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Biomedical subjects

P Mudge

Publications and source records attributed to P Mudge.

11 recordsLinked to original sources
PubMed1997

Assessing case records using monitor criteria developed from consensus guidelines.

OBJECTIVE: To develop criteria to enable the monitoring of general practitioner (GP) case records using consensus guidelines for conditions commonly managed in general practice and to measure how well the case records of a non random sample of GPs conformed to these criteria. METHOD: An iterative process was used to develop criteria from consensus guidelines for 19 conditions. Criteria were also developed to enable monitoring of the structure and content of the patient case record. A non random sample of GPs in Adelaide was approached to allow measurement of the content of their case records against these criteria. This measurement was undertaken by allied health professionals. An overall percentage score of conformity with the criteria was created for 10 acute, and six chronic conditions and for the patient case record review. These were rank ordered and Kendall's rank order correlation coefficients were used to compare the results in these three areas of practice. RESULTS: Criteria were successfully developed for each condition. Thirty-one GPs had their patient case records assessed. There was substantial variability between these practitioners in their conformity to the criteria. Kendall's rank order coefficients found statistically significant correlation between the results for acute and chronic conditions, and between acute conditions and the patient case record review section. CONCLUSION: It is feasible to develop criteria that enable measurement of the conformity of GP case records to these criteria. The overall level of conformity, together with the substantial variability found between practitioners suggest that there is a need for GPs to address this area of their practice.

Clinical Competence↗
PubMed1996

Development of consensus guidelines for conditions commonly managed in general practice. Royal Australian College of General Practitioners.

OBJECTIVE: Initially, the project objective was to develop audit protocols for commonly managed conditions in general practice. However, as the nature of the project evolved these objectives changed to developing consensus guidelines. METHOD: An iterative process was undertaken using mail-outs to gain items for potential inclusion in an audit protocol. This resulted in a change of direction to management guidelines. Consensus, as to the validity of inclusion of items in each guideline, was then achieved by continuing to use an iterative process. RESULTS: Guidelines for 30 presenting complaints were developed. Because a number of differential diagnoses were possible for each complaint, a total of 105 guidelines were developed. A total of 263 general practitioners participated. CONCLUSION: The concept of discriminant actions was developed. It was agreed that this described the clinical decision making that occurs in the general practices of participating practitioners. It is feasible to use an iterative method undertaken by mail to develop consensus guidelines for conditions that are commonly managed by general practitioners.

Australia↗
PubMed1995

Reducing systematic bias in studies of general practitioners: the use of a medical peer in the recruitment of general practitioners in research.

Reducing systematic bias in any group of study participants should be a priority of any researcher. This can be achieved by ensuring the sampling framework is adequate and by increasing response rates. Response rates in studies of general practitioners have to date tended to be low. Generalization of results to the wider population of GPs is therefore reduced. This paper systematically examines those factors which can reduce bias, recognising accurate identification of the target population, gaining good access to respondents, and maximising response rates as crucial factors. The importance of a medical peer in recruitment is examined. Applying these factors to a study situation, three different recruitment strategies were tested. As the strategy improved, there was an incremental improvement in the response rate (44%, 67%, 78%). These results indicate that by specifically addressing strategies which facilitate access to the target population, and increase the legitimacy and credibility of the study, significant improvements in response rates can be achieved.

Australia↗
PubMed1994

Risk prevalence and screening for cancer by general practitioners.

BACKGROUND: This study presents cancer risk prevalence and screening rates of patients attending general practitioners. Conditions addressed include smoking, skin cancer, Pap smears, clinical breast examinations, and mammography. METHODS: A cross-sectional study of 7,160 patients 18-75 years presenting to 230 general practitioners in a metropolitan and country region in Queensland, Australia, was used. Risk prevalence was assessed from patients' self-report of risk behaviors and screening prior to the consultation. Details of preventive care provided in the consultation were based on doctors' self-report at the conclusion of the consultation. RESULTS: Twenty-seven percent of men and 23% of women smoked, rates being highest in the younger age groups. Using national guidelines, prior screening had not occurred as recommended for men and women as follows: skin cancer screening--66% of men, 70% of women; cervical cancer screening--27%; clinical breast examination--45%; mammography--75%. These patients were thus categorized as "at risk," and screening rates for these patients in the consultation were as follows: smokers--34%; skin cancer--5%; cervical cancer--16%; mammography--4%; clinical breast examination--8%. CONCLUSIONS: Significant numbers of patients presenting to general practitioners were at risk of developing cancer, according to national guidelines. Of these, only small proportions of all groups had a preventive intervention by their GP at the consultation identified in this study. While GPs generally see their role in prevention as important, these results raise questions for future cancer prevention policies and training of GPs.

Adolescent↗
PubMed1994

Screening for cardiovascular disease and risk reduction counselling behaviors of general practitioners.

BACKGROUND: This study presents prevalence of risk factors for cardiovascular disease in general practice patients and screening rates for risk factors. Conditions addressed include smoking, weight, alcohol intake, blood pressure, and cholesterol. METHODS: Adult patients (7,160) attending 230 general practitioners in a metropolitan (Brisbane) and rural (Toowoomba) region in Queensland were recruited to a cross-sectional study. A self-administered patient questionnaire provided self-reported information on lifestyle risk factors and rates of previous screening. A doctor's questionnaire completed at the conclusion of the consultation provided information about physician knowledge of patient risk factors and details of preventive care provided in the consultation. RESULTS: Twenty-five percent of patients reported that they smoked, 2% drank beyond defined safe limits, 40% had body mass index > 24.9 (kg/m2). Doctors identified 66% of self-reported smokers, 40% of heavy drinkers, and 59% of overweight patients. Over 90% of patients reported prior blood pressure measurements in agreement with national recommendations; cholesterol screening within the past 5 years was reported by 51% of patients. Screening and/or counselling of patients in the consultation was highest for blood pressure (47%) and smoking (34%) and considerably lower for overweight (22%), alcohol (19%), and cholesterol (6%). CONCLUSIONS: Although preventive activities are being undertaken in general practice, performance of these activities is less than ideal. The barriers to undertaking these activities need to be addressed for change to occur.

Adolescent↗
PubMed1993

Update on Ross River fever.

Ross River fever, or epidemic arthritis, is caused by the Ross River virus and usually mild and short-lived although persisting joint symptoms can develop. This article reviews the cause, diagnosis and treatment of this sometimes debilitating disease.

Alphavirus Infections↗
PubMed1990

The management of hypertension in Queensland general practice.

This survey indicates that hypertension in Queensland is primarily treated by general practitioners. It suggests a real need for a professionally endorsed information package for general practitioners and overwhelmingly points to the need for lifestyle information for patient use. It also identifies the elderly as a special treatment group.

Family Practice↗
PubMed1990

Assessment of physicians' office pathology testing: organisational considerations.

In this paper we consider organizational and design aspects of an assessment of physicians' office pathology testing, and discuss difficulties in measuring the level of performance and effectiveness of such diagnostic services. A major consideration is the trade-off between compliance with a well-defined protocol, and use of the technology in a way which resembles normal operating practice.

Australia↗
PubMed1984

Protocols and dollars.

A protocol is part of the process which translates a research question into a feasible project. It must be specific and include all relevant circumstances under which the research will be conducted (for example, the patient's age, sex, time of presentation, pre existing conditions) with an appropriate decision about each. As the examples show, preparation of a protocol (Table 2) can be a painstaking process and, even after acceptance by a funding organisation, it might require modification.

Australia↗
PubMedDate not supplied

Correlates of physician counseling associated with obesity and smoking.

BACKGROUND: Patient, physician, and consultation variables associated with overweight and smoking counseling in general practice consultations were examined. METHODS: A random sample of full-time general practitioners was used. The sample consisted of 7,160 patients from 230 GPs who attended for consultations on consecutive days, and self-reported information from the doctor and the patient was collected via questionnaire. The aim of this paper is to identify variables associated with the doctor's identification of overweight and smoking status and with the occurrence of counseling for these two behavioral risk factors. RESULTS: Forty percent of patients were overweight (BMI > 24) and 25% were self-reported smokers. Doctors identified 59% of overweight patients and 66% of smokers. Doctors only counseled patients identified as having the risk factor, counseling 36% of identified overweight patients and 49% of identified smokers. Identification of overweight was associated with being female, being heavier, having been previously counseled, being less well educated, presenting with an associated condition, and visiting a doctor who is younger and knows the patient's medical history well. Counseling for overweight was associated with being younger, being previously counseled, presenting with an associated condition, presenting for a routine checkup, visiting a GP who generally has longer consultations, having BP measured in the consultation, visiting an older doctor and visiting a doctor who considers identification of risk behaviors important. Identification of smokers was associated with being a heavier smoker, with those who had been previously counseled, with marital status other than single or married, with a BP measurement being taken in the consultation, and with a doctor who believed it possible to influence lifestyle change. Counseling for smoking was associated with younger patients, longer consultations, previous counseling, BP measurement, presenting with an associated condition, and not presenting frequently. CONCLUSIONS: We have identified factors associated with counseling about behavioral risk factors which provide a framework for planning education programs to increase the level of primary preventive activities within general practice.

Adult↗