The benefits of co-location in primary care practices: the perspectives of general practitioners and patients in 34 countries.

BACKGROUND: There is no clear evidence as to whether the co-location of primary care professionals in the same facility positively influences their way of working and the quality of healthcare as perceived by patients. The aim of this study was to identify the relationships between general practitioner (GP) co-location with other GPs and/or other professionals and the GP outcomes and patients' experiences. METHODS: We wanted to test whether GP co-location is related to a broader range of services provided, the use of clinical governance tools and inter-professional collaboration, and whether the patients of co-located GPs perceive a better quality of care in terms of accessibility, comprehensiveness and continuity of care with their GPs. The source of data was the QUALICOPC study (Quality and Costs of Primary Care in Europe), which involved surveys of GPs and their patients in 34 countries, mostly in Europe. In order to study the relationships between GP co-location and both GPs' outcomes and patients' experience, multilevel linear regression analysis was carried out. RESULTS: The GP questionnaire was filled in by 7183 GPs and the patient experience questionnaire by 61,931 patients. Being co-located with at least one other professional is the most common situation of the GPs involved in the study. Compared with single-handed GP practices, GP co-location are positively associated with the GP outcomes. Considering the patients' perspective, comprehensiveness of care has the strongest negative relationship of GP co-location of all the dimensions of patient experiences analysed. CONCLUSIONS: The paper highlights that GP mono- and multi-disciplinary co-location is related to positive outcomes at a GP level, such as a broader provision of technical procedures, increased collaboration among different providers and wider coordination with secondary care. However, GP co-location, particularly in a multidisciplinary setting, is related to less positive patient experiences, especially in countries with health systems characterised by a weak primary care structure.

[Collaboration between traditional and modern medicines: prospectives of structuring a combined care system for traumatology cases]. / Articolazione tra medicina tradizionale e medicina convenzionale in Mali: prospettive per la strutturazione di un sistema di presa in carico congiunto dei casi di traumatologia ortopedica.

The Italian NGO Terra Nuova (TN) is implementing a project with the aim of promoting collaboration between traditional and conventional medicines within orthopedic traumatology in Mali. The study is supporting the project to formulate rightly the proposal of a joint system of managing traumatology cases. It has the purpose of analysing the ability of the two healthcare systems and identifying the training needs of the respective operators in this field, in order to draw interventions that can improve their therapeutic practice. The research uses quantitative and qualitative methods for data collection and is structured in three under-studies. The study points out a great use of the traditional medicine for traumatology cases, a good ability of the traditional care system to manage such cases, even though some aspects need improvements, and a diffused availability of conventional health workers to collaborate with traditional ones, since the former recognise their own incapability in this field. The study suggest that valorizing strengths and emending weakness of both healthcare systems in managing traumatology cases, will allow the TN intervention to structure and test collaboration between the two medicines with effective prospects for public health.

A new nonvascular interpretation of syncopal migraine.

Migraine suffers who experience spontaneous syncopes (syncopal migraine) during attacks exhibit a dramatic intolerance to bromocriptine, a dopamine agonist. An oral dose of this drug renders these patients unable to stand, even for some hours, because of precipitously falling of arterial blood pressure. Treatment with domperidone, a specific dopamine receptor antagonist, abolishes the syncopal effect of bromocriptine. This evidence is compatible with a supersensitivity of those dopamine receptors, which exert an inhibiting activity and are located on blood pressure regulating centers as well as on cardiovascular sympathergic neurons.

A putative 5-HT central feedback in migraine and cluster headache attacks.

5-HT is considered to play a role in the migraine mechanism; its decrease in the midbrain during migraine attacks has been postulated. CSF TP and plasma and platelet 5-HT levels in migraine and cluster headache sufferers have been evaluated; the values registered were compared to those of neurological and carcinoid patients, respectively. The following results were obtained: (a) no significant difference in the time course of free and total TP after l-TP intravenous loading, (b) increased levels of CSF TP during migraine and cluster headache attacks, (c) impressively increased levels of plasma 5-HT only in carcinoid patients. These findings suggest the existence of a positive 5-HT central feedback mechanism during attacks of migraine and cluster headache and thus exclude peripheral 5-HT effects in the generation of pain.