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Biomedical subjects

P G Norton

Publications and source records attributed to P G Norton.

At least 19 recordsLinked to original sources
PubMed1999

A longitudinal study of performance of physicians' office practices: data from the Peer Assessment Program in Ontario, Canada.

BACKGROUND: The College of Physicians and Surgeons of Ontario has conducted a Peer Assessment Program since 1980. All physicians who turn 70 years of age in a given year are automatically selected for assessment, and the program assesses a random selection of physicians within specific practice and specialty areas. Each assessor--a physician who practices in the same area of medicine as the physician undergoing assessment--reviews the physical facilities, the system of record keeping and the content of approximately 20-30 medical records, and the quality of care provided, as determined by the medical record content and discussions with the physician. The assessed physician is then assigned a grade. In 1998, program records for 109 nonspecialist physicians who had undergone two assessments more than 10 years apart (first assessment, 1981 to 1987; second, 1991 to 1997) were examined to determine possible changes in performance. RESULTS: The mean time between assessments was 12.2 years. Seventy (64.2%) of the 109 physicians showed a decline in grade, whereas 35 (32.1%) received the same grade, and only 4 (3.7%) had an improvement in grade. CONCLUSIONS: This report is consistent with previous observations that performance changes with age. In contrast to previous studies, this report is based on longitudinal rather than cross-sectional data.

Age Factors↗
PubMed1999

Experience of menopausal symptoms by Chinese and Canadian women.

OBJECTIVE: This study examines the differences in frequency and distress caused by menopausal symptoms experienced by Canadian and Chinese women. DESIGN: Cross-sectional surveys were conducted in Canada and China. SETTING: The Canadian studies were conducted in Toronto. The Chinese data were collected in Guangzhou City. PARTICIPANTS: Women, 47-62 years old, 2-7 years after a natural menopause, were recruited. METHODS: Two hundred and eighty-two Canadians were recruited for two menopause studies. Data from 297 Chinese were obtained through a household survey. From a 105-item symptom questionnaire, women indicated the frequency and distress caused by symptoms in the previous month. MAIN OUTCOME MEASURES: Frequency and mean distress score of problems were ranked and compared. Using the importance score method, a Chinese questionnaire was constructed and compared with the Menopause-Specific Quality of Life questionnaire. RESULTS: The frequency of symptoms and distress experienced by Canadian and Chinese women differed markedly. Fourteen of the 29 items differed between the Chinese questionnaire and the Menopause-Specific Quality of Life questionnaire. CONCLUSIONS: There are striking differences between Chinese and Canadian women in the frequency and distress caused by menopausal symptoms. The Canadian questionnaire may not be relevant for Chinese women.

Affect↗
PubMed1998

Long-term follow-up in the Peer Assessment Program for nonspecialist physicians in Ontario, Canada.

BACKGROUND: The College of Physicians and Surgeons of Ontario has assessed randomly selected physician office practices since 1972. Each assessment consists of a tour of the premises and a review of a random selection of 20 to 30 medical records to evaluate the system of record keeping and the content of the records and to thereby indicate the quality of the physician's examinations, history taking, diagnosis and management plan. About 12% of nonspecialist physicians who need help to improve their records and/or the care they provide are identified annually, and following an interview with peers and simple educational interventions, more than 75% are successful in improving. METHODS: A follow-up was conducted to assess physician practices an average of six years after the first intervention. The reviewers were blinded as to whether the physician being reviewed had been reviewed previously. Each revisited physician was matched to three others undergoing their initial assessments in the same year. The matching variables were age, sex, school of graduation (Canadian versus other), rural versus urban practice location, and affiliation status with the College of Family Physicians of Canada. The assessed performance of the two groups was compared. RESULTS: The performance of the revisit group was significantly better than that of the matched group (p = 0.05). CONCLUSIONS: The assessment, interview, and educational interventions undertaken by the licensing authority produced an improvement in practice in the short term in the bottom 10%-15% of all physicians reviewed, which was sustained for more than six years.

Adult↗
PubMed1997

Guidelines for managing domestic abuse when male and female partners are patients of the same physician. The Delphi Panel and the Consulting Group.

OBJECTIVE: To provide clinical guidelines for primary care physicians who are dealing with domestic abuse and who have both the abused woman and her partner as patients. PARTICIPANTS: A 15-member expert panel with members having experience in family practice, gynecology, emergency medicine, medical ethics, nursing, psychology, law, and social work; an 11-member consulting group with members representing medicine, consumers, police, psychology, social work, and nursing; and participants from focus groups including 48 previously abused women and 10 previously abusive men. Members of the expert panel and the consulting group were recruited by the research team. Focus group members were recruited through the agencies from which they were receiving services. EVIDENCE: Available research information, and opinions of the expert panel, the consulting group, and the focus group participants. CONSENSUS PROCESS: Scoring of 144 clinical scenarios was performed by the expert panel using a modified Delphi technique involving 4 iterations. Scenarios were rated in terms of best practice for primary care physicians dealing with suspected and confirmed cases of physical abuse. Consulting group members and focus group participants then commented on the panel's results. Final guidelines were approved by the panel and the consulting group, with comments reserved in the guidelines for information from focus group participants. CONCLUSIONS: It is not a conflict of interest for the physician to deal with abuse of the female partner when both partners are patients. Both patients have a right to autonomy, confidentiality, honesty, and quality care. Patients should be dealt with independently, thereby facilitating assessment of the magnitude and severity of the victim's injuries. Physicians should not discuss the possibility of domestic abuse with the male partner without the prior consent of the abused female partner. Joint counseling is generally inadvisable and should be attempted only when the violence has ended, provided both partners give independent consent and the physician has adequate training and skills to deal with the situation without escalating the violence. If the physician feels unable to deal effectively with either patient because of the dual relationship, referral to another qualified physician is preferred.

Confidentiality↗
PubMed1997

Quality improvement in family practice. Program for Pap smears.

PROBLEM BEING ADDRESSED: With the increasing emphasis on quality improvement, we need programs for improving office practice. OBJECTIVE OF PROGRAM: To demonstrate a simple and inexpensive program that resulted in improvement in the quality of Papanicolaou smears in a family practice teaching clinic. The performance measure was the proportion of smears containing endocervical components. MAIN COMPONENTS OF PROGRAM: The program involved annual feedback on the performance of the physicians in the clinic. Feedback was given to physicians at a regular group meeting; brief discussion of the findings also occurred at that time. There were no other interventions. CONCLUSIONS: A program involving straightforward feedback and discussion for less than 1 hour contributed to a 7% improvement in the proportion of Pap smears with endocervical components. This "low tech" approach should be tested in other settings and with other procedures and treatments.

Education, Medical, Continuing↗
PubMed1997

What factors affect quality of care? Using the Peer Assessment Program in Ontario family practices.

OBJECTIVE: To describe the relationship between the quality of care provided by family and general practitioners in Ontario and the demographics of the practitioners. DESIGN: Descriptive study using univariate and multivariate analysis to relate physician demographics to quality of care. SETTING: Ambulatory family and general practices in Ontario. PARTICIPANTS: Each year from 1990 to 1994, all non-specialist physicians in Ontario reaching 70 years of age and a random sample of physicians younger than 70 who had been in practice more than 5 years were selected for assessment. After exclusion criteria were applied, the sample size was 922 physicians. MAIN OUTCOME MEASURES: Grades assigned by the College of Physicians and Surgeons of Ontario's Peer Assessment Committee. RESULTS: Practices were assessed and graded by the Peer Assessment Committee. Grades were related to many variables, but many variables were correlated. Four variables remained significant at the P < .05 level. Younger physicians, female physicians, certificates of the College of Family Physicians of Canada, and urban physicians had, on average, higher grades. CONCLUSION: Grades reflecting quality of care and record keeping were significantly associated with age, sex, certification status, and practice location. These findings should be examined and, for the benefit of patients, methods for improving care should be developed and explored.

Adult↗
PubMed1996

A menopause-specific quality of life questionnaire: development and psychometric properties.

OBJECTIVE: To develop a condition-specific quality of life questionnaire for the menopause with documented psychometric properties, based on women's experience. METHODS SUBJECTS: Women 2-7 years post-menopause with a uterus and not currently on hormone replacement therapy. Questionnaire development: A list of 106 menopause symptoms was reduced using the importance score method. Replies to the item-reduction questionnaire from 88 women resulted in a 30-item questionnaire with four domains, vasomotor, physical, psychosocial and sexual, and a global quality of life question. Psychometric properties: A separate sample of 20 women was used to determine face validity, and a panel of experts was used to confirm content validity. Reliability, responsiveness and construct validity were determined within the context of a randomized controlled trial. Construct validation involved comparison with the Neugarten and Kraines'Somatic, Psychosomatic and Psychologic subscales, the reported intensity of hot flushes, the General Well-Being Schedule, Channon and Ballinger's Vaginal Symptoms Score and Libido Index, and the Life Satisfaction Index. RESULTS: The face validity score was 4.7 out of a possible 5. Content validity was confirmed. Test-retest reliability measures, using intraclass correlation coefficients were 0.81, 0.79, 0.70 and 0.55 for the physical, psychosocial, sexual domains and the quality of life question. The intraclass correlation coefficient for the vasomotor domain was 0.37 but there is evidence of systematic change. Discriminative construct validity showed correlation coefficients of 0.69 for the physical domain, 0.66 and 0.40 for the vasomotor domain, 0.65 and -0.71 for the psychosocial domain, 0.48 and 0.38 for the sexual domain, and 0.57 for the quality of life question. Evaluative construct validity showed correlation coefficients of 0.60 for the physical domain, 0.28 for the vasomotor domain, 0.55 and -0.54 for the psychosocial domain, 0.54 and 0.32 for the sexual domain, and 0.12 for the quality of life question. Responsiveness scores ranged from 0.78 to 1.34. CONCLUSIONS: The MENQOL (Menopause-Specific Quality of Life) questionnaire is a self-administered instrument which functions well in differentiating between women according to their quality of life and in measuring changes in their quality of life.

Attitude to Health↗
PubMed1985

Relative costs of specialist services in a family practice population.

The frequency and cost of referrals to specialists in March 1984 for 8980 rostered patients attending a family practice clinic located in a teaching hospital were analysed. The patients made 1891 visits to specialists. In all age groups and for all specialties female patients were more likely to be seen. The total direct provider costs were higher for female patients than for male patients. However, costs per patient seen were higher for male patients, except for psychiatry and medicine. Visits to surgeons had the highest total cost, while visits to psychiatrists had the highest cost per patient seen. Of the direct provider costs 61% was for specialist services. The family physician, in the "gatekeeper" role, has an opportunity to control some of the costs of the health care system by ensuring that the best and most efficient use is made of the referral network.

Adult↗
PubMed1985

Snoring as a risk factor for disease: an epidemiological survey.

In a study conducted in four family practice units in Toronto, Canada, 2001 subjects reported on snoring and medical conditions in members of their households. For spouses the prevalence of snoring increased with age up to the seventh decade, with a higher prevalence of nearly 85% in husbands. For 11 medical problems an association existed between snoring, its frequency, and the presence of the condition. This association continued when the data were corrected for sex, age, and marital state. For hypertension both men and women who snored between the fifth and 10th decades had a twofold increase over non-snorers. The prevalence of heart disease and other conditions, except for diabetes and asthma, also increased in snorers in this age group. When corrected for smoking and obesity the association between snoring, hypertension, and heart disease persisted. These findings extend those of Lugaresi et al, and if they could be confirmed snoring as a risk factor for conditions other than sleep apnoea and sleep disorders might be considered. Methods of alleviating the acoustic annoyance of snoring may also provide direct medical benefits.

Adult↗
PubMed1985

Self-audit: its effect on quality of care.

Using a crossover design, it is shown that an individual criteria setting followed by immediate feedback of previous performance produced a sustained and continuing improvement in recording for two common conditions (cystitis and vaginitis). The intervention, which is simple and could easily be applied in other settings, produced improvements significant at the P = .001 level. The study controlled for overall improvement in record keeping. Further testing of this method of influencing physician performance is warranted.

Cystitis↗
PubMed1983

Snoring in adults: some epidemiologic aspects.

Although snoring is a common problem it has received little attention in the medical literature. Therefore, a study was undertaken to determine the prevalence and epidemiologic aspects of snoring. The results showed that it is much more common than previously thought--86% of the married men and 57% of the married women were reported to snore. Overall, snoring was found to be more frequent in adult men than women, and its prevalence in adults was not related to age. It was found that 15% of the husbands and 52% of the wives were bothered by their spouse's snoring. Physicians must be made more aware of this problem and its potential effects on patients.

Adult↗