Background-Obstructive airways disease in older patients is reported to be not only common, but frequently overlooked and untreated by general practitioners. This study examines the value of screening elderly patients in a large semi-rural general practice for potentially treatable asthma and chronic obstructive pulmonary disease (COPD). Methods-A random sample of 353 patients aged 60-75 years attended a nurse run screening clinic for pulmonary function testing, serial peak flow recording, and completion of a symptom questionnaire. Patients with a low forced expiratory volume in one second (below the fifth centile of their predicted value) or >15% mean diurnal variation in peak flow were referred to a doctor's clinic for further diagnostic assessment and/or to discuss possible treatment where appropriate. Results-Fifty eight patients (16.4%) had obstructive airways disease, the prevalence of asthma being 6.5% and that of COPD 9.9%. Of these, 30 had no previous diagnosis of airways disease and were not on treatment; eight of them had significant airways reversibility and 10 were current smokers. No newly diagnosed patients had severe disease as measured by pulmonary function or quality of life assessment, and six patients accepted treatment. Conclusion-Few older patients benefited from a screening programme for obstructive airways disease in a semi-rural general practice.
Occupational therapy private practice appears to play a major role in the provision of rehabilitation services in skilled nursing facilities. A critical look at the meaning of private practice, however, indicates that many of today's private practitioners lack characteristics traditionally associated with that term. Group private practices are well suited to retain the essential qualities of private practice while competing effectively in a corporate environment. They accomplish this difficult task by applying therapeutic principles of growth and change to the complex relationship between the group practice and the skilled nursing facility. Application of these principles allows the occupational therapy group private practice to behave consistently with its professional identity while addressing the competitive demands of the marketplace.
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