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Biomedical subjects

P Schattner

Publications and source records attributed to P Schattner.

At least 19 recordsLinked to original sources
PubMed2001

Promoting evidence-based medicine in general practice-the impact of academic detailing.

BACKGROUND: We undertook a project to promote evidence-based medicine (EBM) within a network of GPs (the Monash Division of General Practice) in Melbourne, Australia. A principal promotional strategy was to conduct practice visits ('academic detailing'). OBJECTIVES: The aim of this study was to measure the impact of academic detailing on GP attitudes and knowledge of EBM. METHODS: All 132 GP members of the division were invited by mail to accept a practice visit about EBM. The GPs had been randomized to one of two groups: to receive academic detailing during the study period or to be visited at a later date. The practice visit consisted of a 30- 45 minute discussion about EBM and the barriers to its practice. Pre- and post-intervention questionnaires were used to measure change in knowledge of and attitudes to EBM over a 3-month period in both groups. RESULTS AND CONCLUSIONS: Academic detailing led to a significant improvement in knowledge scores and self-perceived understanding of EBM, but had little influence on GP attitudes toward it. It is not known whether this would lead to change in clinical behaviour among GPs.

Evidence-Based Medicine↗
PubMed2001

Changing GPs' clinical behaviour. What can divisions do?

BACKGROUND: The increasingly complex challenge for medical practitioners to keep up to date and use the best available evidence in their clinical decision making has led to important studies on the effectiveness of various strategies to change clinician behaviour. Divisions of General Practice can develop an evidence based framework to support this change. OBJECTIVE: The aims of this paper are to: discuss effective interventions to change clinicians' behaviour describe the theories which underlie these strategies suggest a framework for Divisions of General Practice to design and implement effective programs. DISCUSSION: Continuing medical education and guideline implementation serve to highlight the impact of various change strategies. The interventions and the theories that underlie them, whether they be from a social, behavioural or organisational perspective, offer Divisions of General Practice an opportunity to support GPs in their ongoing professional need for quality improvement.

Education, Medical, Continuing↗
PubMed2001

Personal doctoring. Its impact on continuity of care as measured by the comprehensiveness of care score.

OBJECTIVE: To determine the impact of personal provider continuity on continuity of care as measured by the comprehensiveness of care score. DESIGN: Retrospective cross sectional analysis of medical records. SETTING: The setting was a four doctor practice on the New South Wales Central Coast of Australia. METHOD: The subjects were 131 male and 123 female patients with a mean age of 42.7 years (SD 25.9) median age of 42 years and an age range of 1-95 years. The main outcome measures were a comprehensiveness score for each patient in the personal provider continuity and discontinuity of care group over a two year period. RESULTS: The overall comprehensiveness scores in the personal provider continuity group was 7.38 (95% CI: 7.04-7.71) compared to 6.03 (95% CI: 5.7-6.35) for those in the discontinuity group (p < 0.000). A linear regression model revealed that 15.8% of the total variance of the comprehensiveness score is explained by the two independent variables 'modified continuity index' (13.6%) and 'age' (2.2%). Nonrelated independent variables are gender, number of visits and number of years attending the practice. CONCLUSION: Personal doctoring significantly improves continuity of care as measured by the comprehensiveness of care score, and this observation is essentially age independent. These findings clearly suggest that patients should be encouraged to find and stay with one doctor, and that practices should develop systems to enable patients access to their usual provider. Both strategies, combined with the awareness of potential gaps in our service provision, will increase the likelihood of achieving increased continuity of care.

Adolescent↗
PubMed2001

The patient perspective survey. Can consultations for complex health problems be enhanced?

BACKGROUND: Patients with complex health problems pose particular difficulties due to the interaction between psychosocial factors and physical disease. The aim of this study is to investigate the usefulness of a paper based instrument (the Patient Perspective Survey, or PPS) to enhance general practitioner-patient communication and patients' self reported coping skills. METHODS: A previously validated questionnaire was modified and distributed to a self selected group of 21 GPs. They recruited 77 patients with complex health problems and asked them to complete a PPS questionnaire. The patients then returned for an extended consultation to discuss the results of the questionnaire with the GP. Patients and GPs subsequently completed PPS evaluation forms. RESULTS: The PPS was useful for patients with chronic conditions with mixed physical and psychological components. It appeared to enhance the GP-patient relationship and gave patients a better understanding of their coping skills. DISCUSSION: Patients with complex health problems can use paper based questionnaires to improve the quality of communication between themselves and their GPs.

Adaptation, Psychological↗
PubMed2001

Divisions, general practice and continuous quality improvement. What is the connection?

BACKGROUND: Quality improvement in general practice needs to take into account not only the clinical behaviour of individual general practitioners but also the system within which they work. DISCUSSION: Continuous quality improvement (CQI) is an approach to helping clinicians work toward 'best practice' through system wide support. Its emphasis is on the improvement of processes through leadership, a team approach, the use of data, and small scale quality improvement projects. CONCLUSION: CQI may be useful for divisions of general practice to develop and improve their infrastructure and also to support quality improvement in individual general practices.

Benchmarking↗
PubMed2000

[Knowledge of professional rules of ethics among professional nurses].

During recent years numerous publications on ethical issues appeared in German nursing literature. Nursing theorists repeatedly refer to the Code of Ethics of the International Council of Nursing (ICN). The implementation of codes of ethics is discussed as an indispensable stage within the development of independent nursing ethics. However, it is not clear whether nurses in Germany know about the ICN Code of Ethics or other codes of ethics. The authors' objective is to learn more about how much is known about codes of ethics by practical nurses in four selected hospitals. In addition, it is of interest to know, which advantages nurses might associate with codes of ethics and secondly from which sources nurses prefer to receive ethical education. The study shows that only 25% of the participants know about codes of ethics. It also reveals that further education offered by hospitals or the basic nursing education are seen as the most important source of information related to ethics. The major advantage of codes of ethics seen by the participants is to provide guidance in the decision-making process of ethical dilemma situations in nursing. Secondly the Code of Ethics is regarded as a useful framework to define obligations and rights of nurses in the relationship with patients and relatives. The results of the study indicate that the ICN Code of Ethics is practically unknown among nurses and should be discussed more extensively by practical nurses and nursing theorists.

Attitude of Health Personnel↗
PubMed2000

Distance education. Part 1. Conceptualization and development.

INTRODUCTION: The Graduate Diploma/Masters in Family Medicine were developed at Monash University as distance education courses from a previous on-campus version of a Masters course in response to real and perceived needs for more flexible forms of delivery. METHOD: Conceptualization and development involved consultation with experts in distance education and the application of adult learning principles, phenomenology and constructivism in course design. CONCLUSION: Despite initial difficulties and delays, course objectives were met through the application of standardised distance learning and teaching methods applied to four core and 15 clinical elective subjects. These were developed within a three year period for delivery in a predominantly paper based format.

Adult↗
PubMed2000

Distance education. Part 2. Student characteristics, program characteristics, administration and future direction.

INTRODUCTION: A descriptive analysis of student and program characteristics was undertaken. METHOD: Data were obtained using student enrollment forms, periodic surveys and regular feedback which formed part of the formative evaluation. RESULTS: In the five year period 1992-1996, 433 doctors enrolled in the Graduate Diploma, of which 56 proceeded onto Masters. Of the 433, 60% were male. The mean age of students was 41 years, with rural (49%) and solo (45%) practitioners over-represented; 20% held the FRACGP and 15% resided outside Australia. Around 20% deferred or withdrew during the five year period. Of the 56 Masters enrollments, 16 had completed the degree in minimum time, with a further 30 completing within two years. Reasons for enrollment were largely professional with many students expressing the need to overcome isolation and gain intellectual stimulation. CONCLUSION: This Diploma/Masters course which has a strong clinical component has attracted considerable interest among established general practitioners. The program appears to have succeeded because of its flexible delivery, lack of exclusive research orientation and its firm grounding in general practice.

Adult↗
PubMed2000

Distance education. Part 3. Assessment of and feedback to students at a distance.

INTRODUCTION: Assessment of students at distance, in a course with over 20 units (subjects), provides special challenges in providing timely, accurate and detailed feedback both formatively and summatively. METHOD: A description of assessment practices including reflective journals, essays, critical appraisal of literature, case studies or teaching presentations in video and written format, clinical audits, and large research projects is provided. The impact of a multitude of criterion-referenced methods of students, teachers and administrative services as well as quality assurance issues are measured. CONCLUSION: Students preferred multiple levels of formative and summative assessment using criterion referencing to exams. These methods were thought to be contextually relevant to clinical practice and examined knowledge, cognition and performance appropriately. Length of assessment task, difficulty with English as a second language and lack of detail or clarity on written feedback posed problems for a number of students. Quality assurance procedures have been put into place to rectify some of these problems.

Clinical Competence↗
PubMed2000

Distance education. Part 4. Supervision of family medicine research at a distance. A formative evaluation.

INTRODUCTION: A survey on supervision of research projects was undertaken among current general practitioner students, recent graduates and supervisors of a Masters of Family Medicine degree. The aim was to describe and compare the experience of the three groups and, in particular, to identify the problems associated with distance supervision. METHODS: A self-administered questionnaire survey was distributed to current students (n = 21), graduates (n = 16) and current supervisors (n = 7). RESULTS: Forty out of 44 doctors returned completed questionnaires. Distance was a relatively minor barrier to successful supervision, provided that the student and supervisor established good communication patterns and were able to respond to each other with minimal delay. The commencement of the study and its final write-up were critical phases in the supervision process. DISCUSSION: Communication, including emotional and psychological support, was at least as important as expert opinion in helping Masters students to successfully complete their research projects. Attention must be paid to establishing good understanding and regular means of communication at the beginning of the supervisory process.

Data Collection↗
PubMed2000

Distance education. Part 5. Family medicine research at a distance. Guidelines for supervisors.

INTRODUCTION: This paper recommends guidelines for the supervision of Masters degrees or similar postgraduate courses, in which research projects are supervised at a distance. METHODS: The guidelines are based on the experiences of the authors with a five year old Masters of Family Medicine degree and a formative evaluation conducted by questionnaire survey among its students, graduates and supervisors. RESULTS: It is important to establish ground rules for communication at an early point in the supervisory process. Supervisors need to take into account psychosocial, pedagogical and organisational aspects of their mentorship of students. DISCUSSION: These guidelines are relevant to courses where there remains a strong one-to-one relationship between supervisors and students. In these cases, 'distance' need not be a barrier provided that both sides are aware of and committed to maintaining good patterns of communications with each other.

Communication↗
PubMed1999

The experiences of one divisional group of GPs in introducing computers into clinical practice.

OBJECTIVES: To explore the experiences of GPs who have introduced computers into their practices, particularly for clinical use. METHODS: GPs who have introduced computers into their practice for clinical use were identified by a telephone survey of the membership of the Monash Division, Melbourne, Victoria. Eleven 'clinical users' participated in semi-structured interviews to elucidate their experiences of installing computers in their consulting rooms, including their beliefs on how this process could have been given more support. RESULTS: Sixty-two of 67 practices participated in the initial telephone survey. Sixteen percent of responding practices were using computers for clinical purposes, with 11% issuing computerised prescriptions. Interviews with clinical users revealed that most had learned about computer hardware and software through their own independent enquiries. However, the GPs believed that divisions have an increasing role in providing training, education, and offering independent advice about the purchase of appropriate computer systems. DISCUSSION: This group of GPs adopted computers for clinical purposes without much assistance from the medical profession. Their experience of the process of computerisation illustrated that lack of training posed problems as did lack of support. Half of the sample felt that divisions may be able to provide training and education, independent advice and act as a forum to discuss and develop ideas, and thus ease some of the problems associated with adopting new technologies. CONCLUSION: Several suggestions are made for GPs and divisions to assist in the process of computerisation.

Australia↗
PubMed1998

Domestic accidental injuries to children presenting at a rural general practice.

A survey of domestic childhood accidental injuries was conducted at a rural general practice in Arau, Perlis. Data was collected from parents or other caregivers of 171 children, aged 12 years and below, using a pretested questionnaire. Male children between the ages of 6 and 12 years were the most common group affected, with a male to female ratio of 1.7:1. The three most common accidents were injuries from falls (28%), cuts, lacerations, bruises and puncture wounds not resulting from falls (26%), and thermal injuries (22%). The most commonly affected parts of the body were the limbs. Most injuries to children between ages 4 to 12 years occurred in the house compounds, while those to children below 4 years occurred in the kitchen and other locations within the house. Major contributing factors to the injuries were the existence of unsafe home environments, the risk taking activities of the children, the presence of hazardous products in the household and unrealistic parental attitudes to injury prevention.

Accidents, Home↗
PubMed1998

Forms in general practice. Paper war or paper tiger?

OBJECTIVE: To measure GP attitudes to forms in general practice, particularly the common and important ones, and to record the frequency of their use. DESIGN: Qualitative and quantitative methods were used. The former included focus group discussions (three groups) and telephone interviews (25 GPs) and the latter included a questionnaire sent to a random sample of 500 Australian GPs along with a data collection form to record the use of forms during a 3 week survey period. MAIN OUTCOME MEASURES: To describe current problems GPs encounter in completing forms, to obtain recommendations on how these problems could be overcome, and to document the use of forms in general practice. RESULTS: GPs believe that there are significant frustrations with existing forms, including uncertainties about the precise information that some questions request, the length of forms and who is responsible for payment. However, GPs distinguish between the design of forms and their content and recognise greater problems with government entitlement applications than with forms originating from non government sources. Professional bodies such as the Royal Australian College of General Practitioners should have input into the construction of forms. CONCLUSION: Reform in this area would be helpful given that inaccurate data are likely to be collected if forms are inadequate. However, there are barriers to reform, including the multiplicity of forms and the laws which govern them. The introduction of computerised forms may force both the profession and the organisations responsible for their production to rethink what are their essential features.

Adult↗
PubMed1998

Stress in general practice. How can GPs cope?

BACKGROUND: Excessive stress can cause both physical and psychological health problems in GPs, and can lead to decreased quality of patient care. OBJECTIVE: This paper examines the range of coping strategies available to GPs and suggests several support mechanisms. DISCUSSION: Coping strategies include talking to family and peers, problem solving and specific stress management techniques. GPs might need to be taught how to be patients themselves. Divisions can provide support groups for stressed GPs. The profession and government must consider how extra demands on general practice, coupled with further financial pressure, can lead to excessive strain.

Adaptation, Psychological↗