Chronic urticaria is a relatively common complaint in clinical practice. It often has an unknown aetiology or a difficult-to-avoid trigger and although rarely life-threatening, it has a profound impact on quality of life, reaching beyond the
impairment directly related to physical symptoms. All these aspects make its management complex and often frustrating both from a patient and professional perspective. Most patients with urticaria will be seen first in primary care, often by practice or community nursing staff. With good knowledge on diagnosis and management, up to 80% of these patients can be managed adequately in primary care.
General practice nurses (GPNs) are well placed to ensure that patients with respiratory conditions receive high quality, safe, effective, evidence-based care. The National Review of Asthma Deaths (NRAD) (Royal College of Physicians [RCP], 2014) found that two out of three asthma deaths could have been prevented with better routine care. The key components of good asthma care, including the importance of correct inhaler technique, were highlighted by this landmark report. Poor inhaler technique is known to adversely impact upon control of respiratory disease and its symptoms. In 2013, the National Institute for Health and Care Excellence (NICE) published Asthma Quality Standards. However, NRAD found that despite the existence of such solid recommendations and guidance there were potentially avoidable factors related to the implementation of national guidelines in 46% of the deaths that were reviewed. Most recently, the Chronic Obstructive Pulmonary Disease (COPD) Quality Standard was added as an update to COPD guidance (NICE, 2016). Both documents include quality standards around inhaler technique.
Chronic kidney disease (CKD) is an ongoing decline of renal function which may progress quite rapidly or develop slowly over many years. Due to the nature of the disease, it is linked to cardiovascular disease (CVD) and a host of symptoms, comorbidities, high mortality and reduced quality of life. The majority of CKD patients will be identified in primary care. Once diagnosed, patients are likely to become increasingly frequent attenders within general practice. It is therefore useful to have an overview of the disease process and the multifaceted care needs of this specific patient group. General practice nurses (GPNs) are vital members of the multidisciplinary team who are wellplaced to identify, monitor and provide ongoing support for patients with CKD.
INTEGRATING CARE FOR LONG-TERM CONDITIONS IS IMPORTANT
Improving management of people living with long-term conditions (LTCs) has been a key priority for the NHS since the 1990s. At the time, little evidence existed to understand the best practice on managing LTCs and the involvement of primary care. Today, we are in a stronger position where efficacy, safety and other positive outcomes are being demonstrated by implementing a variety of quality improvement approaches and service redesign, all underlined by the rhetoric of integrated care.
Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality. It is estimated that over three million people in the UK have the disease, with just under a third actually having a diagnosis (National Institute for Health and Care Excellence [NICE], 2010a). It is defined as irreversible air flow obstruction, which is insidious and progressive with little day-to-day variability, predominantly caused by cigarette smoking, but with the recognition of ther contributory factors such as exposure to occupational irritants (NICE, 2010a).
Reducing the burden of COPD relies on early and accurate diagnosis before individuals are on the trajectory of functional decline (Department of Health [DH], 2011). This paper outlines the key steps that general practice nurses (GPNs) should take to make a good diagnosis and so make lifelong improvements for patients living with COPD.
While working as a district nurse in a GP practice, the author and a community pharmacist performed a small audit to establish the use of self-monitoring of blood glucose within the practice population. The results indicated that 79 patients were prescribed blood glucose test strips directly in contrast to National Institute for Health and Care Excellence (NICE, 2015) guidance. The results were then shared within the practice to initiate education and a education in unnecessary testing. The following article describes the audit in more depth and explores some of the available evidence on blood glucose monitoring in patients with non-insulin dependent type 2 diabetes.
Coeliac disease is a long-term condition which affects approximately one in 100 people in the UK. This article explores which patients may need to be screened for the condition and the symptoms they may present with. Once diagnosed with the condition, patients need to follow a lifelong gluten-free diet to prevent complications. This article looks at the many roles that general practice nurses (GPNs) have in promoting compliance with the treatment of a gluten-free diet, as well as discussing how they can help to manage the risk of complications such as osteoporosis and infectious disease.
Hay fever is one of the spectrum of allergic diseases that includes eczema and asthma (Wahn, 2015). It is a common condition and the symptoms are distressing and in severe cases may be extremely debilitating. Symptoms may impact upon work, study, outdoor activities and sleep — in fact, the whole lifestyle of a severely affected individual.
Depending on the cause and severity, treatment may be wholly or partially effective. The aim of treatment by avoidance, desensitisation or medication is to minimise or abolish symptoms, while also ensuring that side-effects of medication(s) are minimised. Where the specific trigger or allergen has been identified and had a seasonal effect, it is best practice to start treatment before the season begins.
Spirometry is very easy to do, and very easy to get wrong (Martin, 2010; personal communication). Not only is quality
assured spirometry dependent on the effort exerted by the patient, and the technical ability of the spirometer operator,
but also on the understanding of the results by the person interpreting them.
Interpretation of the results is essential if any meaningful decision is to be made about the patient’s care.
Around 12 million people in the UK have been diagnosed with hypertension (i.e. blood pressure [BP] greater than or
equal to 140/90mmHg) and over five million people have undiagnosed hypertension, which, if left untreated, can lead to premature ill health and death (Blood Pressure Association, 2008).
The risks associated with increasing BP are continuous — with each 2mmHg rise in systolic BP there is a 7% increased risk of mortality from ischaemic heart disease and a 10% increased risk of mortality from stroke (Lewington et al, 2002). However, although BP-lowering strategies have been shown to significantly reduce the risk, population-based studies consistently demonstrate that patients are unaware of the causes and effects of hypertension, and around two-thirds of those diagnosed remain untreated or inadequately controlled (Falaschetti et al, 2009; Antikainen, 2010). This article re-examines the evidence and guidelines to see how we can improve practice within this important area of cardiovascular disease prevention.
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