PubMed Health⌕ Search

Biomedical subjects

H Mokkink

Publications and source records attributed to H Mokkink.

11 recordsLinked to original sources
PubMed1998

Attributes of clinical guidelines that influence use of guidelines in general practice: observational study.

OBJECTIVE: To determine which attributes of clinical practice guidelines influence the use of guidelines in decision making in clinical practice. DESIGN: Observational study relating the use of 47 different recommendations from 10 national clinical guidelines to 12 different attributes of clinical guidelines-for example, evidence based, controversial, concrete. SETTING: General practice in the Netherlands. SUBJECTS: 61 general practitioners who made 12 880 decisions in their contacts with patients. MAIN OUTCOME MEASURES: Compliance of decisions with clinical guidelines according to the attribute of the guideline. RESULTS: Recommendations were followed in, on average, 61% (7915/12 880) of the decisions. Controversial recommendations were followed in 35% (886/2497) of decisions and non-controversial recommendations in 68% (7029/10 383) of decisions. Vague and non-specific recommendations were followed in 36% (826/2280) of decisions and clear recommendations in 67% (7089/10 600) of decisions. Recommendations that demanded a change in existing practice routines were followed in 44% (1278/2912) of decisions and those that did not in 67% (6637/9968) of decisions. Evidence based recommendations were used more than recommendations for practice that were not based on research evidence (71% (2745/3841) v 57% (5170/9039)). CONCLUSIONS: People and organisations setting evidence based clinical practice guidelines should take into account some of the other important attributes of effective recommendations for clinical practice.

Decision Making↗
PubMed1998

Dissemination of guidelines: which sources do physicians use in order to be informed?

OBJECTIVE: To gain insight into processes of dissemination of clinical guidelines, sources of information physicians use to become informed about them, and factors influencing these processes. DESIGN: National survey among a random sample of family physicians using a structured questionnaire. SETTING: Family practice in The Netherlands; evaluation of a national programme of (evidence based) practice guidelines. STUDY PARTICIPANTS: A random sample of 1531 family physicians. MAIN MEASURES: Being informed about national guidelines and specific recommendations from these guidelines; being informed about specific educational programmes on the national guidelines; sources of information used in order to be informed; doctor and practice characteristics. RESULTS: The response rate was 67%, the responders being younger than the non-responders. The scientific journal for family physicians proved to be the most important source of information (85%), discussing the guidelines in the local family doctor group was also important (53%). Following continuing medical education courses was less important (33%). On average 80% knew about the different guidelines and recommendations, 63% about the educational programmes. Doctors who use the scientific journal as a source, who are members of the professional organization of family doctors, who are younger and who are actively involved in education on family medicine, proved to be better informed. CONCLUSIONS: Segmentation of the target group is necessary for effective dissemination of guidelines or new research findings. For some doctors it is desirable to make evidence available quickly, for others spreading the guidelines through the local network may be effective, while for another group a more active, personal approach may be necessary.

Adult↗
PubMed1990

Disease-centred versus patient-centred attitudes: comparison of general practitioners in Belgium, Britain and The Netherlands.

The attitudes of general practitioners in Belgium, Britain and the Netherlands have been sought to determine if they are patient-centred or disease-centred (that is, doctor-centred). The results indicated that many of the doctors held disease-centred attitudes, which in previous studies in the Netherlands and Belgium had correlated with increased prescribing of symptomatic medication, shorter consultation time, inadequate patient records and poorer standards of care within the consultation. Doctors in Belgium had the highest level of disease-centred attitudes, Dutch doctors the lowest. Possible explanations for these differences include differences in the doctor-patient relationship that exist between these countries. Although the results must be interpreted with some care, they should form a basis for discussions about doctor-patient relations and medical education in each country.

Attitude of Health Personnel↗
PubMed1990

Attitudes to risk taking in medical decision making among British, Dutch and Belgian general practitioners.

The attitudes of groups of general practitioners in Belgium, the UK and the Netherlands to risk taking in medical decision making have been determined. The results indicate that many doctors seek to minimize the risks that they take when treating patients. Doctors in Belgium had the highest levels of 'no risk-taking' attitudes with 60% preferring not to take risks; Dutch doctors had the lowest levels with only 24% preferring not to take risks. Possible explanations for this difference include the differences in doctor-patient relationship and the systems of medical education in these two countries.

Attitude of Health Personnel↗
PubMed1989

General practitioners' opinions about their responsibility for medical tasks: comparison between England and The Netherlands.

A questionnaire survey compared a sample of 371 general practitioners in the Avon region of England with 74 general practitioners in the east of the Netherlands. A list of 14 medical tasks--six technical tasks and eight chronic disease management tasks--was presented and the doctors indicated whether each task was totally, often, sometimes, seldom or not at all the responsibility of the general practitioner. The results show that English general practitioners felt more responsibility for chronic problems than the Dutch doctors whereas Dutch general practitioners felt more responsibility for technical tasks than the English. Fewer general practitioners in both countries felt responsible for technical tasks than for chronic disease. Reasons for the differences in terms of the structure of general practice and training are discussed.

Adult↗
PubMed1989

Effects of the vocational training of general practice consultation skills and medical performance.

The effects of the vocational training of general practitioners in the Netherlands on the consultation skills and medical performance of junior doctors were studied. Results obtained at a training institute providing systematic training in these skills (Nijmegen) were compared with those at an institute taking a problem-based learning approach (Groningen). Trainees (n = 63) audiotaped consultations and recorded their medical performance at the start and at completion of training. The skills were evaluated with the aid of validated criteria and medical 'protocols'. Data on 631 pre-training and 624 post-training consultations were compared. Changes in consultation skills and medical performance occurred at both institutes and proved more marked at the institute providing systematic training. Improved medical performance was found to be associated with improved consultation skills. Enhanced clinical knowledge was found to be related to improved medical performance and consultation skills. The most profound changes were found in junior doctors who had started at a lower level of consultation skills and medical performance.

Clinical Competence↗
PubMed1988

The effects of peer review in general practice.

This paper describes the effects of an intensive, structured programme of peer review on the behaviour of general practitioners. Trained assessors evaluated 43 doctors before and after participating in the programme. Both the medical and non-medical performance of the general practitioners was assessed using a previously tested measuring instrument. In addition, the prescribing behaviour of the participants was compared with that of a control group. After taking part in the programme, the work of the general practitioners conformed more closely to a number of criteria for good general practice care. This was particularly true for clarifying the questions and expectations of the patients, active stimulation of patient involvement, history taking and providing information and advice to patients. The greatest change occurred among general practitioners who had previously conformed least with the established criteria. During peer review participants in the project prescribed fewer drugs, such as analgesics, tranquillizers and antibiotics, than before peer review while non-participants prescribed more. The value of these changes is discussed.

Family Practice↗
PubMed1985

Work satisfaction of general practitioners and the quality of patient care.

The emotional reactions of 57 general practitioners to three aspects of work was assessed by means of questionnaires. The quality of patient care was assessed by means of observations of general practice consultations, assessment of audiotaped consulting hour contacts and an analysis of the referral and prescription figures. A distinction was made between the degree of positive and the degree of negative feelings general practitioners have about their work. Many positive feelings (satisfaction, feeling at ease) correlated with more openness to patients, more attention to psychosocial aspects of the complaints but also with a higher rate of referral to medical specialists. On the other hand, many negative feelings (frustration, tension, lack of time) correlated with a high prescription rate and with giving little explanation to patients. To some extent the way that work is experienced by general practitioners correlated with the quality of care for the patients, but what constitutes cause and effect requires further study. A reflection of a doctor's own feelings about work should become part of training, continuing education and medical audit programmes.

Drug Prescriptions↗
PubMed1985

Attitude changes in the vocational training of general practitioners.

This investigation examined the extent to which attitudes of doctors who participated in a one-year training programme for general practice changed in intended directions by training. A large number of questionnaires, validated in earlier research, were administered to 84 trainee general practitioners (GPs) both at the start and at the end of the training year. There appeared to be a strong to very strong shift in the intended direction with regard to the demarcation of work between general practitioners and specialists, the feeling of competence at work, the fear of making mistakes, beliefs about taking risks when making medical decisions, confidence in specialist technical examinations and the way general practice work is experienced. By the end of the training students hardly differed from, or had even gone further in the intended direction than, experienced general practitioners.

Attitude of Health Personnel↗