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PubMed1977

Classifying disease in general practice.

I have developed a system of classifying diseases in general practice based on headings relevant to general practice which are built up in a hierarchy. I believe this is better than abbreviating the International Classification of Disease with the addition of individual symptoms.Ideally, a classification ought to include occupational diseases and psychosocial problems, and it must be accompanied by a terminology defining as precisely as possible the different categories based on criteria relevant to ordinary general practice. It should still follow the main divisions of the International Classification of Disease as far as possible.I believe that general practice will not progress any further unless it is prepared to loosen its traditional allegiance to hospitalorientated disease classifications, which are, for our purpose, inappropriately rigid.

Disease↗

PubMed1979

The manpower debate -- what is the current position in relation to general practice?

With the changing situation in medical manpower, it is important that a close watch be kept on the total number of medical practitioners in the community and their distribution between salaried and self-employed work, between hospital and community practice, between city and country practice, between general and specialist practice and between the general specialties and subspecialties. More accurate manpower data are now being sought by the Medical Boards and what must be emphasized is that the collection of these data has to be regular and ongoing, with surveys being conducted each year at the time of registration, and not just spasmodically as the need arises. The groups involved in planning for medical manpower must be able to work with accurate information. Australia is a long way from defining how many medical practitioners are needed in the community, and the RACGP is certainly a long way from defining the number of general practitioners who are needed. As a result, it is probably inappropriate at present to evaluate the current numbers of general practitioners against any stated level of adequacy.

Australia↗

PubMed1978

Mianserin in the treatment of depressive illness and anxiety states in general practice.

1. In an initial study in general practice, mianserin was shown to be of similar antidepressant efficacy to imipramine. 2. A subsequent placebo-controlled study confirmed that mianserin is an effective as imipramine, and also demonstrated that both mianserin and imipramine are superior to placebo in the treatment of depression in general practice. 3. In a third trial, mianserin was found to be as effective as diazepam in the treatment of anxiety states in general practice. 4. The overall incidence of side-effects in this series of studies, either with mianserin or with the comparison drugs, was very low.

Adolescent↗

PubMed1977

The basis of general practice, its content and relation to training.

The present status is the newly defined discipline of general practice is briefly outlined. The reasons for its worldwide upsurge in the past decade and the relative failure of South Africa to keep abreast are reviewed. A brief exposition is given of the knowledge and skills required for general practice, the consultation, the clinical process and the content of what in some countries is regarded as family medicine. The difference in ethos between 'doctor-orientated' and 'patient-orientated' medicine is discussed. The latter approach is essential to general practice, in which the attidudes of both doctor and patient and their interactions are known to have an effect on the clinical process. The non-directive educative approach is discussed in relation to undergraduate and postgraduate training, and the attempts to make postgraduate general practice examinations valid and reliable, so that they evaluate the actual day-to-day activities of the doctor, are alluded to. The content of general practice is as yet not clearly identified and the problems encountered in delineating these as well as suggested approaches are presented. It is concluded that in South Africa no serious attempts have been made by legislative bodies and most medical educational institutions to recognize general practice as a new displine in spite of pioneering work achieved by the Faculty of General Practice of the College of Medicine of South Africa.

Clinical Competence↗

PubMed1976

Aprospective study of urinary-tract infections in a Dutch general practice.

In a Dutch general practice the adult female population was screened for asymptomatic bacteriuria (A.B.) by repeated urine culture after vulval cleansing. The prevalence of signficant A.B. was 4.7% and increased with age. Women with significant A.B. were followed up for one year. All symptomatic urinary-tract infections were recorded during the same period (incidence 59 per 1000 population). Women with significant A.B. at screening were divided into three groups according to the pattern of the follow-up results: transitory A.B., symptomatic A.B., and persistent A.B. The last group differed from the penultimate group with regare to the site of their urinary-tract involvement, symptomatic cases having predominantly upper-urinary-tract involvement and persistent cases lower-urinary-tract infection. In the matched control group the acquisition-rate of both symptomatic and asymptomatic 0acteriuria was over 12%, a figure similar to the percentage of women present in the practice population during one year with transient, symptomatic, and persistent A.B. Screening for A.B. in the general non-pregnant female population is not advocated at present. Screening and treatment of existing A.B. should be carried out in pregnant women who run an increased risk.

Adolescent↗

PubMed1977

Unhappy bedfellows. Psychiatric consultation in general practice.

Interviews with 20 general practitioners within a five mile radius of a State Psychiatric Clinic in Melbourne, revealed many difficulties associated with the reported increase in social and emotional problems presented by their patients. Most general practices are structured to cope best with the medical aspects of patients' problems. Those problems that are essentially non-medical, create situations where the general practitioner makes decisions in areas not taught to medical students in the past. The directions in which he turns for assistance depend upon a variety of attitudinal factors and the availability of appropriate facilities. An uneasy relationship between many general practitioners, psychiatrists, and psychiatric agencies was noted. A sociological analysis of the results suggests that status and role inconsistencies could be a major factor in some of the problems. This paper aims to stimulate participants towards the resolution of the conflicts.

Communication↗

PubMed1992

An analysis of funding for general practice research in Australia.

OBJECTIVE: To describe the current status of funding for general practice research in Australia. DESIGN: A descriptive survey analysing funding arrangements of research projects included in a national research database, established by the Royal Australian College of General Practitioners. SETTING AND PARTICIPANTS: Research projects involving, or directly related to, general practice that had commenced in Australia since 1 January, 1989. Responses were specifically sought from all universities, the Family Medicine Programme and the Royal Australian College of General Practitioners. MAIN OUTCOME MEASURES: Extent and source(s) of funding received or requested, or both; relationship of funding received to the following: qualification and affiliations of the principal investigator; submission of the research project towards a higher degree; subject area(s) covered by the research; study design method used; and duration of project. RESULTS: A total of 237 projects from 130 principal investigators were included in the analysis. Of these, 149 (63%) had been submitted for funding and 98 (66%) had been successful. The amount of funding ranged between $300 and $855,600. The most common source of funding was the General Practice Evaluation Programme. Research contributing towards a higher degree was associated with successfully receiving funding. Other variables, including the study design and study area, were not significantly associated with an increased success of funding. CONCLUSIONS: The total amount of funds spent on general practice research is still small, relative to the size of the workforce. However, over half of general practice research undertaken in Australia is not submitted for funding. Of the research that is submitted, the success rate of receiving funds is high.

Australia↗

PubMed1992

Problem drug use in a central London general practice.

OBJECTIVE: To describe the profile of problem drug users presenting in general practice and to determine whether they can be cared for in general practice. DESIGN: Study of consultations by problem drug users. SETTING: Central London general practice. SUBJECTS: 150 problem drug users presenting over two years. MAIN OUTCOME MEASURES: Stopping drug use, alterations in lifestyle, obtaining paid work, and stopping drug related crime. RESULTS: Of the 150 patients, 111 were men and 39 women, and 106 were unemployed. 121 patients used heroin, 112 of whom injected. 145 patients accepted a methadone reduction programme and 81 completed it. A further 25 were stabilised on reducing doses of methadone, until places became available for them as inpatients at drug dependency units or rehabilitation projects. CONCLUSION: Withdrawal programmes for patients who misuse drugs can be successfully managed in general practice.

Family Practice↗

PubMed1979

[Inclusion of clinical-dermatological therapy into general practice? (author's transl)].

The ever increasing expenditures in health service urgently call for a critical revision of the therapy habitually practiced so far. This also includes the complete utilization of ambulatory therapeutic approaches. Moreover, after many years of clinical practice, the dermatologist in general practice should not forego the manifold therapeutic methods in which he had been trained and by the application of which he has gained particular experience. The dermatologist's small office consisting of a desk and couch must be a matter of the past once and for all. It is just the dermatologist who has the opportunity to try many forms of clinical treatment in general practice.

Family Practice↗

PubMed1979

Distance as an influence on demand in general practice.

A survey of general practice in the London borough of Lambeth was analysed to discover how the distance from a patient's home to a medical facility affects the utilisation of that facility. It was shown that distance has a negative effect on utilisation for all population groups except men aged 15 to 64. The effect was especially marked for women, for the elderly, and for Social Classes III, IV, and V, which are the groups with highest utilisation rates. Some diagnostic groups singled out for analysis showed the same effect. These results are related to other studies and to an economic theory seeking to explain patterns of demand.

Adolescent↗

PubMed1979

Ketoprofen (Orudis) twice daily dosage in arthritis and tissue injuries: a general practice study.

In a general practice study using ketoprofen (Orudis) in a twice-daily dosage regimen for the treatment of patients with articular and non-articular rheumatic conditions, data were collected on 2,644 patients, over one-third of whom had been previously treated with other anti-rheumatic preparations. More than 80% showed a clinical improvement and the overall incidence of side-effects was relatively low. Three patients suffered a haematemesis--the most serious side-effect encountered. It was concluded that 50 mg or 100 mg twice-daily therapy was equally as effective as the 50 mg thrice daily regimen previously recommended and that the tolerability of ketoprofen was not adversely affected by this concentration of the daily requirement.

Administration, Oral↗

PubMed1992

[Use of anxiolytic agents in general practice during a 3-year period. A retrospective study from a 2-man rural practice].

In a rural general practice with two doctors and 3.671 patients and employing a practice data system (APEX), a retrospective review was undertaken of the anxiolytic drugs (ATC gr NO5B) prescribed. A total of 376 persons received 3,556 prescriptions for a total of 121,111 DDD (Defined Daily Doses). Forty of these patients (approximately 10%) received half of the medicine involved and half of the patients received 5% of the medicine. 68% of the prescriptions were renewals without contact between doctor and patient. A total of 85 new users was observed and the number of new users/annum decreased significantly during the period. One hundred and fifty-two patients consumed < or = 50 DDD during the entire three-year period (short term users) while 168 consumed > 50 DDD during one or more years (long term users). The long term users received anxiolytic drugs more frequently on account of mental illness (46%) than did the short term users (12%). Long term users consulted the doctor twice as frequently and were admitted to psychiatric departments six times as frequently during the period. One fourth of the long term users received disability pensions and one fourth had now or had previous alcohol problems.

Anti-Anxiety Agents↗

PubMed1992

Verbal interactions in general practice. Information, support and doctor satisfaction.

OBJECTIVE: The general practice encounter can be seen as an exchange of information aimed at relief of the patient's presenting symptoms, and it is acknowledged that this goal can most effectively be achieved within the context of the professional's emotional support of the patient. We sought to describe the processes of information exchange and emotional support in detail, and to explore any differences in the speech pattern which were related to the doctors' lesser satisfaction with some consultations. DESIGN: Transcripts of general practice consultations (n = 143) from five medical practitioners were coded and analysed. MAIN OUTCOME MEASURES: The verbal interactions of the consultation were described in categories: for doctors, emotional support, informational support, and diagnostic activity; and for patients, relationship oriented and task oriented. Doctors also rated their satisfaction with each consultation. RESULTS: About two-thirds of the speech by both parties was found to be devoted to information exchange in the forms of diagnosis and medical advice, and the rest to the relationship between the participants. Doctors' satisfaction ratings (extremely satisfactory or otherwise) could be predicted from speech and activity variables by means of logistic regression. CONCLUSIONS: This study describes the verbal interaction which is the vehicle for medical helping in general practice, and it forms a foundation for needed research on how certain features of the verbal interaction are related to quality of care.

Adult↗

PubMed1976

Psychiatric morbidity in general practice and the community.

The "General Health Questionnaire" was used to assess the psychiatric morbidity among 365 consecutive attenders at a general practice and to compare this with a systematic random sample of 213 patients drawn from the lists of the same practice. Those attending a general practitioner are shown to be more psychiatrically disturbed than a random sample of the practice population, and this difference remains when those attending for psychological symptoms are discounted. Various social and demographic characteristics which distinguish between those who do and those who do not attend a doctor with a given set of psychological symptoms are described.

Adult↗

PubMed1978

An evaluation of a course for undergraduate teaching of general practice.

This paper presents an evaluation of the undergraudate fifth year course of teaching in general practice in the Queen's University, Belfast. Two Modified Essay Question papers were randomly selected from those used for some years past in the Department of General Practice, as learning aids and class tests. These were administered to twelve randomly selected groups of students before and after completion of a five week course of teaching. Results show that the composite mean MEQ scores doubled between pre- and post-course tests. The correlation coefficients tabulated do not indicate that the marked improvement in mean scores before and after the course in general practice was influenced to any extent by knowledge acquired in other disciplines. The overall findings clearly establish the value of small group clinical teaching of general practice based on a problem orientated approach to learning. They suggest that the intellectual skills and attitudes required in the 'holistic' approach to problem solving in general practice may differ in some ways from the skills required in specialized areas of medicine. The evaltion justifies the time spent on clarifying the undergraudate educational objectives.

Education, Medical, Undergraduate↗

PubMed1992

General practice partnerships: till death us do part?

OBJECTIVES: To investigate applications for general practice partnership vacancies by established general practitioner principals, the reasons for changing partnerships, and the disincentives to these moves. DESIGN: Confidential postal questionnaire. SUBJECTS: Applicants to 367 general practices in the United Kingdom advertising for a new full time partner. MAIN OUTCOME MEASURES: The proportion of job applications containing at least one application from established principals, proportion of principals appointed as new partners, incentives and disincentives to changing partnership. RESULTS: Of 325 replies (89% response rate) received, 292 were suitable for further analysis. 210/241 (87%) of all applications contained some applications from at least one established principal. 12% of all applications were made by principals. 41/296 (14%) of the newly appointed partners had previously been an established principal. The main reasons for leaving the previous partnership were a desire to move locality or not getting on with previous partners. The disincentives to changing partnerships were largely financial, including the cost of the move and loss of income. CONCLUSIONS: It is possible for established principals in general practice to overcome the disincentives and to change partnerships. There did not seem to be any overall prejudice against appointing principals, in contrast to previously published views.

Career Mobility↗

PubMed1992

Use of general practice by intravenous heroin users on a methadone programme.

Users of intravenous heroin represent a major challenge for general practice. A study was undertaken in a general practice in central London in 1990 to investigate the use of general practice made by intravenous heroin users who were on a methadone programme. Using information recorded in the patients' notes, 29 intravenous heroin users on a methadone programme were identified; 58 non-drug users (two controls per case) were matched for age, sex and general practitioner. A study of the number of routine consultations, missed appointments, emergency appointments and prescribed items showed that during the study period, those on a methadone programme made a larger number of routine consultations than the control subjects (median number of consultations 14 versus 0). When consultations at which only a prescription was issued were excluded this difference disappeared. Appointments were missed by 14 drug abusers (48%) but by none of the control group (P < 0.001). Emergency appointments were made by seven drug abusers (24%) compared with only two controls (3%) (P < 0.01). Even after prescriptions for methadone hydrochloride had been excluded from the analysis, patients on the methadone programme were prescribed significantly more items than patients in the control group (P < 0.001). This research has shown that intravenous heroin users on a methadone programme used general practice to a greater extent than non-drug users, according to the criteria used in the study. The implications that this may have in discouraging budget holding practices from running such schemes are discussed.

Adult↗

PubMed1976

Non-attenders in general practice.

Non-attenders for five years or longer (77 men and 27 women; i.e. 1.9 per cent of the practice) in a general practice of 5,750 patients were identified and paired with controls in the same practice. A survey by questionnaire was carried out.The conclusions were:(1) A higher proportion of non-attenders are self-employed,(2) A lower proportion of them had retired than their attending counterparts,(3) They are spread over the whole age-range, but with a higher concentration in the ages 35 and over,(4) They are evenly spread over the social classes,(5) They seldom seek other sources of medical advice or treatment,(6) They are significantly slimmer than their fellows,(7) Their non-attendance does not, on the whole, cloak serious but remediable illness.

Adolescent↗