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PubMed1995

What do general practitioners and their patients want from general practice and are they receiving it? A framework.

This article outlines a framework for answering four questions of national concern in Australia: what do patients want from general practice? What do GPs want from general practice? What do patients get from general practice? What do GPs get from general practice? These questions are posed with respect to four unique attributes of general practice care: first contact care, longitudinality, coordination and comprehensiveness. The nature of the doctor-patient relationship is also examined because, like the other attributes, it has been reported in the literature to be important to patients and GPs. The framework provides a basis for the empirical study of GP and patient perceptions of general practice care.

Australia↗
PubMed1993

Implementation of the national cervical cancer screening in general practice and feasibility of a general practice-based call system: the GP's opinion.

Thus far, the response to the nationwide screening programme for cervical cancer in The Netherlands, which was started in 1989, has been disappointing. One way to improve response is to involve general practitioners in the call system. A postal survey was conducted to review the implementation of the current screening programme in general practice and to examine the willingness of general practitioners to participate in a general practice-based call system. The response rate to the survey was 90%. The general practitioners were dissatisfied with follow-up, cost and time spent and compliance of women. Of all respondents 60% had already set up a call system within the practice or were willing to do so; another 31% were willing to participate in a regionally organized practice-based call system. On the basis of the results of this study a centralized general practice-based call system is recommended. The next step is to study the applicability of this system in a pilot programme.

Adult↗
PubMed1995

Specialist and general practice views on routine follow-up of breast cancer patients in general practice.

The practice of routinely following-up breast cancer in hospital clinics is of widespread concern: studies have shown that it is not an effective way of detecting recurrent disease and it places great strain on cancer services which are already overstretched. A general practice centred system of routine follow-up may be a solution to this problem in those countries which have a strong primary care base. Such a system would have other benefits such as continuity of care for the patient. The objective of this study was to determine the views of general practitioners and specialists on follow-up of patients with breast cancer in remission, with special emphasis on their views on the transfer of routine follow-up from the hospital to general practice. A postal questionnaire survey of British breast cancer specialists (response rate 77.0%) and a personal interview survey of British general practitioners (response rate 81.8%) were conducted. The results show that British general practitioners are willing to take on greater responsibility for the routine follow-up care of their patients with breast cancer. However, there was frequently a mis-match between specialists' and general practitioners' views on this subject.

Aftercare↗
PubMed1990

Handling of confidentiality in general practice: a survey among general practitioners in The Netherlands.

This paper describes the results of a study of the handling of confidentiality by general practitioners. A sample of 272 general practitioners in the eastern part of the Netherlands was interviewed. The general practitioners were presented with 10 cases involving confidentiality and were asked what course of action they would pursue. Twenty-eight per cent of the general practitioners would never disclose information to others without the patient's consent, while 14% would disclose information to other physicians, members of non-medical professions and relatives. The largest proportion (38%) would disclose information only to other physicians. General practitioners were less likely to divulge information if they were: younger, female or practising in group practices. In particular, general practitioners who involved patients in decision making were less likely to disclose information to third parties. A plea is made for more education about confidentiality in the medical curriculum.

Adult↗
PubMed1995

Rotterdam general practitioners report (ROHAPRO): a computerised network of general practices in Rotterdam, The Netherlands. Rotterdam's HuisArtsen Project.

STUDY OBJECTIVE: Dutch public health services are charged with collective preventive care for the population--care that should, by law, be based on epidemiological data. General practices potentially offer important data for this purpose, particularly since more and more use a computer. This study aimed to assess whether it is possible to obtain useful epidemiological data from this source. DESIGN: In 1990, the Rotterdam Municipal Health Service, in collaboration with the Erasmus University Rotterdam, started a computerised sentinel practice network. The main features of this and a specific small investigation are described. SETTING: The following institutions cooperate in the network: Municipal Health Service Rotterdam Area; Departments of General Practice and of Medical Informatics, Erasmus University Rotterdam; Rotterdam District Association of General Practitioners. PATIENTS: Data are currently collected from 20 general practitioners and > 40,000 patients. In a specific project, the distribution of cardiovascular risk factors in different ethnic groups was compared. MAIN RESULTS: It was possible to build up a regional epidemiological registration system in this manner. In the cardiovascular project we found striking differences between ethnic groups. The risk profile for Turkish men, in particular, was less favourable. The health service also uses the system to improve cooperation between public health and primary health care (for example, in cervical screening, influenza vaccination). CONCLUSION: Computerised general practices offer great possibilities for research and for preventive activities in which public health care and general practitioners can cooperate.

Adult↗
PubMed1990

National standard setting for quality of care in general practice: attitudes of general practitioners and response to a set of standards.

The Nederlands Huisartsen Genootschap (NHG), the college of general practitioners in the Netherlands, has begun a national programme of standard setting for the quality of care in general practice. When the standards have been drawn up and assessed they are disseminated via the journal Huisarts en Wetenschap. In a survey, carried out among a randomized sample of 10% of all general practitioners, attitudes towards national standard setting in general and to the first set of standards (diabetes care) were studied. The response was 70% (453 doctors). A majority of the respondents said they were well informed about the national standard setting initiatives instigated by the NHG (71%) and about the content of the first standards (77%). The general practitioners had a positive attitude towards the setting of national standards for quality of care, and this was particularly true for doctors who were members of the NHG. Although a large majority of doctors said they agreed with most of the guidelines in the diabetes standards fewer respondents were actually working to the guidelines and some of the standards are certain to meet with a lot of resistance. A better knowledge of the standards and a more positive attitude to the process of national standard setting correlated with a more positive attitude to the guidelines formulated in the diabetes standards. The results could serve as a starting point for an exchange of views about standard setting in general practice in other countries.

Attitude of Health Personnel↗
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↗
PubMed1988

Psychiatric screening in general practice: comparison of the general health questionnaire and the hospital anxiety depression scale.

The prevalence of psychiatric disorder in 100 patients attending their general practitioner was found to be 33% based on the criteria of the DSM-3 diagnostic system. Using the DSM-3 diagnosis as a yardstick, the performance of the hospital anxiety depression scale was compared with that of the general health questionnaire. Relative operating coefficient analysis showed good discrimination between ;cases' and ;non-cases' for both questionnaires, and the optimum threshold score was found to be eight for the hospital anxiety depression scale and five for the general health questionnaire. Using these threshold scores the positive predictive value was 81% for the hospital anxiety depression scale and 77% for the general health questionnaire. The hospital anxiety depression scale appeared more sensitive than the general health questionnaire (90% versus 77%) and simpler to complete. In addition, it does not require a different threshold score for each population studied. The use of screening questionnaires in general practice is discussed.

Adult↗
PubMed1994

Near patient testing in general practice: attitudes of general practitioners and practice nurses, and quality assurance procedures carried out.

BACKGROUND: The evaluation of near patient testing in British general practice has largely been confined to studies examining individual tests or comparing equipment. AIM: This study set out to determine the attitudes of practice staff to near patient testing, and the extent to which staff undertook quality assessment. METHOD: Four types of near patient testing machines were introduced into 12 general practices in two regions of England, south west Thames and west Midlands. General practitioner and practice nurse attitudes to near patient testing were assessed by semi-structured interview before and six months after the introduction of the machines. The extent to which routine quality assurance procedures were carried out within the surgery and as part of local and national schemes was examined. RESULTS: Although 80% of general practitioners anticipated changing patient management with near patient testing, only two fifths reported having done so after six months. Nurses generally were enthusiastic at the outset, although one third were unhappy about incorporating near patient testing into their work schedules. Time pressure was the most important factor restricting uptake of near patient testing. Nurses performed quality control regularly but complete local external quality assurance procedures were established in only half the practices. All the practices participated in a national scheme for cholesterol assays. CONCLUSION: General practitioners in this study did not find near patient testing a very useful addition to their resources. Pressure on nurses' time was the most frequently reported limitation.

Attitude of Health Personnel↗
PubMed1991

Combined epidural and general anesthesia versus general anesthesia for abdominal aortic surgery.

The goal of this randomized study of high-risk surgical patients was to determine whether intraoperative thoracic epidural anesthesia in combination with light general anesthesia alters postoperative morbidity when compared to a standard technique of "balanced" general anesthesia. A total of 173 patients scheduled for abdominal aortic reconstruction were admitted to the study; 86 were to receive "balanced" general anesthesia (group 1) and 87 thoracic epidural anesthesia in combination with light general anesthesia (group 2). Preoperative evaluation included standard clinical tools, dipyridamole thallium gammatomography, and radionuclide angiography. In these patients, all of whom had peripheral artery disease, there were no significant differences in associated coronary artery disease, hypertension, and cardiovascular treatment. The distribution of left ventricular ejection fraction and the number of patients with thallium redistribution were not statistically different between the two groups. During the postoperative period, group 1 received analgesia of subcutaneous morphine (n = 35), epidural fentanyl (n = 30), or epidural bupivacaine (n = 21). In group 2, 6 patients with a nonfunctioning epidural catheter due to technical failure received a balanced general anesthesia and were eliminated from the study. During the postoperative period, group 2 received analgesia of subcutaneous morphine (n = 26), epidural fentanyl (n = 25), or epidural bupivacaine (n = 30). Cardiovascular morbidity did not differ between the two groups: 22 patients in group 1 and 19 patients in group 2 had a major postoperative cardiac event.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

Specialism and generalism in the future of general surgery.

The progressive specialism that has characterized the practice of medicine over the last 100 years has occurred almost entirely in a scientific context. Societal needs and social changes have had little influence. As we near the end of the 20th century the benefits of scientific specialism are being questioned. New historical studies of specialism have shown that factors other than new knowledge are the driving force for the creation of some subspecialties. The process by which a new subspecialty is established requires both a national institute and a certification examination. Certification is intended to identify those with specific knowledge and skill by inclusion, but is being perceived increasingly as a process that works by exclusion. General surgery, one of the few "generalist" disciplines, finds itself at a crossroads. Further subspecialization with certification will fragment and destroy the discipline. There are cogent arguments, based on economics and care-delivery issues, to preserve general surgery. Making this choice will commit general surgeons to accept the concept of scientific generalism and to the development of the specialty of general surgery in a social context.

Canada↗
PubMed1992

On the use of the generalized t and generalized rank-sum statistics in medical research.

We have used Monte Carlo methods to compare the type I error properties of the conditional and unconditional versions of the generalized t and the generalized rank-sum tests to those of the independent samples t and Wilcoxon rank-sum tests. Results showed inflated type I errors for the conditional generalized tests but not for the unconditional tests. We also compared the power of the unconditional generalized tests to that of the t and Wilcoxon tests under a variety of conditions. Results showed the generalized tests to be much more efficient than their traditional counterparts in some circumstances, but substantially less powerful in others. Based on these and other considerations, we conclude that the application of these newer statistics in medical research needs further consideration.

Data Interpretation, Statistical↗