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RCGP Primary Care Conference 2013: clinical poster round-up

A primary-care based weight management service has achieved a 5% reduction in weight in 72% of patients referred to it after a year.

The Fakenham Weight Management Service in Norfolk is a CCG-funded ‘hub and spoke’ service – based on a NICE model – and linked to secondary care endocrinology and bariatric services.

Of the 249 obese patients referred to the service, there was a weight loss of 5% or more in 44% of attenders at 6 months, and 72% at one year (mean decreases 4.72kg and 7.82 kg respectively). Over a quarter (27%) had lost 10% or more of their body weight at one year.

Hughes C, Jennings A, Steel N, et al. A service evaluation of a multidisciplinary Tier 3 weight management service based in primary care using a ‘hub and spoke’ model. Abstract P001

An audit of 520 patients with diabetes at one practice has found that - of the 181 who had been prescribed an ACE inhibitor – 14% were on the wrong dose, based on their last eGFR.

The GP authors say their findings have implications for all practices and have decided to repeat the audit annually.

Mitchell A and Mudalige M. An audit reviewing the prescribing of ACE inhibitors in patients with diabetes mellitus and co existing renal impairment at a local GP Surgery. P017

Over half of patients with asthma had not been given a written action plan and only 8% of those who had been given a verbal plan could remember it, according to an audit in north-west England.

Adult asthma reviews in the previous 3 months were compared to recommendations by BTS/SIGN guidelines. Telephone interviews explored patients’ general understanding of their asthma and action plan, if they had one. Researchers found 51% of patients were not provided with an asthma action plan. Only 8% of patients who had been given verbal action plans could recall it

Fisher P, Begum T and Gill N. Are asthma reviews following the BTS/SIGN guidelines? P029


Major problems in the education of patients – and the knowledge of GPs - on the use of adrenaline auto-injectors have been suggested by two studies from Buckinghamshire.

In the first, 20 patients were asked about what they’d been told when first prescribed an AAI and asked to demonstrate their technique. Seventeen had never had the use of an AAI demonstrated to them. Even more worryingly, five had tried to use the pen in an emergency and only one managed to do so without problems. That patient was one of the few who had been shown how to.

In the second study, seven GPs and three registrars who had prescribed an AAI were asked to demonstrate the technique, using a trainer pen. Only one used the trainer pen correctly and three of the others would have injected the adrenaline into their thumb.

Lombardelli A-M. Improving patient training in adrenaline auto-injector self-administration technique when prescribed in primary care may increase correct use in anaphylaxis. P036

Lombardelli A-M. Improving GPs’ knowledge on the correct self-administration technique for adrenaline auto- injectors could enhance patient management in anaphylaxis. P037


All the above poster abstracts can be accessed here.