10
RESEARCH BRIEFS
Journal Grab
Keeping patients satisifed
OPIOID prescriptions for chronic pain have been rising.
While there are concerns about this, an American study has
ascertained whether it satisfi es patients.
Data came from a national survey. The sample involved
19,500 patients with chronic musculoskeletal problems,
including 2560 who were taking prescription opioids.
There were signifi cant diff erences between the users
and non-users. People on opioids were in poorer health and
reported more severe pain.
After adjusting for these factors, the opioid users
were 32% more likely to be very satisfi ed with their care.
Moderate and heavy users were more likely than other users
to be satisfi ed.
Dr John Dowden MBBS
ANN FAM
MED
2018;
16:6-13
MEDICALOBSERVER.COM.AU MARCH 2018
Dementia
clues in the
environment
PATIENTS sometimes
present to hospital rather
than consulting a GP.
Research from regional
NSW has studied how
out-of-hours general
practice services aff ect
emergency departments.
All patients who
attended an after-hours
GP clinic in Bathurst
were invited to partic-
ipate in a survey. To
assess their satisfaction,
they were surveyed again
within two weeks.
A total of 827 patients
presented in a fi ve-
month period and 219
completed the survey.
According to 76% of
the patients, their visit
was essential. The GPs in
the clinic considered 87%
of the presentations to
be appropriate. Only 3%
were not appropriate.
The presenting prob-
lem was satisfactorily
resolved in 79% of cases.
Only 2% of the patients
needed to be referred
to hospital. THE majority of demen-
tia cases are not
explained by risk fac-
tors such as diabetes
and hypertension. A
systematic review was
conducted to look for
potential risk factors in
the environment.
The review included
60 studies, including 16
on aluminium, which
found moderate evidence
of an association. For
most metals, however,
the evidence was weak.
The eff ect of sele-
nium supplements was
uncertain.
Air pollution was
associated with an
increased risk. The evi-
dence was stronger for
nitrous oxides and par-
ticulate matter than for
environmental tobacco
smoke. Diesel fumes had
no eff ect.
There were several
studies of fertilisers and
pesticides. While some
found no eff ect, there
was moderate evidence
of a link with dementia.
Three high-quality
studies found an associ-
ation between low con-
centrations of vitamin D
and dementia risk.
COMMENT
COMMENT
Observational data need to be interpreted with caution.
A diff erent analysis of the same data did not fi nd a greater pro-
pensity for heavy opioid users to be satisfi ed with their care.
It could be that the patients are satisfi ed because opioids
relieve their physical pain.
Alternatively, they could have become dependent and the
prescriptions are meeting their desire for opioids.
A complexity in the decision to prescribe is how doctors
are paid.
If remuneration is partly based on reports of patient satis-
faction there may be a temptation to give patients what they
want rather than what they need.
After-hours
clinics lower
ED visits
BMC FAM
PRAC
2017: 18:86
FAR RIGHT
BMC
GERIATICS
2016; 16:175
The clinic clearly saved
the emergency depart-
ment a lot of work.
If the clinic had not
been available, 60% of
the patients said they
would have gone to the
hospital. That fi gure
could have been even
higher if the clinic
had charged for consul-
tations.
COMMENT
The problem with
cross-sectional studies is
that they cannot confi rm
a cause, although they
can give clues for further
research.