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At least 253 records · Page 14Linked to original sources
PubMed2002

General practice research: attitudes and involvement of Queensland general practitioners.

OBJECTIVES: To determine general practitioners' (GPs') attitudes towards and involvement in general practice research. DESIGN: Postal survey and semi-structured interviews conducted from May to September 2001. PARTICIPANTS AND SETTING: 467 of 631 GPs in four Queensland Divisions of General Practice responded to the survey (74% response rate); 18 selected GPs were interviewed. MAIN OUTCOME MEASURES: Survey - attitudes to research; access to information resources; and involvement in research. Interviews - the need for general practice research; barriers against and factors enabling greater participation in research. RESULTS: 389/463 (84%) GPs, especially younger and more recent graduates, had positive attitudes to research, but only 29% wanted more involvement. 223/462 (48%) were aware they had access to MEDLINE, although presumably all those with Internet access (89%) would have free access via PubMed. Barriers included the general practice environment (especially fee-for-service funding), and the culture of general practice. Enabling factors included academic mentors; opportunities to participate in reputable, established research activities relevant to general practice; and access to information resources. CONCLUSIONS: Although Australian general practice has a weak research culture, about a third of GPs would like to increase their involvement in research. However, the research must be perceived as relevant, and structured to minimise the inherent barriers in the environment and culture of general practice.

Adult↗
PubMed1971

British view of Canadian general practice.

The Canadian general practitioner is remunerated by an item-of-service system of payment which encourages servicing demands rather than needs, discourages delegation of work to paramedical workers, and involves his staff in a massive amount of paper work. He has an excellent hospital attachment, which unfortunately is overdone. His community facilities are piecemeal and his office organization is rudimentary. There are few incentives for good general practice in the community. He spends an inordinate amount of time examining well people. The university departments of general practice are extremely good and much should be heard from them very quickly. The patient's attitude towards his doctor is quite different from the one prevailing currently in Britain.I returned happily to British general practice.

Diagnostic Services↗
PubMed1995

[The general practice course catalog--an attempt at quality assurance in graduate general practice education].

Additionally to the training in the hospital and in the practice, the rules for continuing education for general practise, established at the meeting of medical German physicians in 1992 demand the participation in theoretical seminars. The content and duration of these seminars is content and duration of these seminars is laid down in recommendations of the chamber of the physicians of Germany to ensure the quality of the courses. According to this, the first recommendations consists of the Course Book for General Medical Practise regarding a course of 240 hours duration. This is a nation-wide standardized curriculum which was accepted from all German chambers of physicians as the basis of the further education in family medicine. The standardization and the structuring of the content, goals, and methods of teaching and learning as well as the organization of the seminars, the working materials for the teachers, regular training for the presenters and teachers, methods for a nation-wide evaluation of the seminars, and independence from commercial interests are the features to ensure the quality of the courses.

Education, Medical, Continuing↗
PubMed1992

Medical audit in general practice. I: Effects on doctors' clinical behaviour for common childhood conditions. North of England Study of Standards and Performance in General Practice.

OBJECTIVE: To estimate the effects of medical audit, particularly setting clinical standards, on general practitioners' clinical behaviour. DESIGN: Before and after study strengthened by a replicated Latin square. SETTING: 62 training general practices in the north of England. SUBJECTS: 92 general practitioner trainers, 84 (91%) of whom completed the study; random sample of 3500 children consulting one of these trainers for any of five conditions--acute cough, acute vomiting, bedwetting, itchy rash, and recurrent wheezy chest--stratified by doctor consulted, condition, and age. INTERVENTIONS: Clinical standard set by each of 10 small groups of general practitioner trainers for one randomly selected childhood condition. Each group also experienced a different type of medical audit, randomly selected, for each of the four other study conditions (receiving a clinical standard set by another trainer group, tabulated data comparing clinical performance with that of all other groups, tabulated data from only their own group, and nothing ("control" condition)). MAIN MEASURES: Content of initial consultation divided into: history, examination, investigation, diagnosis, and management (abstracted from medical records and "enhancement forms" completed by doctors). RESULTS: There was increased prescribing of bronchodilators for acute cough, oral rehydration fluids for acute vomiting, antibiotics for itchy rash, and bronchodilators and oral steroids for recurrent wheezy chest and reduced prescribing of antibiotics for acute cough and recurrent wheezy chest and tricyclic antidepressants for bedwetting. Fewer children were "discharged." Each change was consistent with the standard and either limited to doctors who set a standard for that condition or significantly greater for them than all other doctors. CONCLUSION: Setting clinical standards improved prescribing and follow up.

Acute Disease↗
PubMed1994

Asthma at the interface: bridging the gap between general practice and a district general hospital.

A clinic supervised by a nurse, using principles originally developed in general practice, was established in the paediatric department of a district general hospital. A randomised controlled study was conducted comparing children admitted with asthma or attending outpatients who were given a patient education programme and self management plan (intervention group) with a control group. The study comprised 91 patients aged 3-14 years admitted for asthma or attending a hospital outpatient department from November 1989 to November 1990. Seventy seven patients completed the study and kept diaries for a median of 283 days. Patients in the intervention group had significantly less restriction of activity (95% confidence interval (CI) -0.27 to -0.01) and fewer episodes of peak flow below 30% of best (95% CI 0.03 to 1.17). Patients in the intervention group were more likely to make the correct response to an acute exacerbation of their asthma than the control group (71% v 47%, 95% CI 9.51 to 39.1). The intervention group had fewer school absences and fewer home visits by a general practitioner. There was an increase in the readmission rate for the intervention group. A subgroup of patients who self managed by doubling their use of inhaled steroids during an exacerbation performed better than those patients who only increased their bronchodilator or were managed on salbutamol or sodium cromoglycate alone. Improvements in patient follow up and the structure of the self management plans used, particularly changing the peak flow level at which inhaled steroids are doubled, may further improve the outcome of patients attending the asthma clinic.

Absenteeism↗
PubMed1991

[Coworkers in focus. An analysis of video recordings from receptions in general practice--a method of self evaluation of the coworker and for future development of cooperative forms in general practice].

The article describes a simple method for self-assessment and group-assessment of video recordings from the reception area in a general practice. In a group setting, the method was found to increase the receptionists' confidence in their own professional skills and revealed the need to pay more attention to communication between patients and receptionists. The layout of the reception area was rearranged and changes in the daily routines in the practice were suggested.

Communication↗
PubMed1984

Practice research. Training for general practice: clinical behaviour in trainers and trainees.

A study of 20 trainers and their trainees in general practice showed that trainees had a statistically significant improvement in their diagnosis of otitis media during their trainee year and also became quicker in the time taken for history taking and examination. There was a fall in trainees' prescribing of antibiotics for otitis media during the study but this was accompanied by a notable rise in prescribing of decongestant-antihistamine mixtures to a level similar to that of the trainers. Trainees seemed to accept readily their trainers' prescribing policies and were hesitant to challenge them. An important finding was that trainees had little influence on trainers' prescribing, the latter showing no appreciable changes during the study.

Anti-Bacterial Agents↗
PubMed2005

A balancing act--the role of the general practice trainer.

BACKGROUND: The general practice trainer is recognised by The Royal Australian College of General Practitioners (the RACGP) as the most important element of Australian general practice training. The college has recently introduced new standards for trainers to ensure high quality general practice training. OBJECTIVE: This paper describes the various roles and responsibilities of the general practice trainer, and highlights the potential conflicts contained within them. DISCUSSION: The role of the general practice trainer is complex, challenging and diverse. It comprises separate--though interconnected--core roles of mentor, role model, clinical educator, assessor and pastoral carer. The balance of the various roles depends on the individual circumstances of the trainer-registrar relationship, and at times is potentially conflicting. Greater definition and consideration of the various facets of the role may lead to greater sustainability, satisfaction and reward for the trainer, and enhanced learning for the registrar.

Australia↗
PubMed1993

Functional dyspepsia versus other functional gastrointestinal disorders: a practical approach in Belgian general practices.

This paper identifies the symptom profile associated with the four main diagnoses of functional digestive disorders (dyspepsia, gastro-oesophageal reflux disease (GORD), gastritis, and constipation) made by general practitioners in Belgium. Results are also presented from a multicentre study in which the effects of cisapride, administered as an oral tablet or suspension, were evaluated in patients with these functional digestive disorders. Analysis of symptom patterns revealed that early satiety and postprandial abdominal bloating were the most prominent symptoms, followed by eructation (belching), heartburn, regurgitation, postprandial epigastric burning or discomfort, and nausea. These symptoms occurred in all diagnostic groups. However, different symptom patterns were associated with each of the disorders; for example, heartburn and regurgitation were the core symptoms in patients diagnosed as having GORD, early satiety and abdominal bloating were characteristic of patients diagnosed with dyspepsia, and fasting or postprandial pain were characteristic of patients given the diagnosis of gastritis. Therefore, it appears that these diagnoses used by general practitioners in Belgium closely correspond to reflux-like, dysmotility-like and ulcer-like dyspepsia, as defined by an international working party. Cisapride improved the core symptoms in about 80% of patients with GORD or dyspepsia, relieved all epigastric symptoms in about 80% of patients with gastritis, and significantly decreased the use of laxatives and increased stool frequency in constipated patients. Cisapride was well tolerated and thus appears to be a useful option in the treatment of functional digestive disorders in a general practice setting.

Adult↗
PubMed1989

[Diagnosis and treatment in general practice. 6. Attitudes of general practitioners--a study in Copenhagen County].

We assume that general practitioners' (GPs) attitudes have considerable significance for their daily work, partly because the "free enterprise" structure permits GPs a fair degree of work autonomy, partly because several studies point to notable variations in GP behaviour which have not been explained by other variables. General practitioners seem to have developed an official professional ideology which differs in some respects from the ideology of other doctors. The core issues of Danish GP ideology, according to commission reports, textbooks and research can be summarized into four main principles: 1. A holistic (bio-psycho-social) model of disease, 2. The GP as a family doctor, 3. The GP as a "gate-keeper" (the central referral role) and 4. General practice as a "free enterprise". We mailed attitude questionnaires to a random sample of 100 practices in the county of Copenhagen. The purpose of the study was to establish the extent to which GPs would agree to the above ideology, and also to look for systematic differences between groups of doctors. The response rate was 76%. We found overall agreement to the family doctor principle among GPs which is in accordance with earlier studies. Attitudes to the "free enterprise" principle of practice organization were favorable in a similarly homogeneous way, and a significant minority favored even further liberalization. Disagreements were more pronounced concerning the holistic (bio-psychosocial) model of disease. Just over half of respondents adhered fully to the model, but doctors from high-income areas were significantly less enthusiastic than other doctors about the model. Similarly, most general practitioners favored the "gate-keeper" role.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel↗
PubMed1997

Handling nutritional advice in general practice in Norway.

General practitioners (GPs) in Norway are in a unique position to influence their patients' lifestyles during consultations. The specialty of family medicine has been recognized in Norway since 1985. In continuing medical education, nutrition issues are integrated with the discussion of relevant diseases. The first book on health education for Norwegian general practice (1990) contains a set of general dietary guidelines. GPs are informed of the results of the National Health Screening Service, which measures blood pressure and serum lipids and records smoking habits. Serum cholesterol concentrations and coronary artery disease mortality are declining. GPs have been involved in this achievement, although they were found in 1988 to set more conservative cutoffs of serum cholesterol concentrations for dietary advice than an expert committee. GPs have been directly involved in preparing the latest cholesterol guidelines. In 1994 Norwegian GP organizations started a project of quality indicators in general practice (SATS). Of the four conditions that are themes for the first project, treatment of diabetes mellitus has a major nutritional aspect.

Adult↗
PubMed2004

Systematic review of published multi-practice audits from British general practice.

BACKGROUND: Audit has been a major part of attempts to improve patient care in Britain, with substantial resources devoted to it since the 1990 National Health Service reforms. Systematic reviews have considered audit to be of variable, but often moderate, effectiveness. However, these have included few studies from British primary care, and as quality improvement activities may be context specific, it is hard to judge how effective audit has been here. RESULTS: A search for audits published in peer-reviewed journals revealed 48 two-stage projects carried out in British general practice, of which 27 principally concerned chronic disease management and nine prescribing. Most audits showed some improvements in performance, and those using controls showed 27/56 (48%) parameters had changed significantly (P < 0.05). CONCLUSIONS: This review adds further evidence that audit can often be moderately effective. However, it is frequently used as one of a complex set of interventions making precise evaluation difficult. Those responsible for clinical governance will need to choose carefully the subjects they audit in order to use their limited resources to maximum effect. These projects are illustrative examples but once again do not identify any 'magic bullets' that would be highly likely to improve professional performance.

Family Practice↗