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Biomedical subjects

Robert K McKinley

Publications and source records attributed to Robert K McKinley.

11 recordsLinked to original sources
PubMed2006

Regulatory end-point assessment of the consultation competence of family practice trainees in Kuwait.

BACKGROUND: No single approach to the regulatory assessment of global consultation competence has been shown to possess the required levels of validity, reliability and feasibility. OBJECTIVE: To evaluate the approach adopted in Kuwait to the regulatory end-point assessment of the global consultation competence of family practice trainees with particular reference to validity, reliability and feasibility. METHODS: Family practice trainees in Kuwait were individually and directly observed for 3 hours in consultation with a minimum of 10 patients by a pair of examiners. Performance was judged against the explicit criteria of consultation competence as contained in the Leicester Assessment Package (LAP). RESULTS: The marks independently allocated by the pairs of examiners to 126 trainees between 1994 and 2001 were within five percentage points on 91% of occasions. A reliability coefficient of 0.82 was achieved when two examiners independently marked candidates consulting with 10 real patients; this rose to 0.95 at the critical 50% pass-fail margin. The main sources of variance contributing to the reliability of marks allocated were candidate performance (42%) and the interaction of candidate performance across cases, i.e., case specificity (30%). The clinical challenges presented by the patients were judged by both examiners to be sufficient to enable performance to be assessed across the seven LAP consultation categories as follows: behaviour and relationship with patients (100% of consultations), interviewing/history taking (100%), record keeping (99%), patient management (99%), problem solving (98%), physical examination (95%), and anticipatory care (86%). Each assessment involved a pair of examiners and lasted approximately 3.5 hours. CONCLUSION: The Kuwait clinical examination achieves high content validity and authenticity as it uses direct observation of performance, validated and explicit criteria against which performance is judged, and real patient challenges. It can discriminate between different levels of consultation performance and satisfies the recognized reliability threshold for regulatory examinations (0.82 vs 0.80). Accordingly, we recommend the use of such an approach in the regulatory end-point assessment of the global consultation competence of trainees in family practice. Such an approach is more valid, and is likely to be more feasible, than simulated surgeries or the short-case OSCE format.

Family Practice↗
PubMed2005

The prevalence of dysfunctional breathing in adults in the community with and without asthma.

Functional breathing problems, including symptomatic hyperventilation, may impair quality of life. Symptoms associated with functional breathing disorders have been reported as being common in secondary care settings, and can affect 29% of adults with current asthma in the community. The prevalence of dysfunctional breathing in the general adult population is unknown. The Nijmegen Questionnaire has been reported to have useful sensitivity and specificity for diagnosing dysfunctional breathing. A cross-sectional postal survey of adults without current asthma was undertaken in a single UK general practice. The results were analysed in conjunction with a previously described survey of adults with current asthma from the same population. The questionnaire was posted to a random sample of 300 people aged 16-65 without current asthma, and 69% were returned. 8% (95% confidence intervals 4-12%) had positive screening scores. Positive screening scores were more common in women (14%, 7-20%) than men (2%, 0-5%, p=0.003). Comparison with the previous survey showed that the prevalence of positive screening scores was higher in those with current asthma than those without (29% vs. 8%, p<0.001). Dysfunctional breathing may affect up to one in 10 people, and is more common in women and in people with asthma.

Journal Article↗
PubMed2005

Design of a questionnaire to measure trust in an emergency department.

OBJECTIVE: To develop a valid and reliable questionnaire for measuring patient trust in an emergency department (ED) that can be administered by phone, direct interview, or mail. METHODS: This was a survey conducted at a Level 1 urban trauma center with an annual census of 52,000 visits. Literature review, focus group discussions, and direct patient interviews identified potential items for pilot surveys. Fifteen ED nurses, residents, and faculty scored the items on a 1-10 scale, rephrasing or removing ambiguous items to ensure face and content validity. A telephone survey with responses recorded on a five-point Likert scale was conducted. Reliability and internal consistency of items were tested using SPSS software. Factor analyses were performed using principal components analysis and Varimax rotation with Eigen values set at 1.0. RESULTS: A total of 383 patients seen in the ED were surveyed. Using two pilot surveys, 18 of 42 potential items were extracted among five factors identified as important to the development of trust. Internal consistency for the final 18 items was calculated, and a Cronbach's alpha of 0.88 was obtained for all items. Test-retest reliability was calculated by telephoning 38 patients twice, two weeks apart, and correlation coefficients of >0.748 were obtained for all items. CONCLUSIONS: This questionnaire can be used for telephone or direct interview to survey patients' trust in EDs.

Factor Analysis, Statistical↗
PubMed2004

Management of COPD in primary care in Leicestershire.

AIM: To determine the proportion of general practices in Leicestershire, UK, with the resources to provide high quality COPD care. METHODS: A postal survey of all 147 Leicestershire practices with postal and telephone follow up. RESULTS: The response rate was 65%. 45 practices (47%) had COPD registers, 44 practices (46%) had COPD protocols and eight practices (8%) had COPD clinics. 52 practices (54%) owned one or more spirometers and 13 (15%) had at least one person with current (within the last two years) approved/formal training in performing spirometry. Four practices (4%) had COPD protocols, registers and clinics and trained operators with current training. DISCUSSION: Very few practices have the resources to provide high quality care of COPD in the practice. Maintenance of current approved training for spirometry operators is likely to be a major and continuing barrier to providing such care. This may be best provided at locality level by intermediate care.

Journal Article↗
PubMed2004

Ending the doctor-patient relationship in general practice: a proposed model.

BACKGROUND: The doctor-patient relationship in general practice is often viewed by practitioner and patient alike as a long-term 'personal' relationship. Little, however, is known about how such relationships are ended in general practice. METHODS: This paper uses theoretical insights obtained from the sociology and social psychology of social relationships, together with the authors' own empirical work on the removal of patients from GPs' lists, to develop a theoretical model of ending the doctor-patient relationship in general practice. RESULTS: Ending the relationship involves 'breakdown' and 'termination'. 'Breakdown' in the relationship occurs when one party decides that the other has acted in such a way as to threaten that party's identity as a 'good' patient or doctor. 'Termination' may be patient initiated, doctor initiated or by mutual consent. CONCLUSIONS: It is proposed that further research is needed to delineate the rules and rituals governing entry into and maintenance of the doctor-patient relationship in general practice as well as those that govern its ending.

Attitude of Health Personnel↗
PubMed2004

Care of people dying with malignant and cardiorespiratory disease in general practice.

BACKGROUND: Provision of palliative care for people dying with malignant disease is a well-characterised aspect of general practice workload. The nature of end-of-life care of people with non-malignant disease is less well described. AIM: To compare the general practice care provided in the last year of life to people who died with malignant and with cardiorespiratory disease. DESIGN: Case record review. SETTING: Two Leicestershire general practices: one inner-city, one semi-rural; total practice population 26,000 people. METHOD: General practice review of the records of all people registered with the practices who died with malignant or cardiorespiratory disease between 1 August 2000 and 31 July 2002 to determine: cause and place of death, recorded comorbidity, palliative medication prescribed, number of consultations and continuity of care, receipt and duration of palliative care. RESULTS: When compared with people who died with cardiorespiratory disease, those who died with malignant disease were more likely to have had a terminal phase of their illness identified and to have been prescribed more palliative drugs. Both groups consulted a similar number of times, experienced similar continuity of care, had similar comorbidity, and were equally likely to die at home. CONCLUSION: People who died with cardiorespiratory disease were less likely to be in receipt of formally identified terminal care and were likely to have had fewer drugs prescribed for palliation than people with malignant disease, yet they make similar demands of practices. They are likely to have unmet needs with respect to palliation of symptoms.

Adult↗
PubMed2003

Patients' accounts of being removed from their general practitioner's list: qualitative study.

OBJECTIVE: To explore patients' accounts of being removed from a general practitioner's list. DESIGN: Qualitative analysis of semistructured interviews. SETTING: Patients' homes in Leicestershire. PARTICIPANTS: 28 patients who had recently been removed from a general practitioner's list. RESULTS: The removed patients gave an account of themselves as having genuine illnesses needing medical care. In putting their case that their removal was unjustified, patients were concerned to show that they were "good" patients who complied with the rules that they understood to govern the doctor-patient relationship: they tried to cope with their illness and follow medical advice, used general practice services "appropriately," were uncomplaining, and were polite with doctors. Removed patients also used their accounts to characterise the removing general practitioner as one who broke the lay rules of the doctor-patient relationship. These "bad" general practitioners were rude, impersonal, uncaring, and clinically incompetent and lied to patients. Patients felt very threatened by being removed from their general practitioner's list; they experienced removal as an attack on their right to be an NHS patient, as deeply distressing, and as stigmatising. CONCLUSIONS: Removal is an overwhelmingly negative and distressing experience for patients. Many of the problems encountered by removed patients may be remediable through general practices having an explicit policy on removal and procedures in place to help with "difficult" patients.

Adolescent↗
PubMed2003

Breaking up is never easy: GPs' accounts of removing patients from their lists.

OBJECTIVE: The aim of this study was to understand why GPs choose to end their relationship with patients by removing them from their lists. METHODS: Semi-structured interviews were carried out with 25 GPs from 22 general practices in Leicestershire. Qualitative analysis was performed using the constant comparative method. The main outcome measures were participants' accounts of removing patients from their lists. RESULTS: GPs use removal as a means of ending their professional relationships with problematic patients. All of the doctors indicated that they wished to retain the right to remove patients and stressed that removal is a rare event which they only use as a "last resort". There are two distinct but overlapping types of patients who are most likely to become eligible for removal: "bad" patients, who break the rules of the doctor-patient or practice-patient relationship, and "difficult" patients, with whom the doctor-patient relationship is so strained that doctors feel they can no longer care for them. The doctors may choose to remove a patient without warning or else to write a short letter giving "relationship breakdown" as the reason. They find it hard to confront the patient openly about the difficulties in the relationship. CONCLUSIONS: The ability to remove patients is a right that GPs value. They report that it is rare for them to seek to end their relationships with patients and, when they do, it is for reasons that are important in the maintenance of professional boundaries or fulfilling professional responsibilities.

Adult↗