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PubMed1999

Clinical examination for abdominal aortic aneurysm in general practice: report from the Medical Research Council's General Practice Research Framework.

At the time of the 1992-1994 annual reviews in the thrombosis prevention trial, general practitioners (GPs) carried out clinical examination for aneurysms by abdominal palpation in 4171 men. When an aneurysm was suspected, the patient was referred to hospital for further investigation. Aneurysm was suspected in 60 men (1.4%) and confirmed in 25 (0.6%), the mean diameter of confirmed aneurysms being 5.0 cm (range = 3.1-8.0 cm). Of the 25 men in whom aneurysm was confirmed, 10 (40%) underwent elective surgery and one died while under investigation. Examination by abdominal palpation for aortic aneurysm, which is not widely used in either general practice or in hospital practice, other than vascular surgery, is clinically worthwhile even though not all aneurysms will be detected by this means.

Aged↗
PubMed2000

A comparative study on the service profiles and practice facilities among urban general practices in east and west Malaysia.

1171 urban general practices in East and West Malaysia were compared regarding their service profiles and practice facilities. In general, practices in both parts put important emphasis on preventive health care. More practices in East Malaysia were providing hormone replacement therapy and sexually transmitted diseases services but less were providing intrapartum care, counselling services including sexual and marital counselling and problems associated with social deviance such as alcohol and drug abuse. Although most practices in East Malaysia were solo practices, they were more comprehensive in terms of the provision of practice facilities when compared to those in West Malaysia. A greater number of them had ultrasound facilities, peak flow meters, ECG machines, computers and blood biochemistry facilities.

Family Practice↗
PubMed2005

A practical method for monitoring general practice mortality in the UK: findings from a pilot study in a health board of Northern Ireland.

BACKGROUND: The Baker report into Dr Harold Shipman's murders recommended monitoring mortality in general practice, but there is currently no practical method available to implement this. AIM: To monitor mortality rates in response to the Baker report and to use the data to improve quality of care. DESIGN OF STUDY: Prospective mortality monitoring study. SETTING: Eastern Health and Social Services Board, Northern Ireland. METHOD: Linked quarterly mortality data from 1994-2001 were compiled for 114 general practices in Eastern Health and Social Services Board in Northern Ireland. Cross-sectional control charts compared crude and adjusted mortality rates across all the practices. Longitudinal control charts analysed quarterly mortality rates over 28 quarters within each practice. Practices were sent their own control charts and invited to feedback workshops. Special cause variation in mortality was investigated as follows: checks on data, case-mix, practice structures, processes of care and finally individual carers. RESULTS: Age, sex and deprivation adjusted cross-sectional control charts identified 18 practices as showing special cause variation in their mortality (11 high and 7 low). Assignable causes were found for all high special cause practices: large numbers of nursing home patients (six practices), very high levels of deprivation and high morbidity not captured by our case-mix adjustment (five practices). For three of seven low special cause practices, case-mix adjustment underestimated affluence and overestimated morbidity levels. Feedback indicated widespread support for the principle of monitoring, but concerns about the public disclosure of mortality data. CONCLUSIONS: We have successfully developed and piloted a general practice mortality monitoring system with the support and participation of local stakeholders. This used control charts for analysis and followed a scientific strategy for investigating special cause variation.

Epidemiologic Methods↗
PubMed1989

[Diagnosis and treatment in general practice. 5. Attitudes of general practitioners--a review].

The word "attitude" means continuing orientation of the individual towards the world. Attitudes consist of cognitive beliefs and affective reactions, which predispose the individual towards certain action patterns and which have emotional (positive/negative) value. Doctors' attitudes are developed by the joint influences of selection and socialization. Doctors are predominantly recruited from the middle classes and are therefore characterized by middle class attitudes, valuing hard work, activity, self-discipline and rationality. The curriculum of medical school has a further and independent influence on the personalities of physicians-to-be, shaping their attitudes towards patients and medical work. This study gives a review of the official professional ideology of general practitioners (GP's) which, in some respects, differs from the ideology of other doctors. The basic issues, according to general practitioners' commission reports, textbooks, and research can be subdivided into four main principles: 1. A holistic model of disease, 2. The GP as a family doctor (a continuous and personal doctor-patient relationship), 3. The GP as a "gate-keeper" (the central referring role), 4. General practice as a "free enterprise". The two first principles deal with the substance of the GP's work and they stress holism, continuity and dialogue. The two last principles on the other hand deal with the structure of GP's work, stressing freedom and power. Thus general practitioners' ideology and attitudes serve to emphasize differences between hospital medicine and general practice. Differentiation between GP roles and roles of their psycho-social co-workers in the primary health care is not equally marked. Demarcation of general practice ideology in this respect is needed.

Attitude of Health Personnel↗
PubMed1999

Australian divisions of general practice asthma survey 1997. General Practitioner's Asthma Group of the National Asthma Campaign.

AIM: To conduct an attitudinal postal survey of all 118 divisions of general practice known to the National Asthma Campaign. METHOD: A questionnaire aimed to determine the perceived barriers to improved asthma care in the divisions, current asthma projects and the most suitable way that the General Practitioners Asthma Group (GPAG) and the National Asthma Campaign (NAC) could assist divisions of general practice. RESULTS: Eighty seven (74%) replies were received. Twenty-four divisions (28%) were running asthma projects, mostly about asthma education. The greatest barrier to asthma care for the doctor was a lack of time (57% of respondents) and the greatest barrier for the patient was perceived to be a lack of asthma education (34% of respondents). Asthma educators employed by the division or individual surgeries were ranked as the preferred method for overcoming these difficulties. CONCLUSIONS: Divisions of general practice are becoming involved in the management of asthma throughout Australia although there are considerable hurdles to overcome. The role of the GPAG and NAC in this process is discussed.

Asthma↗
PubMed1991

Hormone replacement therapy in general practice: a survey of doctors in the MRC's general practice research framework.

OBJECTIVES: To survey current prescribing practice for hormone replacement therapy among general practitioners and to elicit their views on the role of hormone replacement therapy in the prevention of osteoporosis and cardiovascular disease; to determine whether they would participate in randomised controlled trials to evaluate the long term beneficial and adverse effects of hormone replacement therapy. DESIGN: Postal questionnaires to general practitioners throughout the United Kingdom. PARTICIPANTS: 1268 general practitioners in the Medical Research Council's general practice research framework. RESULTS: 1081 (85%) doctors in 220 (95%) practices responded. The doctors were currently prescribing hormone replacement therapy to an estimated 9% of their female patients aged 40 to 64, and 55% of doctors were prescribing opposed hormone replacement therapy (oestrogen plus progestogen) to more patients than a year previously. Over half the doctors would consider prescribing hormone replacement therapy for prevention of osteoporosis (670, 62%) and cardiovascular disease (611, 57%) to asymptomatic women. Overall, 79% of the doctors (851) would definitely or probably consider entering women who have had a hysterectomy into a randomised controlled trial comparing unopposed (oestrogen only) hormone replacement therapy with opposed hormone replacement therapy; 49% (524) would enter patients with a uterus into such a trial. Among a subsample, 85% (180/210) would consider entering patients without menopausal symptoms into a trial comparing hormone replacement therapy with no treatment (unopposed in patients who have had a hysterectomy, opposed in those with a uterus). CONCLUSION: There is considerable uncertainty among general practitioners as to the balance of beneficial and harmful effects of hormone replacement therapy in the long term, particularly relating to its use for prevention of osteoporosis and cardiovascular disease. Most of these doctors would be prepared to participate in randomised controlled trials to determine the long term effects of this increasingly widely used treatment.

Adult↗
PubMed1999

Use of the General Practice Research Database (GPRD) for respiratory epidemiology: a comparison with the 4th Morbidity Survey in General Practice (MSGP4).

BACKGROUND: The General Practice Research Database (GPRD) covers over 6% of the population of England and Wales and holds data on diagnoses and prescribing from 1987 onwards. Most previous studies using the GPRD have concentrated on drug use and safety. A study was undertaken to assess the validity of using the GPRD for epidemiological research into respiratory diseases. METHODS: Age-specific and sex-specific rates derived from the GPRD for 11 respiratory conditions were compared with patient consultation rates from the 4th Morbidity Survey in General Practice (MSGP4). Within the GPRD comparisons were made between patient diagnosis rates, patient prescription rates, and patient "prescription plus relevant diagnosis" rates for selected treatments. RESULTS: There was good agreement between consultation rates in the MSGP4 and diagnosis or "prescription plus diagnosis" from the GPRD in terms of pattern and magnitude, except for "acute bronchitis or bronchiolitis" where the best comparison was the combination category of "chest infection" and/or "acute bronchitis or bronchiolitis". Within the GPRD, patient prescription rates for inhalers, tuberculosis or hayfever therapy showed little similarity with diagnosis only rates but a similarity was seen with the combination of "prescription plus diagnosis" which may be a better reflection of morbidity than diagnosis alone. CONCLUSIONS: The GPRD appears to be valid for primary care epidemiological studies by comparison with MSGP4 and offers advantages in terms of large size, a longer time period covered, and ability to link prescriptions with diagnoses. However, careful interpretation is needed because not all consultations are recorded and the coding system used contains terms which do not directly map to ICD codes.

Adult↗
PubMed1991

Abortion attitudes and practices of family and general practice physicians.

BACKGROUND: Approximately 1.5 million abortions are performed each year in the United States. Little information has been published on the abortion attitudes and practices of family physicians. The object of this investigation was to assess the abortion attitudes and practices of family and general practice physicians in Kansas. METHODS: A 19-item self-administered survey questionnaire was designed and mailed to 856 family and general practice physicians in Kansas. RESULTS: A 63% survey response rate was obtained. Seventy-eight percent of the physicians reported that abortion should be legal, but only 56% of the respondents classified themselves as pro-choice. Conversely, only 8% reported that legal abortion should not be available, even though 33% classified themselves as pro-life. The majority of physicians reported that abortion is an appropriate option to save the life of the mother, in cases of rape or incest, and when a fetal anomaly is diagnosed. Only three respondents (0.5%) had performed abortions during the previous year. In general, female physicians and physicians over the age of 40 years (regardless of sex) were more likely to be pro-choice and to view a woman's personal decision as a circumstance in which abortion may be appropriate. CONCLUSIONS: Physician's views about abortion and their practice patterns are important components of health care for thousands of women each day.

Abortion, Induced↗
PubMed1989

[Glucose analysis in general practice. An examination of 4 instruments designed for general practice and self-monitoring].

Several examinations have shown that the analysis of glucose in primary health care is of poor quality. The reason could be the quality of the instruments and/or the way the instruments are operated. We have examined Glucometer II, Glucochek SC, Reflolux II and Hypocount GA. These instruments were studied both in general practice and at Haukeland Hospital. The test results were compared with the routine used in the hospital laboratory. There were no major analytical differences between the instruments. All the instruments were found to have an analytical quality lower than what is recommended by the Norwegian Quality Control. The requested analytical quality for the instrument depends on the clinical needs. We would recommend that these glucose instruments be used to diagnose acute hypo/hyperglucemia and to some extent in control of diabetes. For a certain diagnosis of diabetes, the use of a more precise instrument is to be preferred. The need for a Quality Control program for glucose measurement in primary health care is emphasized.

Blood Glucose↗
PubMed2000

Quality assessment in general practice trainers.

INTRODUCTION: General practice trainers hold a key position in general practice training, especially through their provision of a role model. Their own competence in general practice care is important in this regard. The purpose of the study was to evaluate whether a quality assessment programme could identify the strengths and weaknesses of GP trainers in four main domains of general practice care. METHODS: The quality assessment programme comprised validated tests on four domains of general practice: general medical knowledge, knowledge of medical-technical skills, consultation skills and practice management. The criterion for the identification of relative strengths and weaknesses of GP trainers was a variation in the scores of trainers indicating higher and lower scores (strengths and weaknesses) within each domain. RESULTS: GP trainers (n=105) were invited to participate in the study and 90% (n=94) did so. The variation in scores allowed the indication of strengths and weaknesses. Main strengths were: general medical knowledge of the digestive system; knowledge of medical skills relating to the skin; consultation skills concerning empathy; practice management with regard to accessibility. Main weaknesses were: general medical knowledge of the neurological system; knowledge of the medical/technical skills relating to the endocrine metabolic and nutritional system; consultation skills regarding shared decision making; practice management involving cooperation with staff and other care providers. DISCUSSION: This first systematic evaluation of GP trainers identified their strengths and weaknesses. The weaknesses identified will be used in the improvement process as topics for collective improvement in the GP trainers' general curriculum and in individual learning plans.

Educational Measurement↗
PubMed1989

[Diagnostic activity in general practice. 2. Frequency of examination of urinary glucose and blood pressure determination among patients in general practice].

In order to estimate how frequently examinations of urine for glucosuria and blood pressure measurements are performed in the primary health care sector to detect common incapacitating diseases such as diabetes and hypertension, the authors carried out a study in five general practices in Denmark for a period of five years. The study was retrospective because it is not possible to study one's own behaviour prospectively. Nearly 1,000 persons aged 30 years or more were involved. 9% of the group had no contact with the health care sector during the period. In 49%, the urine had been tested at least once for glucose; 58% where women were concerned but only 40% of the men. Men under the age of 55 years were significantly underrepresented. Examination of the urine was only undertaken in 51% of the persons aged 55-74 years. Twelve new cases of diabetes were discovered, nine of these were diagnosed in general practice. Hypertension had been diagnosed in 52 patients before the registration period. 60% of the remainder had blood pressure measurements on at least one occasion during the period. Men under 55 years were significantly underrepresented (42%). Sixty-four new cases of hypertension were discovered, 59 of these in general practice. Screening for common diseases such as these is primarily performed by general practitioner. Several other works from general practice where no special efforts were made to systematize screening for diabetes or hypertension did not reveal any better results. It is estimated that 25% of diabetic patients and 50% of hypertensive patients remain undiagnosed. The present rather random screening for these diseases is insufficient.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗