InnovAiT: Education and inspiration for general practice

Headache is one of the most common presentations in primary care and accounts for 4.4% of all consultations. Most headaches are due to primary headache disorders such as migraine and tension-type headache. However, headaches can be associated with serious underlying conditions such as intracranial tumours, and it is often concerns about this that will trigger a patient to consult their GP. Since headache is predominantly managed in primary care (with only 2–3% referred to specialists), GPs must have a clear and focused strategy for diagnosis and management. This article aims to provide an overview of the assessment of patients presenting with headache to enable GPs confidently to manage this common symptom.

Migraine affects 15% of the UK adult population and occurs three times more frequently in women compared with men. It is a common reason for patients to consult their GP. The primary aim in the management of migraine is the control of symptoms to minimise the impact on the patient's lifestyle. Expectations of a complete cure are unrealistic. However, under-treatment is neither cost-effective nor time-effective and different options should be offered until the most beneficial treatment plan is reached. As migraine typically varies with time, patients’ needs may change and the differential diagnosis should be reviewed regularly.

Huntington's disease (HD) is an inherited neurodegenerative disorder with a prevalence of 1 in 10 000. It is an autosomal dominant condition characterized by involuntary movements, changes in behaviour and cognition as well as psychiatric manifestations. There are currently no treatments that will cure or slow its progression. But, direct mutation testing allows a definitive diagnosis to be given and at-risk individuals to undergo predictive testing if they so wish. HD can be multigenerational in its impact upon a family which means GPs are in a unique position to educate, support and coordinate care for these patients. The aim of this article is to give an overview of HD, including its genetics, clinical features, different types of genetic testing and reproductive options as well as to introduce some of the ethical issues that can arise during a consultation. Many of the concepts covered are applicable to other genetic conditions that GPs may come across in their practice.

Venous thromboembolism (VTE) is a dynamic disease process that results in two distinct but related conditions: deep vein thrombosis (DVT) and pulmonary embolism (PE). DVT is thrombus formation that most commonly, but not exclusively, affects the lower limbs. The estimated incidence of symptomatic DVT is 1 per 1000 per year in the general population of the UK; however, it is often asymptomatic and thus the overall incidence is likely to be higher. Significant complications arising from DVT include PE (often from an asymptomatic DVT) and post-thrombotic syndrome (PTS), which occurs in 30% of patients with proven DVT. There is significant morbidity and mortality associated with both of these conditions, but with timely diagnosis and treatment much of this is potentially preventable. Therefore, a high index of suspicion within primary care is needed to ensure early diagnosis and appropriate treatment. This article aims to highlight the current evidence-based management of DVT and PE, from clinical suspicion to treatment.

‘Cardiomyopathy’ describes disease of the heart muscle. The European Society of Cardiology (ESC) defines cardiomyopathy as ‘a myocardial disorder in which the heart muscle is structurally and functionally abnormal in the absence of coronary artery disease, hypertension, valvular disease, and congenital heart disease sufficient to explain the observed myocardial abnormality’. In Europe, approximately 1 in 400 people suffer with some form of cardiomyopathy, and this is likely to be an underestimate due to a proportion of asymptomatic patients. Cardiomyopathy often has a strong genetic component. GPs are well placed to identify high-risk individuals due to their knowledge of a patient's family history. Cardiomyopathies are chronic conditions, and GPs are therefore central in the long-term management of these patients.

Heart failure has a prevalence of nearly 1% in the general population and is associated with age and other cardiovascular disease. It occurs when the heart is unable to maintain an adequate circulation for normal activity. This article explores the definition, diagnosis and impact of heart failure, and updates the reader on current national and international guidance on investigation and management.

The prescribing of medication is a significant element of the overall workload of a GP and it is estimated that an average of 300 prescription items are prescribed each week by every GP. The workload in primary care continues to increase and consequently, GPs are expected to prescribe ever more complex and expensive drugs. Data from the NHS Information centre show that in 2008, drug expenditure by GPs in UK stood at £4.5 billion, representing 50% of primary care costs, and this is expected to rise annually by 9%. The prescribing of large numbers of drugs inevitably leads to medication errors, with the Medical Protection Society (MPS) suggesting in 2010 that medication errors account for 20% of all errors in general practice with the cost of adverse events estimated at £750million a year. The data suggest that many of the errors are preventable; so it is advisable for doctors to consider potential risks when prescribing and for practices to have safety systems in place to avoid adverse events.