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At least 343 records · Page 19Linked to original sources
PubMed2000

Where's the common ground? A survey of hospitals, community health centres and divisions of general practice in Australia.

BACKGROUND: Divisions of general practice are key structures for integration between general practice and other health services in Australia. AIM: To compare the views of divisions of general practice toward integration of care with those of hospitals and community health services. METHOD: Representative national samples of public hospitals and community health centres (CHCs) and a census of divisions of general practice (DGP) were surveyed on their current collaborations and links as well as barriers to and factors that enhance integration between general practitioners and other health services. RESULTS: There is wide agreement on the need for greater integration. Personal links (via letter, phone and face to face) were thought to be useful. However, general practice liaison officers were seen as especially useful. All organizations rated different accountabilities and responsibilities as a highly significant barrier. Resources, structures for collaboration and high level organisational support were rated as being more useful in enabling greater integration. CONCLUSION: Formalizing collaboration will require changes to funding and accountability. However there is also a need for cultural change to support greater integration of patient care between general practice and both hospitals and community health services.

Australia↗
PubMed1991

Disciplines within general practice.

The disciplines within general practice derive partly from its community setting, and partly from the nature of professional expertise. The maladies range from a high prevalence of low risk, self-limited illness to a low prevalence of high risk, persistent disease. Each set calls on different knowledge and skills. The setting offers the substrate for studying social and behavioural sciences and community health development in action. Choosing a few particular fields, and developing those with rigour, could strengthen general practice as a discipline with special insights and skills to offer all branches of clinical practice. Four fields of activity have been identified. In each, general practice has a clear responsibility and opportunity. I have suggested some knowledge and skill areas for their success--clinical 'working' knowledge, decision making and judgment, predictive knowledge, planning knowledge, calibration of investigators, intuitive knowledge, local knowledge, leadership skills and people management, measurement of burden of illness, calculation of cost-benefit trade-offs, building of local databases, re-learning fine discrimination in clinical perception, and understanding of community development. These subjects have not been part of formal medical education, or of much academic study in family practice. Despite their being central to the success of daily practice, the curriculum is silent about the study of these areas of practical knowledge, reasoning, judgment and skill. Worse, we do not have a common language to express clearly what we are talking about. Experience and skill lie within the practitioner, and are used in practical, concrete situations.(ABSTRACT TRUNCATED AT 250 WORDS)

Family Practice↗
PubMed1997

Monitoring the performance of general practices.

Performance indicators for general practice which reduce complex processes to simple counts can have little validity. Additionally, performance indicators are often statistically unreliable in small populations like general practices. Instead, it is possible to combine these measures of performance by using multiple regression to predict the outcome from a set of processes. This allows one to adjust the outcome for differences in the practice populations. It also improves the statistical reliability, because data from all practices are used to predict the outcome. This approach has statistical problems, because it is an ecological analysis, and does not pick out the poor performers ('bad apples'). The regression approach is similar to the concepts of continuous quality improvement (CQI). It is arguable that using CQI to improve quality is more likely to lead to cooperation from general practices than trying to pick out the poor performers.

Cooperative Behavior↗
PubMed2006

GP wellbeing and general practice issues.

INTRODUCTION: Studies of general practitioner wellbeing have demonstrated remarkably consistent findings. However, the implications for day-to-day general practice have been unclear. This study was based on a survey comprising items extracted from transcripts of interviews with GPs and designed to link general practice issues with self reported wellbeing. METHODS PARTICIPANTS: 480 GP Australian Family Physician (AFP) subscribers (2.18% response rate); aged 26-81 years (mean 45.5 years); 273 (56.9%) men and 199 (43.1%) women. MEASURE: A survey insert in AFP September 2003 with questions about wellbeing, demographic details and 27 items about general practice issues. RESULTS: Almost 15% reported poor/very poor wellbeing, 47% reported good wellbeing and 38% reported very good/excellent wellbeing. Poor wellbeing was associated with being single, divorced or widowed, and reports of being alone in an adversarial context and more negative reactions to patients. Excellent or very good wellbeing was associated with being coupled and reports of general practice as a vocation. DISCUSSION: Targeted wellbeing strategies advocating social support may ameliorate the stress of general practice, especially for those GPs who are single.

Adult↗
PubMed1996

Content of a trainer's report for summative assessment in general practice: views of trainers.

BACKGROUND: Summative assessment of doctors completing general practice vocational training will become compulsory for those completing training after 1 September 1996. One component of the assessment will be a trainer's report. AIM: A study set out to consider the content of the trainer's report. It aimed to determine which elements of general practice general practitioner trainers believe are the most important for independent general practice; to seek the views of trainers as to the most appropriate methods for assessing these elements in summative assessment of general practitioner registrars; and to determine how frequently trainers have been sufficiently concerned about the performance of registrars to consider not signing the form denoting satisfactory completion of the training year. METHOD: A questionnaire was sent to 1296 general practitioner trainers in the United Kingdom. The main outcome measures used were: the percentage of respondents indicating that an element was very important/crucial for independent general practice; the percentage of respondents indicating a favoured method of assessment that did not include a trainer's report at all; and the proportion of trainers who had ever considered not signing the form denoting satisfactory completion of the training year. RESULTS: The response rate was 78%. Of 75 elements examined, 31 were considered important for independent general practice by 70% or more of respondents. For 29 of these 31 elements, fewer than 30% of respondents would choose a method of assessment that did not include a trainer's report at all. Twenty-six per cent of respondents had considered not signing the form denoting satisfactory completion of the training year, which represents a trainer considering not signing this form once every 29 years. CONCLUSION: These results provide a basis for the content of a structured trainer's report for summative assessment in general practice; such a report is likely to contain about 30 items. Data from the Joint Committee on Postgraduate Training for General Practice and the present study suggest that, for every form not signed, trainers considered not signing the forms of another 13 general practitioner registrars. This highlights the need for a report that will help trainers to make the difficult decision as to whether or not a registrar is ready for independent practice.

Education, Medical, Graduate↗
PubMed1994

Evaluation of a rule base for decision making in general practice.

BACKGROUND: Decision making in general practice relies heavily on judgmental expertise. It should be possible to codify this expertise into rules and principles. AIM: A study was undertaken to evaluate the effectiveness, of rules from a rule base designed to improve students' and trainees' management decisions relating to patients seen in general practice. METHOD: The rule base was developed after studying decisions about and management of thousands of patients seen in one general practice over an eight year period. Vignettes were presented to 93 fourth year medical students and 179 general practitioner trainees. They recorded their perception and management of each case before and after being presented with a selection of relevant rules. Participants also commented on their level of agreement with each of the rules provided with the vignettes. A panel of five independent assessors then rated as good, acceptable or poor, the participants' perception and management of each case before and after seeing the rules. RESULTS: Exposure to a few selected rules of thumb improved the problem perception and management decisions of both undergraduates and trainees. The degree of improvement was not related to previous experience or to the stated level of agreement with the proposed rules. The assessors identified difficulties students and trainees experienced in changing their perceptions and management decisions when the rules suggested options they had not considered. CONCLUSION: The rules developed to improve decision making skills in general practice are effective when used with vignettes. The next phase is to transform the rule base into an expert system to train students and doctors to acquire decision making skills. It could also be used to provide decision support when confronted with difficult management decisions in general practice.

Clinical Competence↗
PubMedDate not supplied

Teenagers at risk of unintended pregnancy: identification of practical risk markers for use in general practice from a retrospective analysis of case records in the United Kingdom.

The United Kingdom has one of the highest teenage pregnancy rates in Western Europe with a high proportion of unintended pregnancies resulting in termination. General practice is one source of contraceptive and sexual advice for teenagers but it is difficult to target young women most at risk. This study was performed to determine whether it was possible to identify any markers that could alert general practitioners to the need to give appropriate opportunistic preventive advice. This was a retrospective case-control study in which the general practice medical records of young women with a recorded history of termination of pregnancy resulting from conception between the ages of 13-19 years inclusive were examined for details of consultations and contraceptive provision prior to conception. Where appropriate, comparison was made with an age and practice-matched control group. A total of 53 cases were identified and compared with 159 controls. In the 12 months prior to conception approximately half of the cases had discussed contraception and two-fifths had been prescribed oral contraception. A significantly higher proportion of cases than controls had consulted for emergency contraception and also for urinary tract symptoms. Weaker associations were also found with younger age of starting contraception, and also recorded side-effects or dissatisfaction with contraception. Lapsed contraception and previous pregnancy were noted as other potential markers of risk. The findings from this study may assist primary care professionals in focussing opportunistic sexual health interventions at some teenagers who are at higher risk of unintended pregnancy.

Abortion, Induced↗
PubMed2003

The detection of mild cognitive impairment in the general practice setting.

Results from a general practice study of cognitive impairment are used to construct guidelines for the detection of mild cognitive impairment (MCI) in general practice. The role of the general practitioner in the diagnosis of MCI is discussed and the potential feasibility of general practice screening is evaluated with data from a two-year prospective study conducted in the Montpellier region of France. Neuropsychological tests with the highest predictive value for dementia conversion and suitable for use in general practice, were determined by logistic regression modelling. An examination comprising three tests (delayed auditory verbal recall, verbal fluency and visuospatial construction), were found to give a specificity of 99% and sensitivity of 73%. Reports from other research centres suggest that MCI detection should not be limited to cognitive performance alone. It is suggested that proxy observations of behavioural change and information relating to loss of ability to perform activities of daily living should also be used to improve sensitivity and also to provide information needed in patient management. It may be potentially feasible for the family practitioner to verify cognitive complaints and to screen for MCI with a high degree of accuracy using a brief test battery derived from empirical observations in population studies.

Activities of Daily Living↗
PubMed1998

Screening in general practice and primary care.

General practice and its associated primary care services are the final common pathway for the delivery of most screening programmes. The absence of nationally agreed priorities, guidelines and identifiable resources has meant that screening in primary care remains somewhat arbitrary, practice varies widely and programmes remain largely unevaluated. Discussion of screening has focused largely on test characteristics and performance with less attention being given to issues of policy formation, priority setting, implementation and quality assurance. Without these elements, quality and test performance deteriorate, recruitment and follow-up are incomplete and a poorly discriminating test of doubtful utility is applied inequitably and inefficiently. For general practice there are two major concerns. The first is to improve delivery of programmes of proven efficacy, such as breast or cervical screening, that already have a national framework. The second is to develop and provide a national structure for preventive programmes for cardiovascular and smoking-related disease. For cardiovascular disease, the issue is no longer whether to screen and advise whole populations for multiple risk factors, but how best to implement this programme. In this chapter, the case for screening for cardiovascular disease is reviewed and potential strategies for improving delivery of screening in general practice and primary care discussed.

Cardiovascular Diseases↗
PubMed2001

Randomised trials within the general practice evaluation program. Why so few?

BACKGROUND: The General Practice Evaluation Program (GPEP) provided competitive funding for general practice research from 1990-1999. METHODS: Projects funded by GPEP between November 1990 and December 1999 were audited to determine the extent of randomised trials and other interventional studies. RESULTS: Thirty-three (13%) of the 248 projects were interventional studies; of these 21 (8% of all projects) were randomised trials. CONCLUSIONS: While GPEP has made a significant contribution toward Australian general practice research, few randomised trials and other interventional studies have been funded. Reasons include the specific evaluative focus and restrictions on project duration and funding. Randomised trials should be supported within future general practice research funding.

Australia↗
PubMed1995

General practitioner registrars' views about a career in general practice.

BACKGROUND: Current low morale in general practice and the fall in the number of general practitioner registrars (trainees) has led to concern about the decline in popularity of general practice as a career. AIM: A study was performed to evaluate the career intentions of general practitioner registrars and the factors underlying their decisions. METHOD: An anonymous postal questionnaire seeking both quantitative and qualitative data was sent to 138 registrars during June 1993. All were registrars at practices in the south west region of England. Outcome measures used were the popularity of different types of general practice work and identification of variables and emergent themes considered important in career choice. RESULTS: A total of 101 registrars returned questionnaires (73%). Of the respondents, 96% expressed an interest in general practice as a career. However, registrars expressed considerable uncertainty about the future of general practice and therefore their career. Continuity of care and a holistic approach were considered valued aspects of work in general practice. Increased workload, increased out-of-hours work and erosion of professional autonomy emerged as negative aspects of a career in general practice. Of the respondents, 91% considered time for leisure activities an important factor when considering future career, 72% would have been glad to do away with 24-hour cover and 99% agreed that general practitioners increasingly fear litigation. CONCLUSION: Although registrars were interested in general practice as a career they had many concerns and expressed uncertainties. The future popularity of general practice is likely to depend on addressing these concerns and on the clarification of the future direction of the profession.

Adult↗
PubMed1995

Management of angina pectoris in general practice: a questionnaire survey of general practitioners.

BACKGROUND: Little is known about the current management of angina pectoris in general practice. AIM: This survey set out to assess general practitioners' perceptions of current investigation and treatment for angina pectoris. METHOD: A postal questionnaire was sent to all 217 general practitioners listed with the Hampshire Family Health Services Authority who have access to a regional cardiac centre in Southampton. RESULTS: The response rate was 79% (171 of 217). The majority (80%) of general practitioners reported referring 10% or fewer of their patients with angina to a cardiologist at the regional centre, and 72% reported referring a quarter or fewer of their patients to a hospital physician. Most (77%) considered an exercise test useful for diagnosis of angina, but almost half (47%) were uncertain about its prognostic value. Most respondents (79%) were not confident of interpreting the results of an exercise test. The majority (79%) believed that there was scientific evidence to show that coronary angioplasty relieves symptoms and 21% were of the opinion that it prolongs survival. Ninety six per cent believed coronary artery bypass grafting relieves symptoms and 62% that it prolongs survival. CONCLUSION: General practitioners do not appear to refer the majority of patients with angina pectoris for hospital investigation, and express divergent and contradictory opinions about exercise testing and the scientific evidence for the benefits of coronary angioplasty and coronary artery bypass surgery. Easier access to cardiological investigation and population based data about the value of exercise testing and survival benefits from coronary intervention are required to optimize selection of patients in the community who are most likely to benefit from coronary revascularization.

Angina Pectoris↗
PubMed2002

An evaluation of general practice websites in the UK.

BACKGROUND: General practice websites are an emerging phenomenon, but there have been few critical evaluations of their content. Previously developed rating instruments to assess medical websites have been criticized for failing to report their reliability and validity. OBJECTIVES: The purpose of this study was to develop a rating instrument for assessing UK general practice websites, and then to evaluate them critically. METHODS: The STaRNet Website Assessment Tool (SWAT) was developed listing criteria that general practice websites may meet, which was then used to evaluate a random sample of websites drawn from an electronic database. A second assessor rated a subsample of the sites to assess the tool's inter-rater reliability. The setting was an information technology group of a general practice research network using a random sample of 108 websites identified from the database. The main outcome measures were identification of rating criteria and frequency counts from the website rating instrument. RESULTS: Ninety (93.3%) sites were accessible, of which 84 were UK general practice websites. Criteria most frequently met were those describing the scope of the website and their functionality. Apart from e-mail to practices, criteria related to electronic communication were rarely met. Criteria relating to the quality of information were least often met. Inter-rater reliability kappa values for the items in the tool ranged from -0.06 to 1.0 (mean 0.59). Values were >0.6 for 15 out of 25 criteria assessed in 40 sites which were rated by two assessors. CONCLUSIONS: General practice websites offer a wide range of information. They are technically satisfactory, but do not exploit fully the potential for electronic doctor-patient communication. The quality of information they provide is poor. The instrument may be developed as a template for general practices producing or revising their own websites.

Family Practice↗
PubMed1994

Long term acid suppressing treatment in general practice.

OBJECTIVE: To determine the current practice in selected general practices for prescribing long term (> 6 months) treatment to suppress gastric acid secretion. SETTING: Seven general practices in the Harrow area that always or usually refer to Northwick Park Hospital. SUBJECTS: 60,148 patients on lists of the general practices. DESIGN: Identification of patients receiving long term treatment through repeat prescribing data, followed by a manual and computer survey of patients' notes for indications and investigations. Patient compliance and views on treatment were sought by a postal questionnaire. MAIN OUTCOME MEASURES: Indications for treatment, treatment given, investigations undertaken before and during treatment. RESULTS: 492 patients (0.82% of the population) were taking long term acid suppressing treatment. The most common diagnosis was duodenal ulcer disease (183 (37%) of all patients); oesophageal disease (118 (24%)) was also common. 93 patients (19%) were treated for abdominal pain where no diagnosis had been reached or who had only a diagnosis of gastritis on endoscopy. Ranitidine was prescribed in 394 (80%) patients. 298 (74%) patients found treatment helpful, but 108 (27%) had a poor understanding of their diagnosis. 317 patients (78%) took their drug as prescribed. 37 patients were also taking prescribed non-steroidal anti-inflammatory drugs and an additional 43 patients took regular aspirin or ibuprofen without prescription. CONCLUSIONS: Long term acid suppressing treatment is common, and a substantial number of patients are taking these drugs long term without a diagnosis having been reached. It is hoped that protocols for investigation and treatment will improve these figures. Patients need to be better informed about their disease and the possible adverse effects of taking non-steroidal anti-inflammatory drugs in acid related upper gastrointestinal disease.

Abdominal Pain↗
PubMed2006

General practice: professional preparation for a pandemic.

General practice will play a key role in both prevention and management of an influenza pandemic. Australian pandemic plans acknowledge a role for general practice, but there are few published data addressing the issues that general practitioners and their practices will face in dealing with such a crisis. The outcome will revolve around preparation in three key areas: Definition of the role of general practice within a broad primary care pandemic response, and adequate preparation within general practices so they can play that role well. Planning exercises and forums must include GPs, and rehearsals must include practical experience for general practices and their staff. Local Divisions of General Practice and GP practices can advocate for this, can define their role, and can prepare by using pandemic preparedness checklists; Definition and enactment of communication strategies to facilitate transfer of useful clinical and administrative data from practices and rapid dissemination of information into the community via general practice; Resource provision, which should be centrally funded but locally distributed, with personal protective equipment, vaccines and antivirals readily available for distribution. Resources must include support for human resource management to ensure appropriate health care professionals reach areas of workforce demand. Administrative, clinical and financial resources must be available to train GPs and practices in pandemic awareness and response.

Attitude of Health Personnel↗
PubMed2000

One-year follow-up of 2829 patients with moderate to severe lower urinary tract symptoms treated with alfuzosin in general practice according to IPSS and a health-related quality-of-life questionnaire. BPM Group in General Practice.

OBJECTIVES: To determine the effectiveness of alfuzosin on symptom reduction, patients' perceived health-related quality of life (HRQL) improvement, adverse outcomes, treatment failure, and progression to acute urinary retention and prostate surgery in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH) in a 1-year prospective, open-labeled study. METHODS: A total of 2829 patients (mean age 65.9 years) were included in the study and received either alfuzosin 2.5 mg three times daily or alfuzosin slow release 5 mg twice daily. The evaluation was based on the International Prostate Symptom Score (IPSS), the eighth IPSS question, and a nine-item BPH HRQL questionnaire (BPHQL9) exploring well-being, the patient's perceived sexual life, and BPH-specific interferences with activities. RESULTS: A total of 2442 patients (86. 3%) completed the study; the main reasons for noncompletion were adverse events (n = 141, 5.0%), lack of efficacy (n = 136, 4.8%), and death (n = 48, 1.7%); 121 patients (4.3%) underwent prostate surgery, and 33 patients (1.2%) experienced acute urinary retention. No correlation was found between noncompletion and prostate volume or baseline severity. The distribution of patients (in percentages) according to the IPSS, IPSS question 8, and BPHQL9 classes of severity (mild/moderate/severe) at baseline was 1.9/49.0/49.1, 0. 7/65.5/33.8, and 7.7/50.4/41.9, respectively, and at 1 year was 47. 4/50.3/2.4, 34.1/64.9/1.0, and 39.0/50.9/10.1, respectively. The IPSS (19.5 +/- 0.1) was reduced by 49.6% (9.9 +/- 0.1) at 6 months and by 53.8% (11.1 +/- 0.1) at 12 months. Symptom reduction strongly correlated with the initial symptom severity (P <0.0001). The BPHQL9 score (34.6 +/- 0.3) gradually improved up to 12 months (52 +/- 0.4; +93.3%), and this improvement involved all three dimensions. Vertigo (n = 53, 1.9%), hypotension (n = 47, 1.6%), and dizziness (n = 16, 0. 6%) were the most frequent adverse events. CONCLUSIONS: This study confirms the effectiveness of alfuzosin and the need to include HRQL measurement in the decision-making process when assessing patients with lower urinary tract symptoms.

Adrenergic alpha-Antagonists↗