Biomedical subjects

Helena Britt

Publications and source records attributed to Helena Britt.

42 records · Page 3Linked to original sources

PubMed2002

A comparison of general practice encounters with patients from English-speaking and non-English-speaking backgrounds.

OBJECTIVE: To determine whether doctor-patient encounters in general practice with patients from a non-English-speaking background (NESB) differ from encounters with patients of English-speaking background (ESB) in terms of the type of practice where the encounters occur and the type of problems managed. DESIGN AND SETTING: A national cross-sectional survey of GP-patient encounters from a sample of all active registered GPs in Australia. PARTICIPANTS: A random sample of 1047 GPs recruited in the 12 months from April 1999 to March 2000, each providing details of 100 consecutive patient encounters. MAIN OUTCOME MEASURES: GP demographics, practice characteristics, patient demographics (including whether the patient mainly spoke a language other than English at home), and problems managed at the encounter. RESULTS: After adjusting for significant predictors, encounters with NESB patients were significantly more likely to occur at solo practices than practices of five or more GPs (odds ratio [OR], 2.15; 95% CI, 1.49-3.09), in metropolitan practices (OR, 6.34; 95% CI, 4.04-9.96), and with GPs who mostly consulted in a language other than English (OR, 5.44; 95% CI, 3.78-7.83). NESB encounters were relatively more likely to involve a respiratory problem (OR, 1.14; 95% CI, 1.04-1.26), endocrine/metabolic problem (OR, 1.41; 95% CI, 1.22-1.63) or digestive problem (OR, 1.14; 95% CI, 1.02-1.27), and relatively less likely to involve a psychological problem (OR, 0.73; 95% CI, 0.61-0.88) or social problem (OR, 0.67; 95% CI, 0.49-0.92). CONCLUSION: Differences in morbidity management rates between encounters with NESB patients and ESB patients may reflect both differences in underlying prevalences of some disorders in the population of general practice patients, as well as different reasons among the two groups for attending general practice.

Adult↗

PubMed2002

Where there is no surgeon: the effect of specialist proximity on general practitioners' referral rates.

OBJECTIVE: To determine the effect of proximity of surgical specialists on general practitioners' (GPs') rates of referral of surgical problems to specialist care (ie, are surgical referral rates of GPs in rural or remote areas similar to those of GPs in urban centres?). DESIGN: A cross-sectional survey of GP-patient encounters. SETTING: The Bettering the Evaluation and Care of Health (BEACH) program, which involves all active registered GPs in Australia. PARTICIPANTS: A random sample of 3030 GPs, each providing details of 100 consecutive patient encounters. MAIN OUTCOME MEASURES: Proportion of surgical problems (including ophthalmological and obstetric and gynaecological) referred to surgical specialists (surgeons' rooms, hospital outpatient departments or hospital emergency departments). RESULTS: Absence of a local specialist did not significantly influence the proportion of surgical problems referred by GPs overall, but the proportion referred was significantly lower for obstetric (odds ratio [OR], 0.56; 95% CI, 0.44-0.70) and ophthalmological (OR, 0.60; 95% CI, 0.49-0.73) problems. Other factors independently associated with referral of a lower proportion of problems included male GPs, female and younger patients, holders of a Health Care Card, injury-related and non-cancer-related problems, follow-up presentations, and more than one problem managed at an encounter. CONCLUSIONS: Our findings confirm that rural and remote GPs undertake much of their patients' antenatal care, and are less likely to use specialists when managing ophthalmological problems. Absence of local specialists in other surgical specialties is not a barrier to referral of patients with surgical disorders.

Australia↗

PubMed2002

Influencing antibiotic prescribing by prescriber feedback and management guidelines: a 5-year follow-up.

BACKGROUND: The extent of use of antibiotics for upper respiratory tract infection (URTI) prompted a previous study of an educational intervention based on prescriber feedback and management guidelines. This study demonstrated a reduction in antibiotic prescribing for URTI and a more appropriate choice of antibiotic for tonsillitis/streptococcal pharyngitis. There are few long-term follow-up studies of educational programmes of this kind. OBJECTIVES: This follow-up study aimed to examine if the reduction in antibiotic prescribing observed in the intervention group of the original study remained present after 5 years, and how the prescribing behaviour of the GPs involved in the follow-up differed from a large national survey of GP prescribing. METHODS: Attempts were made to contact the 157 GPs involved in the original study. Of these, 121 were both located and currently working in general practice. Ninety-six consented to take part and, of these, 79 completed a morbidity and treatment survey of 100 patient encounters (response rate 65.3%). RESULTS: The intervention group (n = 37) maintained their pattern of prescribing of antibiotics for URTI and choice of antibiotic for tonsillitis/streptococcal pharyngitis, with no significant change between the completion of the original study and the 5-year follow-up. The control group (n = 42) showed a downward trend in antibiotic prescribing for URTI, with the effect that no significant differences remained between groups at the 5-year follow-up. At the 5-year follow-up, both groups prescribed significantly fewer antibiotics for URTI and showed greater adherence to prescribing guidelines for tonsillitis/streptococcal pharyngitis than participants in a large national GP survey (n = 984). CONCLUSION: This study demonstrated maintenance of prescribing behaviour in the intervention group in the long term. However, the changes in prescribing observed in the control group and the power limitations of the study make it uncertain whether this was the result of a sustained effect of the educational intervention. The differences in both groups from the large national GP survey suggest that other influences on prescribing (such as participation in vocational training for general practice) were also having an important effect.

Adult↗

PubMed2002

Time for care. Length of general practice consultations in Australia.

BACKGROUND: Past estimates of the length of Australian general practice consultations have been based on Medicare item numbers claimed, which carries probable serious inaccuracies. AIMS: To describe the length of general practitioner consultations. METHODS: A random sample of 926 GPs recorded the start and finish times in minutes of their consultations for which a Medicare item number was claimed between April 2000 and March 2001, within a continuous cross sectional national study of general practice activity. RESULTS: Mean length of the consultations was 14.8 minutes (range 1-106). Mean length per GP varied widely (mean of means 14.8, range 3-39, mode 15.0 minutes). Female GPs had significantly longer consultations than males. Younger (< 45 years) male metropolitan GPs had the shortest mean length. Most attendances (85.7%) were designated Level B, 1.5% as Level A, 11.7% Levels C and 1.1% as level D. Mean length of Level A was 7.1 minutes, Level B-13.0, Level C-26.1, and Level D-44.9 minutes. CONCLUSION: This study suggests that the majority of GPs are not practising 'six minute medicine', and may assist cost projections of any changes to the Medicare Schedule.

Adult↗

PubMedDate not supplied

GP visits by health care card holders. A secondary analysis of data from Bettering the Evaluation and Care of Health (BEACH), a national study of general practice activity in Australia.

BACKGROUND: Patients of low socioeconomic status are more likely to hold a commonwealth government health care card. Card holders are recipients of age, disability, unemployment or other low income pensions. OBJECTIVE: To compare the general practice managed morbidity of health care card holders with noncard holders. METHOD: Data from one year of the continuous Australian national survey of general practice activity (comprising 98,000 encounters from 980 general practitioners) were used to compare patient and encounter characteristics and the problems managed for health care card holders and noncard holders. Logistic regression adjusted for patient confounders (age and sex, practice size, comorbidity and measured social factors) to describe morbidity associated with health care card status. RESULTS: Health care card holders were more likely to have respiratory, circulatory, musculoskeletal, psychological, neurological, endocrine, digestive, urinary and social problems managed. They were more likely to have chronic and psychosocial problems managed and to receive prescriptions. Female card holders were less likely to have a genital check up (including Pap smear). CONCLUSION: This analysis supports a relationship between socioeconomic status and health. Those from a low socioeconomic status (health care card holders) experience worse psychosocial health and more chronic health problems, have more medications prescribed and receive less preventive care.

Australia↗

PubMedDate not supplied

EPC encounters in Australian general practice.

The BEACH program, a continuous national study of general practice activity in Australia, gives us an overview of the content of Enhanced Primary Care (EPC) encounters in Australian general practice. The EPC program was introduced on 1 November 1999, and contained three major aspects of care--health assessments, care plans and case conferences.

Adolescent↗