Biomedical subjects

C Martin-Bates

Publications and source records attributed to C Martin-Bates.

3 recordsLinked to original sources

PubMed1993

General practice workload during normal working hours in training and non-training practices.

The aim of this study was to design and test a form to review workload in training and non-training practices. The study was conducted in the Oxford, Reading and Milton Keynes districts over a period of one week and involved 31 training and 21 non-training practices consisting of 156 and 66 doctors, respectively. Doctors in training practices (excluding trainees) spent a mean of one hour less per week in contact with their patients than doctors in non-training practices. Doctors in training practices spent approximately the same time per week on administration as those in non-training practices, one hour more in both meetings and non-practice work and almost two hours more in training and studying. The mean total practice workload per doctor in training practices was two hours more than in non-training practices and, when non-practice work was included, the difference increased to three hours. Compared with other doctors, trainees saw fewer patients in the surgery, in clinics and on visits, but spent more time on studying and training. This study produced broadly similar results to previous surveys, although doctors in the present study saw fewer patients each week and spent more time with each patient than in other studies.

Data Collection↗

PubMed1991

Outcomes of referrals to gynaecology outpatient clinics for menstrual problems: an audit of general practice records.

OBJECTIVE: To determine referral rates and intermediate and long-term outcomes for patients consulting for menstrual disorders and referred by their general practitioner to gynaecology outpatient clinics. DESIGN: General practitioners' records of referrals to outpatient clinics and retrospective audit of general practice notes to determine outcomes. SETTING: General practices in the Oxford Regional Health Authority area referring to 19 gynaecology outpatient clinics. SUBJECTS: 205 patients aged 15-59, referred in 1983/4 and follow up in 1988/9. MAIN OUTCOME MEASURES: Immediate outcomes: the initiation by hospital specialists of investigation, treatment or advice. Five year outcomes: general practice consultation rates and symptom prevalence. RESULTS: Of 18,754 index referrals recorded by 33 practices over a period of 6 months, 2513 (13%) went to gynaecology clinics. Menstrual disorders constituted 21% (n = 539) of the gynaecology referrals; there was more than three-fold variation between the practices in referral rates. In the 5 years following the index referral, of the 205 audited patients 167 (81%) had been admitted to hospital, 91 (44%) had had a hysterectomy (including 87 (60%) of the 145 patients referred for menorrhagia), 98 (48%) had dilatation and curettage; 25 (12%) received only drug therapy; and 10 (5%) had no active treatment for these symptoms from either the specialist or the general practitioner. Only 29 (14%) had consulted their general practitioners about menstrual problems in the 12 months preceding the audit. CONCLUSIONS: Guidelines are needed to assist referral decision-making. If audit is to be used to promote good practice these guidelines should consider the patients' anxieties and preferences, as well as the most appropriate use of investigations and treatments.

Adolescent↗

PubMed1991

Outcome of general practitioner referrals to specialist outpatient clinics for back pain.

In 1983-84 general practitioners in the Oxford region kept records of their referrals to outpatient clinics over a period of six months. Five years later in 1988-89 the general practice notes of 182 patients referred for back pain were studied to determine the outcomes of their referral. The actions initiated in the outpatient clinics were compared with the general practitioners' main reason for referral recorded at the time of referral. Of the 182 patients 136 (74.7%) received specialist treatment following the outpatient referral despite the fact that general practitioners had given treatment as the main reason for referral in only 28.6% of cases. Patients' mean consultation rate for back pain declined from 4.2 consultations per annum to 0.9 (P less than 0.001) over the five year period, but there was a small but significant increase in consultations for other problems. Five years after the referral 33.3% of patients were still consulting their general practitioner for back pain. The referral system for patients with chronic back pain could be rationalized to reduce the need for re-referrals and multiple follow-up outpatient consultations. There is a need to improve communications between general practitioners, specialists and patients about the purpose of referral, the likely effects of treatment and the scope for prevention. A survey of the outcome of referrals for common conditions, such as back pain, is a useful first step in the development of referral guidelines.

Adult↗