A prospective, pragmatic, and superiority RCT with two parallel arms of general practices in the Municipality of Aarhus, Denmark. All general practices are invited (n = 100). The intervention runs for 12 months and consists of four virtual conferences between endocrinologists and an individual general practice. Before the first conference, an introductory webinar teaches GPs about how to use an IT-platform to identify and manage T2D patients. The main analysis (month 12) concerns the difference between the intervention and control arm. It is expected that the virtual conferences at the patient level will improve adherence to international recommendations on diabetes medication for T2D patients and improve the risk profile with a reduction in glycated haemoglobin, blood pressure, and cholesterol. The study design allows for identifying a significant difference between the intervention (n = 15) and control group (n = 15) regarding the three primary clinical outcomes with a power of 0.8870-0.9941. At the general practice level, it is expected that general practitioners and practice staff in the intervention group will improve self-reported diabetes competence and organization. The control arm will get the intervention when the primary intervention ends (months 12-24), and the intervention arm transitions to a maintenance phase. DISCUSSION: The potential of virtual conferences is yet to be fully tapped because of methodological limitations. Studies have also not yet systematically evaluated virtual conferences in the context of chronic care using a high-quality research design. Given the nature of this real-life intervention, general practitioners and endocrinologists cannot be blinded to their allocation to either the intervention or comparison arm. TRIAL REGISTRATION: ClinicalTrials.gov, United States National Institutes of Health trial ID: NCT05268081. Registered on 4 March 2022.

External validation of the Medication Risk Score in polypharmacy patients in general practice: A tool for prioritizing patients at greatest risk of potential drug-related problems.

Drug-related problems are important causes of patient harm and increased healthcare costs. To assist general practitioners in prioritizing patients in need of a critical medication review, we aimed to assess the ability of the Medication Risk Score (MERIS) to stratify patients with polypharmacy in general practice according to their risk of drug-related problems. We conducted a cross-sectional multi-centre external validation study. Patients receiving more than five concomitant medications (polypharmacy) were eligible. The outcome was potentially serious drug-related problems as evaluated by expert consensus. Performance was assessed in terms of calibration and discrimination indices. Of 497 patients, 489 were included in the main analysis. The median age (interquartile range) was 70.5 years (60-79). In total, 372 potentially serious drug-related problems were observed in 253 patients (52%). The MERIS was well calibrated above a score level of 10. The area under the receiver operating characteristic curve was 0.70 (95% confidence interval: 0.65-0.74). The performance of the MERIS was fair in patients with polypharmacy in general practice. Given the scale of drug-related problems and the lack of efficient prioritization tools in this setting, the MERIS could be a useful risk indicator to complement usual practice.

Facilitators and barriers in diagnosing rheumatoid arthritis as described by general practitioners: a Danish study based on focus group interviews.

OBJECTIVE: To explore the perspectives of general practitioners (GPs) on facilitators and barriers in diagnosing rheumatoid arthritis (RA). DESIGN: Qualitative study based on focus group interviews, and using latent thematic analysis. SETTING: General practices from Central Region Denmark. SUBJECTS: Eleven GPs participated in three different focus groups. Forty percent were female, the mean age was 53 years (range 37-64), and the mean since medical licensing was 16 years (range 5-23). Sixty percent of the GPs worked in an area served by a university hospital, and 40% were served by a regional hospital. MAIN OUTCOME MEASURE: Themes describing experiences and reflections about facilitators and barriers in diagnosing Rheumatoid Arthritis. RESULTS: Four themes emerged: (A) If the patient is not a textbook example, (B) The importance of maintaining the gatekeeper function, (C) Difficulties in referral of patients to the rheumatologist, and (D) Laboratory tests-can they be trusted? Barriers were identified in all themes, but facilitators only in A, C, and D. The overarching theme was Like finding a needle in a haystack. CONCLUSION: The GPs found several barriers for diagnosing RA (symptom awareness, GP's gatekeeper function, suboptimal collaboration with rheumatologists and limitations in laboratory tests). They identified education, more specific tests and better access to rheumatologists as possible facilitators for diagnosing RA. To facilitate earlier referral of suspected RA in general practice and strengthen mutual information and collaboration, future research should focus on these facilitators and barriers.KeypointsEarly diagnosis is essential for the prognosis of RA, and the diagnostic process begins in general practice.Suggested facilitators: training courses in interpretation of laboratory tests and the clinical manifestation of RA, and videos on joint examinations.Suggested barriers: compliance with the gatekeeper function, suboptimal collaboration with rheumatologists, limitations of laboratory tests, and diversity of clinical manifestations.

[Patients with spinal cord injuries experience many sequelae]. / Patienter med rygmarvsskade har mange følgetilstande

Spinal cord injuries (SCI) affect all organs and may cause multiple sequelae. Complications after SCI can be life-threatening and socially disabling. Furthermore, a spinal cord injury is often a chronic condition and the patient may have contact with both the general practitioner and several departments in a hospital. Thus, it is important for all doctors to recognize risks and morbidities related to SCI, in order to prevent and treat the short- and long-term complications and disabilities. This article systematically describes the most commonly encountered sequelae after SCI.

A nationwide study on delirium in psychiatric patients from 1995 to 2011.

OBJECTIVES: Delirium shares symptoms with some mental illnesses. This may lead to misdiagnosis of delirium in psychiatric patients and a risk of inadequate management. Moreover, literature on delirium in psychiatric patients is sparse. The aim was to analyse possible changes in the diagnostic incidence of delirium in psychiatric patients from 1995 to 2011, and to investigate the patients with regard to sex, age, and type of patient. METHODS: All first time ever diagnoses of delirium among psychiatric patients were identified in the nationwide Danish Psychiatric Central Research Register (DPCRR) from 1995 to 2011. The delirium diagnoses include (1) delirium unspecified, (2) delirium with dementia, and (3) drug-related delirium, all in accordance with International Classification of Diseases-10. The incidence rates were age standardised. RESULTS: A total of 15 680 persons diagnosed with delirium for the first time were identified in the DPCRR between 1995 and 2011. The total incidence rate of delirium has decreased, reaching 8.4/1000 person-years in 2011. In 2011, 2.6% of the demented patients were diagnosed with delirium with dementia. Diagnosis of delirium is significantly more common in men, and the three groups of delirium showed a characteristic age distribution. CONCLUSION: Our incidences were markedly lower when compared with previous studies. This suggests a possible underdiagnosis of delirium in psychiatric hospitals and should be investigated further, as delirium is a serious state and identifying the syndrome is important for sufficient treatment.

Delirium during psychiatric admission increases mortality in psychiatric patients during and after hospitalization. A nationwide study from 1995 through 2012.

OBJECTIVE: Delirium is a common acute neuropsychiatric disorder caused by a variety of physical insults. It is commonly associated with a variety of serious adverse outcomes, including elevated mortality. There are few studies of delirium occurring in psychiatric patients, including its mortality. The aim was to determine the psychiatric diagnostic profile of Danish psychiatric inpatients diagnosed with delirium and to compare standardized mortality ratio (SMR) in this group with the Danish population and general psychiatric inpatients from 1995 through 2012. METHODS: All first time ICD-10 diagnoses of delirium among psychiatric inpatients were identified in the nationwide Danish Psychiatric Central Research Register (DPCRR) from 1995 through 2012. RESULTS: A total of 7179 persons diagnosed with delirium were identified in the DPCRR between 1995 and 2012. Of these patients 40.8% had more than one diagnosis of delirium during the period. We identified three distinct groups, based on the first delirium-diagnosis; unspecified delirium (76.9%), comorbid delirium-dementia (19.8%), and drug-related delirium (3.3%). Use of sedative-hypnotics was noted in 46% of those with drug-related delirium. The SMR of delirious psychiatric inpatients compared to all psychiatric inpatients was stable at 1.7 throughout the time period. CONCLUSION: Delirium occurring in psychiatric inpatients is associated with elevated mortality. Sedative-hypnotic agents are commonly involved in drug-related delirium. Particular preventative effort is warranted for patients with a previous history of delirium, as we found approximately 40% with more than one episode of delirium.