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Biomedical subjects

J Gérvas

Publications and source records attributed to J Gérvas.

18 recordsLinked to original sources
PubMed1995

[Study of the demand for laboratory tests in primary care].

OBJECTIVE: To study the demand for laboratory test from a sample of Primary Care doctors. DESIGN: A crossover observational study. SETTING: Primary care medical clinics in Spain and Andorra. PARTICIPANTS: Volunteer doctor with primary care practices. INTERVENTION: The study was based on: a) a questionnaire to the doctors taking part, on their clinical consultations, b) recording of the age and gender of patients seen during four consecutive weeks, and c) the logging of the laboratory tests requested during these four weeks. MAIN RESULTS: 82 doctors took part. They had 37,383 clinical consultations, asking for 1,965 analytical studies with 7,248 tests; i.e., they generated 5.25 requests for analysis per hundred consultations. The doctors who requested most analyses had less consultations/day and less consultations/inhabitants/year. When the distance to the laboratory increased, the analyses per consultation lessened and the analyses per inhabitant went up. The most common reason for requesting analysis was the follow-up of an already-known pathology. CONCLUSIONS: A request for analysis is made in 5.25% of primary care consultations. The most common reason is to follow up an already-known pathology.

Diagnostic Tests, Routine↗
PubMed1994

[Consultations with third parties in general medicine].

OBJECTIVE: To quantify and describe consultations carried out with third parties in General Medicine. DESIGN: Prospective and descriptive study. SETTING: Three General Medical consulting rooms in INSALUD's Health Area IV, Madrid. PARTICIPANTS: All those consultations carried out with third parties from 15 February 1993 until 200 cases per doctor had been reached. INTERVENTION AND MAIN RESULTS: The data of the patient, the third party and the meeting were recorded for a total of 603 consultations using a third party. These consultations made up 18% of the total number at the three consulting rooms. According to the criterion of the doctor involved, more than half of these consultations were not clinically justified. People attended fundamentally to obtain prescriptions (76%), notes for short periods of time off work (9.6%) and referral to specialists (8.9%). The third party was usually a woman (62%) and spouse or mother of the patient (45 and 28%, respectively). CONCLUSIONS: In the three General Medical consulting rooms studied, which were organized on the traditional model, third-party consultations are common and clinically unjustified in more than half the instances. These consultations are due fundamentally to difficulties of access to Primary Care services. Increasing the General Practitioner's availability for on-demand consultations could lessen this high incidence of third-party consultations.

Adolescent↗
PubMed1994

Primary care, financing and gatekeeping in western Europe.

Primary care in western Europe is delivered by general practitioners (GPs) but their role within the overall health system is poorly understood. The aim of this article is to present an overview of the characteristics of general practice in the context of health systems and to describe their variability and interrelationships. Data were obtained from two main sources: publications of official organizations and EC research projects. The characteristics of general practice are described and analysed with regard to three features: mode of payment, gatekeeper function and practice organization and workload. Despite their focus on general practice as the cornerstone of the health system, western European countries differ considerably in the major characteristics of primary care. There is variability in the ratio of GPs to population and in the extent to which patients relate to individual physicians. Although all countries have universal health insurance, the mode of payment of GPs differs. In some countries, the gatekeeper function of general practice is more highly developed and the use of specialist services varies accordingly. Practice characteristics such as workload, length of consultation, ordering of tests and reappointments also vary with differences in payment and gatekeeping arrangements. In particular, fee-for-service was associated with weaker physician-patient relationships, reduced attractiveness of general practice, more home visiting and longer consultations. Strong gatekeeping arrangements are not incompatible with high public satisfaction and are associated with lower visit rates. However, strong gatekeeping is not characteristic of fee-for-service arrangements. These findings suggest a need for more concerted research that could inform policy decisions concerning primary care in the USA as well as in Europe.

Adolescent↗
PubMed1993

[Primary care research: the content of articles published in scientific journals].

OBJECTIVE: The quantifying, by subject area, of research published in scientific journals on primary health care, in five different cultural/geographic areas. DESIGN: Descriptive study. SETTING: Scientific journals on primary health care. PARTICIPANTS: Original articles published in 1991 in the following journals on primary health care (general practice): Atención Primaria, Canadian Family Physician, Family Practice, Journal of Family Practice and Scandinavian Journal of Primary Health Care. INTERVENTIONS AND MAIN RESULTS: The classification adopted here was that used in the research into primary health care by the Canadian Association of Family Physicians. The five journals between them published 263 original articles. Articles on organisation and provision of health services constituted 42% of the total; next in frequency were articles on epidemiology (18%) and on psychosocial concerns. Methodological studies and research into training and professional kills represent a scarce 6% and 8% respectively. CONCLUSIONS: The most commonly occurring subject in primary health care research is research on services. In the future it would be desirable to develop other areas (the clinical and psycho-social areas, methodology, and training).

Canada↗
PubMed1992

[Effect of the physician's and the patient's sex on the clinical interview].

OBJECTIVE: To analyse differences attributable to the sex of the doctor and of the patient in the activities and content of the clinic appointment in Primary Attention. DESIGN: Analysis of interaction, in terms of activities and content, in 157 clinic appointments. SITE. General medical consultations in four Primary Attention Public Health Centres. PATIENTS: Those who used the health services on the day of the study. INTERVENTION: Tape recording of the appointments. MAIN MEASUREMENTS AND RESULTS: The interviews were recorded. There were shown to be differences according to the sex of the doctor and of the patient in terms of the development and content of the interviews. The style of the woman doctor involved longer interviews with greater social content; in general sameness of sex (doctor and patient) led to greater mutual complementation in the interviews. CONCLUSIONS: It has been shown that there are differences in the activities and content of the clinic appointments in Primary Attention which depend on the sex of the patient and doctor.

Female↗
PubMed1992

[Impact of consensus conferences held in Spain].

OBJECTIVE: To show the impact of these consensus meetings on health-workers. DESIGN: A descriptive study using a postal survey. SITE. The Province of Avila. PATIENTS OR OTHERS PARTICIPANTS: Registered doctors and nurses in the Province of Avila, in the month of March, 1991. MAIN MEASUREMENTS AND RESULTS: 19.2% of the doctors and 13% of the nurses answered the survey. The consensus meetings were known to 29.6% of the doctors and 13.5% of the nurses. Out of these, 70.3% of the doctors and 54.5% of the nurses refer to a modification in their behaviour. Nevertheless, the majority of the health-workers saw well-monitored hypertense patients monthly and believe that the entire population's level of cholesterol should be determined. This runs against the recommendations of the consensus meetings. There were no differences on this between those who knew of the meetings and those who did not. CONCLUSIONS: The results and recommendations of the consensus meetings were inadequately publicized. They have little or no effect on healthworkers' behaviour.

Consensus Statements as Topic↗
PubMed1992

Minimum basic data set in general practice: definitions and coding.

A minimum basic data set (MBDS) was designed and used in general practice. The most important purpose and need for establishing such a data set is to assist in the provision of patient care. MBDS is designed to meet common needs for many general practitioners. Minimum means that individual programmes or the GP are free to collect as much additional data as they may wish. The MBDS includes two kinds of data: permanent and dynamic/encounter items. Permanent items are: patient data (identification, problem list, chronic treatments, source of payment) and GP data (professional characteristics). Dynamic/encounter items are: date, place, reasons for encounter, problems, process and prior encounter status.

Family Practice↗
PubMedDate not supplied

[The most often quoted journals in primary care].

The bibliographical references of original articles published during 1988 in four primary care magazines from diverse cultural backgrounds were analysed: Canadian Family Physician (Canada), Journal of Family Practice (United States), Atención Primaria (Spain), and Journal of the Royal College of General Practitioners (United Kingdom). There are 4,225 bibliographical references used in the 328 original reviewed articles. These references had been published in 725 different magazines, of which the ten most oft-quoted account for 38% of the total references. In addition to the four magazines included in our review, the list includes the following: British Medical Journal, New England Journal of Medicine, Journal of the American Medical Association, Lancet, Canadian Medical Association Journal, Annals of Internal Medicine, and American Journal of Obstetrics and Gynecology.

Canada↗