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Biomedical subjects

Richard Grol

Publications and source records attributed to Richard Grol.

68 records · Page 4Linked to original sources
PubMed2002

Asthma education tailored to individual patient needs can optimise partnerships in asthma self-management.

This paper studies the effects of patient education, tailored to individual needs of patients as part of an asthma self-management program. A tailored education program was designed which took into account individual information needs of patients by using a feedback instrument. Totally 98 steroid dependent asthmatics entered the tailored education program, 95 patients received usual care. Outcome measures were information exchanged and patient satisfaction. Study duration was 6 months. Patients in the tailored education group showed a significant reduction in information need (P=0.005). Patient satisfaction increased from 87.9 to 93.7 in this group while this did not change in the usual care group (P=0.000). Use of this tailored education program improved the GP-patient interaction within the context of a clinically effective asthma self-management program. Findings from this study may be applicable to other chronic conditions as well.

Acute Disease↗
PubMed2002

Attributes of clinical recommendations that influence change in practice following audit and feedback.

The object of this study was to determine which attributes of clinical practice recommendations influence changes in clinical practice following audit and feedback. This was an observational study using multilevel modeling to examine the relationship between attributes of clinical practice recommendations and compliance with the recommendations before and after audit and feedback. Sixteen hospital gynecology units in Scotland participated in a national audit project. Clinical practice recommendations covering selected gynecological topics were developed and data collected to assess baseline (preintervention) compliance. Summaries of performance were fed back to consultant gynecologists in each hospital and follow-up (postintervention) data were collected. Trained audit assistants used standardized forms to abstract data from case notes. Compliance data were available at baseline and follow-up for a total of 42 clinical practice recommendations. Altogether, 4,664 case notes contributed to baseline data and 4,382 to follow-up data. Thirteen attributes describing clinical practice recommendations were developed, based upon previous work, and pretested. A panel of seven consultant gynecologists rated the extent to which each of the 42 recommendations possessed each of the 13 attributes. The main outcome measures were the association of each attribute with compliance and with changes in clinical practice. Recommendations compatible with clinician values and not requiring changes to fixed routines were independently associated with greater compliance at baseline and follow-up. However, recommendations incompatible with clinician values were independently associated with greater change in practice following audit and feedback. Attributes of recommendations may influence the effectiveness of audit and feedback in secondary care. Recommendations seen as incompatible with clinician values are associated with lower compliance but greater behavioral change following audit and feedback.

Attitude of Health Personnel↗
PubMed2002

Willingness of patients to perform self-management of asthma and the role of inhaled steroids.

OBJECTIVE: Asthma self-management is a generally accepted effective treatment strategy for asthma patients. Acceptance by patients may be a barrier for successful implementation. In this study, the role of inhaled steroids in starting asthma self-management is described. DESIGN: Cross-sectional explorative study. SETTING: General practice. SUBJECTS: 283 adult steroid-requiring asthma patients were invited by their GP to participate in a self-management programme. MAIN OUTCOME MEASURES: In a multivariate logistic regression model, the relation between baseline dosage of inhaled steroids, occupational status, age and sex as independent variables and willingness to participate as dependent variables was explored. RESULTS: Of all invited, 148 (52%) were willing to participate. Subjects not using inhaled steroids were least willing to participate (43/143 = 30%). Subjects with low doses of inhaled steroids ( < 400 mcg daily) were most willing to participate (44/54 = 81%). Unemployed asthmatics had a higher tendency to participate than patients with a regular job. CONCLUSION: Acceptance of self-management by patients is not a limiting issue in promoting self-management of asthma in general practice. High acceptance in patients taking low or intermediate doses of inhaled steroids makes general practice the most appropriate setting for self-management. A selection procedure is recommended.

Administration, Inhalation↗
PubMed2002

Patient satisfaction with availability of general practice: an international comparison.

OBJECTIVE: To identify associations between the characteristics of general practitioners and practices, and patients' evaluations of the availability of general practice. DESIGN: Written surveys completed by patients. SETTING: General practice care in nine European countries: Denmark, Germany, The Netherlands, Norway, UK, Belgium (Flanders and Wallonia), Switzerland, Slovenia and Spain. STUDY PARTICIPANTS: 15996 adult patients consecutively visiting the general practitioner (response rates per country varied between 47 and 89%). MAIN MEASURES: The Europep instrument to assess patients' evaluations of five aspects of the availability of general practice care: (1) getting an appointment, (2) getting through on the phone, (3) being able to speak to the practitioner on the telephone, (4) waiting time in the waiting room, and (5) providing quick services for urgent health problems. Each general practitioner recorded age, sex, number of years in the practice, number of practitioners and other care providers in the practice, and urbanization level of the practice. RESULTS: Patients' more positive evaluations were associated with fewer general practitioners in the practice, except for quick services for urgent health problems (range of conditional overall odds ratios, 1.69-2.02). In addition, a number of significant unconditional overall odds ratios were found, particularly those related to the number of general practitioners' working hours and the number of care providers in the practice. None of the associations was found consistently in all countries. CONCLUSION: Patients favour small practices and full-time general practitioners, which contradicts developments in general practice in many countries. Policy makers should consider how the tensions between patients' views and organizational developments can be solved.

Adult↗
PubMed2002

Inside guidelines: comparative analysis of recommendations and evidence in diabetes guidelines from 13 countries.

OBJECTIVE: To compare guidelines on diabetes from different countries in order to examine whether differences in recommendations could be explained by use of different research evidence. RESEARCH DESIGN AND METHODS: We analyzed 15 clinical guidelines on type 2 diabetes from 13 countries using qualitative methods to compare the recommendations and bibliometric methods to measure the extent of overlap in citations used by different guidelines. A further qualitative analysis of recommendations and cited evidence for two specific issues in diabetes care explored the apparent discrepancy between recommendations and evidence. RESULTS: The recommendations made in the guidelines were in agreement about the general management of type 2 diabetes, with some important differences in treatment details. There was little overlap in evidence cited by the guidelines, with 18% (185/1,033) of citations shared with any other guideline, and only 10 studies (1%) appearing in six or more guidelines. The measurable overlap in evidence between guidelines increases if multiple publications from the same study and the use of reviews are taken into account. Research originating from the U.S. predominated (40% of citations); however, nearly all (11/12) guidelines were significantly more likely to cite evidence originating from their own countries. CONCLUSIONS: Despite the variation in cited evidence and preferential citation of evidence from a guideline's country of origin, we found a high degree of international consensus in recommendations made for the clinical care of type 2 diabetes. The influence of professional bodies such as the American Diabetes Association may be an important factor in explaining international consensus. Globalization of recommended management of diabetes is not a simple consequence of the globalization of research evidence.

Australia↗
PubMed2002

Continuity of care in general practice: a survey of patients' views.

BACKGROUND: It is not known how patients value continuity for different health problems. In addition, it is not clear how different types of patients value continuity. It has been argued, for example, that young and healthy individuals have different ideas about continuity from older people with chronic illnesses. More extensive exploration of patients' views and expectations on personal continuity is important as this may help to organise general practice better in the future. AIM: To explore patients' views on continuity of care in general practice and their relations to patient characteristics. DESIGN OF STUDY: Postal questionnaire survey. SETTING: Thirty-five general practices throughout The Netherlands. METHOD: A sample of 25 patients from each practice was sent a questionnaire. RESULTS: The response rate was 644/875 (74%). The percentage of patients feeling that it was important to see their personal doctor varied, from 21% for a splinter in the eye, to 96% for discussing the future when seriousy ill. The main reasons for preference of their own general practitioners (GPs) were the GP's assumed better medical knowledge of the patient and understanding of the personal and family background. Multiple linear regression analysis (GLM) showed that patient characteristics could explain 10% to 12% of the variance in these views on personal continuity. CONCLUSION: The importance that patients attach to continuity of care depends on the seriousness of the conditions/facing them. Patients in The Netherlands desire a high level of personal care for serious conditions. Patient characteristics, such as age, sex, and frequency of visits to the GP influence views on continuity of care only to a minor extent.

Adolescent↗
PubMed1999

Is 'shared decision-making' feasible in consultations for upper respiratory tract infections? Assessing the influence of antibiotic expectations using discourse analysis.

OBJECTIVES: To examine the discourse of consultations in which conflict occurs between parents and clinicians about the necessity of antibiotics to treat an upper respiratory tract infection. To appraise the feasibility of shared decision-making in such consultations. DESIGN: A qualitative study using discourse analysis techniques. SETTING: A general practice with 12 500 patients in an urban area of Cardiff, Wales. PARTICIPANTS: Two consultations were purposively selected from a number of audiotaped sessions. The consultations took place during normal clinics in which appointments are booked at 7-minute intervals. The practitioner is known to be interested in involving patients in treatment decisions. METHOD: Discourse analysis was employed to examine the consultation transcripts. This analysis was then compared with the theoretical competencies proposed for 'shared decision-making'. RESULTS: The consultations exhibit less rational strategies than those suggested by the shared decision-making model. Strong parental views are expressed (overtly and covertly) which seem derived from prior experiences of similar illnesses and prescribing behaviours. The clinician responds by emphasizing the 'normality' of upper respiratory tract infections and their recurrence, accompanied by expressions that antibiotic treatment is ineffective in 'viral' illness - the suggested diagnosis. The competencies of 'shared decision-making' are not exhibited. CONCLUSIONS: The current understanding of shared decision-making needs to be developed for those situations where there are dis-agreements due to the strongly held views of the participants. Clinicians have limited strategies in situations where patient treatment preferences are opposed to professional views. Dispelling 'misconceptions' by sharing information and negotiating agreed management plans are recommended. But it seems that communication skills, information content and consultation length have to receive attention if such strategies are to be employed successfully.

Journal Article↗
PubMed1998

What can patients do to improve health care?

OBJECTIVE: To give an overview of the value of different interventions for increasing the role of individual patients in improving the quality of care provision. SEARCH strategy: Medline searches and manual searches in medical journals covering the period from 1980 until June 1997. INCLUSION CRITERIA: Studies reporting descriptions and evaluations of seven types of interventions that aim to help integrate the needs and preferences of individual patients into health care provision. DATA EXTRACTION: The following information was extracted: assumptions underlying the interventions; resources needed for development and implementation; and acceptability to clinicians. MAIN RESULTS: Several interventions for increasing patients' roles in health care could be successful in clinical practice, such as feeding forward patient data to clinicians, interactive patient education and feedback to health care providers about patients' evaluations of care. The available research focuses on feedback methods. Insights into the benefits and limitations of the use of the different interventions for improving care are limited. CONCLUSION: The active role that patients' views play in the contact with a care provider is often neglected. Promising interventions for the empowerment of individual patients require further development and evaluation.

Journal Article↗
PubMedDate not supplied

Attitudes and management of alcohol problems in general practice: descriptive analysis based on findings of a World Health Organization international collaborative survey.

AIMS: To determine if general practitioners' (GPs) experience of education on alcohol, support in their working environment for intervening with alcohol problems, and their attitudes have an impact on the number of patients they manage with alcohol problems. METHODS: 1300 GPs from nine countries were surveyed with a postal questionnaire as part of a World Health Organization (WHO) collaborative study. RESULTS: GPs who received more education on alcohol (OR = 1.5; 95% CI, 1.3-1.7), who perceived that they were working in a supportive environment (OR = 1.6; 95% CI, 1.4-1.9), who expressed higher role security in working with alcohol problems (OR = 2.0; 95% CI, 1.5-2.5) and who reported greater therapeutic commitment to working with alcohol problems (OR = 1.4; 95% CI, 1.1-1.7) were more likely to manage patients with alcohol-related harm. CONCLUSION: Both education and support in the working environment need to be provided to enhance the involvement of GPs in the management of alcohol problems.

Alcohol-Related Disorders↗
PubMedDate not supplied

Attitudes and managing alcohol problems in general practice: an interaction analysis based on findings from a WHO collaborative study.

AIMS: To determine if GPs' attitudes towards working with drinkers moderated the impact that training and support had on screening and brief intervention activity in routine practice. METHODS: Subjects were 340 GPs from four countries who were part of a World Health Organization randomized controlled trial to evaluate the effectiveness of training and support in increasing screening and brief alcohol intervention. GPs' self-reported attitudes towards working with drinkers were measured with the Shortened Alcohol and Alcohol Problems Perception Questionnaire. RESULTS: Whereas training and support increased GPs' screening and brief intervention rates, it did so only for practitioners who already felt secure and committed in working with drinkers. Training and support did not improve attitudes towards working with drinkers and, moreover, worsened the attitudes of those who were already insecure and uncommitted. CONCLUSIONS: To enhance the involvement of GPs in the management of alcohol problems, interventions that increase both actual experience and address practitioners' attitudes is required. Such support could take the form of on-site support agents and facilitators.

Alcoholism↗
PubMedDate not supplied

Unexplained complaints in general practice: prevalence, patients' expectations, and professionals' test-ordering behavior.

OBJECTIVE: To gain insight into general practitioners' (GPs) test-ordering behavior for patients presenting with unexplained complaints. An unexplained complaint's symptoms are not alarming, and there is no plausible medical or psychosocial explanation for it. The Dutch College of General Practitioners (DCGP) recommends a watchful, waiting attitude for test ordering for unexplained complaints. METHODS: Observational, cross-sectional study of 567 doctor-patient consultations performed by 21 GPs. RESULTS: On average, 13% of consultations involved complaints considered unexplained by GPs. Unexplained complaints were positively related to test ordering (adjusted odds ratio [OR] = 2.4, 95% confidence interval [CI] 1.1-5.3), despite the DCGP's recommendation. Patients' expectations about testing influenced test ordering even more (adjusted OR = 4.1, 95% CI 2.2-7.6). DISCUSSION: Unexplained complaints happen daily in general practice. Besides the DCGP's recommendation, factors such as GPs' desire to understand complaints and patients' expectations seem to have impacts. Guideline development and quality improvement projects should respect, next to Bayesian rules, GP- and patient-related determinants of test ordering.

Adult↗
PubMedDate not supplied

Patients' needs for contact with their GP at the time of hospital admission and other life events: a quantitative and qualitative exploration.

PURPOSE: Our goal was to explore patients' anticipated needs for contact with their general practitioner (GP) at the time of hospital admissions and other life events. METHODS: We undertook a questionnaire survey of 875 patients from 35 general practices spread throughout The Netherlands and a qualitative interview study with 30 patients. RESULTS: Most patients expected to need contact with their GP if admitted to a hospital for a serious condition, such as a malignancy (98%) or a heart attack (97%). For minor conditions, such as a minor foot operation, contact was considered less important (33%). At the time of major life events, many patients anticipated needing contact as well: 81% in the case of a birth within the family, 90% in the case of a death in the family. In the quantitative analysis patients' wants were related only to a minor extent to patient characteristics. The qualitative analysis, however, distinguished categories of patients with different needs. Some patients were more technical in their needs, others focussed primarily on the relationship. CONCLUSION: Patients appear to have considerable need for contact with their physician at the time of hospital admission and other life events. The profession should reflect on this underexplored field and attempt to take a policy-making position toward initiating patient contact.

Adult↗
PubMedDate not supplied

After-hours care in the United Kingdom, Denmark, and the Netherlands: new models.

There are indications that after-hours care in some countries is of poor quality. European after-hours care is shifting away from individual and group practices with local after-hours call schedules toward large-scale after-hours care services. Experiences with primary care cooperatives in three countries show that this model can lighten physicians' workloads, reduce the number of face-to-face contacts, reduce use of emergency services and hospital admissions, and lower costs. Most patients accept these new models but are dissatisfied if they expect to see a physician. Local or regional integration of all emergency services seems to be the most promising model for after-hours care.

After-Hours Care↗