Wheezing is a common problem among preschool children (Bhatt, 2013), and its prevalence is rising in the UK (Kuehni et al, 2001). This has an inevitable impact on healthcare costs. Indeed, it is estimated that caring for this patient group costs around £53 million (Brand et al, 2008). This article informs general practice nurses (GPNs) about the condition which can vary greatly in frequency and acuity, so that appropriate supportive management and follow-up can be offered when a child presents with this condition to the surgery. The patient story sets the scene of a typical wheezing preschool child, and raises the questions about whether to treat or not to treat; the concerns parents have about treatment, acute episodes and the overall management of preschool children with wheeze.
Atrial fibrillation (AF) is the most common sustained adult cardiac arrhythmia with over one million people diagnosed with AF in the UK (Health and Social Care Information Centre, 2014; Information Services Division [ISD] Scotland, 2015; Department of Health, Social Services and Public Safety, 2015; Stats Wales, 2015). This is the second article of two that discusses the need to improve the management of AF in primary care. ‘Part 1’ considered case identification and the assessment and management of AF-related stroke risk. ‘Part 2’ addresses optimum heart rate control and how this might be achieved, patient education and utilising audit tools to improve the quality of AF management in primary care.
Respiratory disorders, in particular asthma and chronic obstructive pulmonary disease (COPD), have been recognised for many years and remain among the most common chronic long-term conditions that are seen in primary care. Despite the development of guidelines, standards and effective treatments, both diseases continue to carry a high morbidity and mortality, a significant societal cost in terms of lost school and work days, and high consultation and admission rates.This article follows the development of our knowledge of these common disorders and looks at how far we have progressed in our diagnosis, knowledge and treatments, as well as what the future may look like in terms of care management and treatment options.
Atrial fibrillation (AF) is the most common sustained adult cardiac arrhythmia with over one million people diagnosed with AF in the UK (Health and Social Care Information Centre, 2014; Information Services Division [ISD] Scotland, 2014; Department of Health, Social Services and Public Safety, 2014; Stats Wales, 2014). Many more people are thought to have undiagnosed AF (National Institute for Health and Care Excellence [NICE], 2014) and the true UK prevalence is currently estimated to be 2.4% (Public Health England [PHE], 2015). The number of people with AF could significantly rise due to the growing elderly population and the increasing prevalence of those living longer with associated long-term conditions. Clinicians working in primary care can expect to see a growing demand to provide high-quality care for people with or at risk of developing AF. This includes checking for it, treating people who are newly-diagnosed and providing onward monitoring of people with an established diagnosis of AF. This two-part series looks at how to improve the provision of AF management in primary care.
Frailty is a clinical syndrome which focuses on loss of reserve, energy and wellbeing. Currently, older people with frailty tend to present late and often in crisis to health and care services so their care may be hospital-based, episodic, and unplanned. There is a need to reframe frailty as a long-term condition that can be mainly managed within a primary and community care setting, with timely identification for preventative, proactive care underpinned by supported self-management and person-centred care. General practice nurses (GPNs) will play a vital role in this new paradigm for frailty as key workers, coordinators of care, and supporters to patients and their carers at all stages of the frailty trajectory.
Long-term conditions: chronic obstructive pulmonary disease.
The use of spirometry as an objective measurement in the diagnosis of chronic obstructive pulmonary disease (COPD) is widely acknowledged and discussed in guidelines about COPD, as well as those specific to spirometry (British Thoracic Society [BTS]/Association for Respiratory Technology and Physiology [ARTP], 1994; Levy et al, 2009; National Institute for Health and Care Excellence [NICE], 2010; Primary Care Commissioning [PCC], 2013). As a relatively simple test to undertake, it has been performed in primary care for several years now but with varying degrees of expertise and understanding (Strong et al, 2014). The standard of secondary care lung function testing (LFT) has never been questioned. Overall, this inequity of testing has resulted in an estimated 50% of people having an incorrect diagnosis (Tinkelman et al, 2006). This results in people taking medication they do not need, or not receiving treatment they do. This article will enable the reader to identify gaps in their own knowledge about the use of spirometry in COPD diagnosis.
Venous leg ulcers make up a large part of a nurse’s caseload, with the application of compression bandaging requiring competent and skilled practitioners. At Central and North West London Foundation Trust (CNWL) Camden Integrated Primary Care (IPC) Service recruiting and retaining community nurses is a challenge, a situation which is shared across all London boroughs. In particular, it is difficult to maintain consistent standards for wound cleansing and compression bandaging, resulting in the responsibility for a large caseload falling to a small number of practitioners. Following a review of innovative products on show at the European Wound Management Association (EWMA) conference in May 2014, an alternative to traditional compression bandaging was identified as a possible solution to this problem; namely, UCSTM for effective debridement and Juxta CURESTM as an alternative to compression bandaging (both medi UK Ltd, Hereford).
Long-term conditions: seasonal allergic rhinitis.
Allergic rhinitis (AR) is a common disorder which has a major impact on the lives of sufferers and families. Although currently there is no cure for this disease, a variety of therapeutic interventions can alleviate the symptoms. It is important that general practice nurses (GPNs) are able to differentiate allergic and non-allergic rhinitis (NAR) from viral upper respiratory tract infections (URTIs) in order to best manage their patients. It is also necessary to ask appropriate questions of those patients attending for asthma review, as they may have unrecognised and untreated disease. Familiarity with the range of medications and their administration is advocated. Patients with troublesome, non- responding symptoms need to be referred, as do those with red flag signs.
As a consequence of increasing prevalence, cost, and complications of diabetes, there has been a significant shift in the management of patients with diabetes from secondary to primary care in the last decade (Hawthorne et al, 2012). This article explores some of the goals, issues and practicalities in caring for people with diabetes in primary care, based on a community model used by a diabetes specialist team in London, and the role of diabetes specialist teams in supporting general practice nurses (GPNs) and other healthcare professionals in the multidisciplinary team. It also highlights the importance of ongoing diabetes education and training to ensure that all patients receive early diagnosis, appropriate health checks, an individualised treatment plan, and appropriate referral as needed.
This article is intended to give some insights into the perspective of a carer of a child with eczema and to offer practical advice on how general practice nurses (GPNs) can effectively help patients with this debilitating skin condition. Eczema can have a negative impact both on self-esteem and quality of life for patients and carers. The long-term, sometimes lifelong nature of eczema, means that patients need to be educated in how to care for their skin. GPNs can advise patients and carers about how best to self-manage this disorder, which in turn can help them to cope.
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