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PubMed1997

The formation of professional and consumer solutions: ethics in the general practice setting.

A general practice research project on ethics is underway at the University of New South Wales, funded by GPEP (General Practice Evaluation Program, Commonwealth Department of Human Services and Health, GPEP 386). Ethical issues, as defined and explored by general practitioners and consumers, are being examined across four areas of Sydney. So far, telephone interviews have been conducted (64% response rate) with a random sample of general practitioners (GPs). Face-to-face interviews have been conducted with 107 consumers, randomly sampled using ABS collection district information. Focus groups have been formed to discuss acceptable solutions to GP and consumer identified ethical issues. This report will report on some preliminary findings to date and will explore professional and consumer roles in the formation of ethical solutions.

Bioethical Issues↗
PubMed1990

Doctors' characteristics and practice patterns in general practice: an analysis based on management of urinary incontinence.

Six case histories concerning female urinary incontinence were mailed to 191 randomly selected general practitioners (GPs) in Norway, of whom 139 (73%) replied. Great variations in suggested investigations and treatment were found between individual doctors. Four explanatory variables were examined: doctors' sex, years since graduation, urban/rural location, and GP specialization. GP specialists treated fewer patients adequately than non-specialists. Experienced female doctors instructed more patients in pelvic floor exercises, prescribed more oestrogens, referred more patients, and also indicated the possibility of surgery more frequently than their colleagues. Nevertheless, patient management is largely independent of a doctor's sex and age, practice location, and GP specialization.

Estrogens↗
PubMed1995

Continued prescribing of inappropriate drugs in general practice.

Seven general practitioners used various methods to identify patients in their practices whom they had inherited and whose medication they regarded as inappropriate in the light of current knowledge. Information was collected in each case about the drug concerned, the patient, the original prescriber, and the reason for continued prescribing. Each patient was also interviewed. Altogether, 25 different drugs were prescribed for 40 patients: in 16 the inappropriate drug was one acting on the brain, in 13 an antihypertensive, in seven it was given for heart disease and in three, for asthma. The influence of the original prescriber, and the patient's dependence on the drug, helped to explain its continued use. Almost half the patients said that they might consider changing their medication. The study underlines the importance of reviewing long-term medication and offers a method of scrutinizing repeat prescribing in general practice. Community pharmacists could help in this process.

Adult↗
PubMed2003

Improving the safety features of general practice computer systems.

General practice computer systems already have a number of important safety features. However, there are problems in that general practitioners (GPs) have come to rely on hazard alerts when they are not foolproof. Furthermore, GPs do not know how to make best use of safety features on their systems. There are a number of solutions that could help to improve the safety features of general practice computer systems and also help to improve the abilities of healthcare professionals to use these safety features.

Computer Literacy↗
PubMed1993

Prevalence of hearing impairment and hearing complaints in older adults: a study in general practice.

In one general practice, 660 people aged 60 years or over were screened by means of pure tone audiometry and a specific questionnaire to assess the prevalence of hearing impairment and hearing complaints. Hearing impairment was defined as an average loss of 35 dB or more in the 1, 2 and 4 kHz frequencies in one or both ears. In total, 37.4% (95% CI, 33.3-41.1%) of the participants was hearing impaired. The prevalence was higher in men (55.1%) than in women (44.9%) and clearly increased with age in both sexes. The prevalence of hearing complaints in terms of hearing difficulties and/or tinnitus, was 37.3% (95% CI, 33.6-41.0%), and increased with age, especially in women. Of the subjects with hearing impairment, 64.4% reported hearing complaints. Of the subjects without hearing impairment, 21.1% experienced hearing complaints. This study suggests that screening older adults with relatively simple methods, may identify a large proportion of men and women in general practice with hearing problems. Providing information to both patients and general practitioners about the possibilities of hearing improvement is a crucial step in making people become more aware of hearing problems. This could ultimately lead to improvement of the quality of life of older men and women with hearing problems.

Age Factors↗
PubMed1981

Secretory otitis media--a retrospective general practice survey.

The general practice records of 68 children with secretory otitis media (SOM) were studied. A control group was matched one-for-one on the basis of sex, year of birth and general practice list. The SOM group had twice the incidence of recorded atopy, twice the incidence of recorded previous upper respiratory tract infections (URTI), and three times the incidence of recorded attacks of acute otitis media (AOM) compared with the control group. The recorded antibiotic treatment of URTI and AOM in the two groups was similar. Antihistamines and decongestants were seldom recorded in the treatment of AOM. The higher incidence of atopy found in the children with SOM prompts the suggestion that antihistamines and decongestants used by general practitioners in the routine treatment of AOM and URTI might help prevent the development of SOM. A prospective double-blind trial along these lines seems desirable.

Acute Disease↗
PubMed1987

Reliability and validity of the classification of death in general practice.

The general practitioner in the Netherlands is solely responsible for assigning the natural causes of a patient's death when it occurs at home and for entering it on the certificate of death B, which is then forwarded to the CSO (Central Statistics Office). The CSO however, records the cause of death in the appropriate category of the ICD-9 of the WHO. The value of these data, therefore, depends upon the agreement between the general practitioner's cause of death and the CSO categories of causes of death. To assess the degree to which the CSO classification reflects the general practitioner's cause of death, form B from eight general practitioners practicing in Hoorn were compared with the classification of the CSO during a period of five years, 1979-83. There was a 65% (237/365) agreement between the classifications. Of the remaining 128 cases 68% (87/128) of the classification differences were caused by a wrongly described cause of death on the B certificate. In 32% (41/128) the classification rules of WHO made it hardly possible for the general practitioner to classify uncertain causes of death. The conclusions of this survey are that the quality of the statistics on causes of death will improve if the general practitioners are more careful with filling in the certificate of death B; the classification rules of the ICD-9 makes it possible to classify unknown causes of death; and if the certificate of death B becomes more 'user friendly'.

Classification↗
PubMed2004

Flexible teaching and learning in general practice.

BACKGROUND: Changing general practice workforce characteristics, with fewer people prepared to work excessive hours, mean that both teachers and learners need greater flexibility in their approach. OBJECTIVE: This article describes the strategies one practice has used in aiming for optimum and stimulating medical education. Issues such as finding the right match between learner and teacher, and enriching the learning environment are discussed. Personal, professional and workforce boundaries are examined, as is the maintenance of identity and integrity. DISCUSSION: Flexible teaching and learning needs to involve vertical and horizontal integration. Mentors who are thriving personally should lead by example. A nonclinical agenda is paramount. Appropriate accreditation within the training program and acknowledgment of the differences between rural and metropolitan general practice training needs further work.

Clinical Competence↗
PubMed2006

The course and prognosis of hip complaints in general practice.

BACKGROUND: The general practitioner needs to discriminate complaints with need of specialist care from those that can be managed in primary care. However, no previous research has studied prognostic indicators for the course of hip complaints in a primary care population. PURPOSE: The purpose of this study was to investigate the course of hip complaints presented in general practice and to identify relevant prognostic indicators of outcome. METHODS: Data were collected by means of self-administered questionnaires containing questions about sociodemographic variables, characteristics of the complaints, and several intraindividual and extraindividual factors, including several psychosocial variables (e.g., pain coping, distress, and kinesiophobia). After 3 and 12 months of follow-up perceived recovery, change in pain intensity and change in functioning were assessed. Multiple regression analyses were performed to investigate the association between the potential prognostic indicators and the 3 outcome measures. RESULTS: We included 139 patients with hip complaints, presented in general practice. Only 24% reported recovery after 3 months, increasing to 37% after 12 months. A history of hip complaints, a longer duration of the current episode of hip complaints, or more severe complaints, were associated with a less favorable prognosis. Furthermore, more vital patients and patients who met the Norm for Healthy Activity had a higher probability of a favorable outcome. Pain transformation and worrying were significant associated with recovery and changes in functioning after 3 months. CONCLUSIONS: Different prognostic indicators were found to be associated with perceived recovery, changes in pain intensity, and changes in functioning. Future research should aim at investigating the mechanisms that can underlie these associations.

Adaptation, Psychological↗
PubMed2004

[Disappearance of differences in antibiotic resistance of Staphylococcus aureus strains isolated in hospitals and in general practice].

There is general opinion that Staphylococcus aureus strains isolated in hospitals are more frequently resistant to antibiotics than community strains, however, the increasing resemblance between hospital and community strains has been recently reported. The aim of the study was to compare the antibiotic resistance and phage-type pattern of S. aureus strains isolated from patients treated either in hospitals or in general practice in northern part of Poland. The study was conducted on 771 S. aureus strains isolated from different specimens. Phage typing was performed according to the method of Blair and Williams. The drug susceptibility was determined by the disc-diffusion method. There were no significant differences in antibiotic resistance or phage-type pattern when hospital and community methicillin-sensitive S. aureus (MSSA) strains were compared. The most MSSA were resistant to penicillin (84.6% and 82.1% respectively) and doxycycline (49.3% and 50.4% respectively) whereas they were rarely resistant to other antibiotics. The predominance of phage group II was found in both hospitals (28.0%) and general practice (29.9%). Phage group III, usually associated with hospitals, occurred in small percentage (12.9% and 9.4% respectively) while to this group predominantly (76.6%) multiresistant methicillin resistant S. aureus (MRSA) isolated in hospitals belonged. These results suggest, that there is only slight difference in antibiotic resistance between hospital and community S. aureus strains. Antibiotic resistance pattern mainly results from frequency of appearance of MRSA, mostly occurring in hospitals.

Bacteriophage Typing↗