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Setting priorities and identifying barriers for general practice research in Europe. Results from an EGPRW meeting.

BACKGROUND: In spring 2002, WONCA Europe, the European Society of General Practice/Family Medicine and its Network organizations reached consensus on a 'new' European definition of general practice. Subsequently, the European General Practice Research Workshop (EGPRW) started working on a European General Practice Research Agenda. This topic was addressed during the 2002 EGPRW autumn meeting. OBJECTIVE: Our aim was to explore the views of European general practice researchers on needs and priorities as well as barriers for general practice research in Europe. METHODS: In seven discussion groups, 43 general practice researchers from 18 European countries had to answer the following questions. (i) What major topics should be included in a research agenda for general practice in your country? (ii) What are the barriers to adequate implementation of general practice research in your country? Group answers were listed and subsequently categorized by two authors. RESULTS: Research on 'clinical issues' (common diseases, chronic diseases, etc.), including diagnostic strategies, was considered to be the core content of general practice research, with primary care-based morbidity registration essential for surveillance of disease, clinical research and teaching in general practice. There was also consensus on the need for research on education and teaching. 'Insufficient funding opportunities' was perceived to be the major barrier to the development of general practice research. CONCLUSIONS: These findings could be used as a basis for national checklists of 'content of' and 'conditions for' general practice research. European general practice research training programmes should be developed further.

Communication Barriers↗

An extended course in general practice.

An extended course in general practice sponsored by regional advisers and university departments of general practice in Scotland, consisting of six sessions lasting two to four days interspersed with group discussion meetings and spread over a period of 18 months, is described and evaluated. Participants developed skills in teaching, confidence in group learning and insight into their abilities as teachers and organizers of training in general practice.

Education, Medical, Continuing↗

Medical general practice: influencing clients' levels of satisfaction.

A general practice consultation involves a variety of doctor-client interactions. Commonly, a diverse range of clients attend a general practice. Further, general practices vary in their design and in service provision. There are significant risks that clients' experiences may not match prior expectations, resulting in lower levels of satisfaction with the consultation. This study describes the pilot testing of the widely used Model of Service Quality adapted to a general practice context. The results suggest that the adapted model may be used to help improve practice design and, consequently, client satisfaction with the service provided.

Adult↗

Distance education. Part 6. Evaluation of a core subject within the Graduate Diploma/Masters in Family Medicine. Principles of general practice.

AIM: To evaluate 'Principles of General Practice' (formerly known as the Academic Basis of General Practice), a core unit of the Graduate Diploma/Masters in Family Medicine. METHOD: Content analysis of feedback sheets and transcripts from teleconferences were analysed to facilitate the process evaluation of this core unit. Content analysis of qualitative responses to the question: 'What did you learn?' at the end of the course formed the impact evaluation. RESULTS: GPs who participated in the evaluation of the Principles of General Practice highlighted four learning outcomes in response to the question: 'What did you learn?' Categories included discipline specific and patient specific. Personal and professional outcomes were further divided into the following subcategories: affirmation of current practice; confidence in dealing with uncertainty; engaging in reflective practice; overcoming professional isolation; and providing opportunities for career change. CONCLUSIONS: The most cited reasons for participating in this course were the professional and personal. Students found that the course clarified their roles, raised self-esteem and confidence, and provided them with a sense of pride in their profession. The reflective learning style resulted in students gaining insight into themselves and their therapeutic roles, with reported changes in clinical practice, including more confidence in dealing with uncertainty. In addition to meeting course objectives there were a number of unanticipated outcomes identified. The most surprising was the recognition that general practice was a medical specialty, supported by a body of literature. For some, this assisted them to overcome feelings of professional isolation and alienation. A number of students saw this course as a stimulus to blending their clinical work with a teaching role to enhance professional growth and satisfaction.

Clinical Competence↗

Evaluation of behavior therapy intervention in general practice.

Thirty general practitioner consultations with patients with psychological problems referred to a clinical psychologist for behaviour therapy, were examined. Treatment was carried out wholly within the practice. Consultations for advice and psychotropic drug prescriptions were compared during one year, both before and after treatment, and were found to be reduced by over 50 per cent following treatment. Contact with clinical psychology services, therefore, considerably reduced the demand made by these patients for general practitioner time.

Adult↗

The use and perceived value of diabetes clinical management guidelines in general practice.

OBJECTIVE: To assess attitudes to and use of NSW Health Department (NSWHD) guidelines for the clinical management of diabetes mellitus by divisions of general practice, general practitioners, patients and allied health professionals. METHOD: A mail cross sectional survey of divisions of general practice and a series of focus groups of GPs, patients and allied health professionals, on extent of use and perceived usefulness of the NSWHD guidelines. RESULTS: Forty divisions had or recently concluded a diabetes shared care project. Thirteen out of the 31 diabetes projects with guidelines reported using the NSWHD guidelines. Nineteen divisions were aware of the NSWHD guidelines. While the general response to the guidelines in both the survey and the focus groups was positive, there were suggestions for modifications. Many respondents were not aware of the guidelines. CONCLUSION: Optimal use of the guidelines in general practice requires improved dissemination and an implementation strategy based not only on GP education but also systems to reduce barriers to implementation and to support better quality of GP care.

Attitude of Health Personnel↗