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PubMed1982

Monitoring adverse reactions to antibiotics in general practice.

In a general practice in Derbyshire 298 patients who had been given antibiotics were questioned about possible adverse reactions to the drug prescribed. Four methods of assessing adverse effects of drugs in the community were used, and a comparison was made of the replies elicited from patients by doctor and health visitor respectively. Significant differences were shown to occur in the way in which each investigator completed the questionnaires. If ancillary staff are to be employed in monitoring adverse effects of drugs in the community on a large scale then they will have to use a method less reliant on the differentiation of incidental symptoms from drug side effects than is required in the present survey.

Anti-Bacterial Agents↗
PubMed2000

Safety and efficacy of sustained-release alfuzosin on lower urinary tract symptoms suggestive of benign prostatic hyperplasia in 3,095 Spanish patients evaluated during general practice.

OBJECTIVES: This general practitioner-run study assess the security as well as the efficacy and impact on health-related quality of life of a sustained-release (SR) form of alfuzosin in Spanish patients suffering from lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). MATERIAL AND METHODS: 3,095 patients with symptomatic BPH were enrolled into a national, multicentric, open, phase IV observational study. The period of active treatment studied (5 mg, twice daily) was 60 days. Safety was assessed by monitoring blood pressure and spontaneous adverse events. Symptoms were assessed using a validated Spanish International Prostate Symptom Score (I-PSS). Impact of symptoms on health-related quality of life was assessed using the quality of life index (L). RESULTS: 101 adverse events were reported in 82 patients (2.6%). 28 adverse events (2.6%) were classified as severe. 49 patients (1.6%) dropped out of the study due to adverse events but only 17 of these patients (0.5%) showed adverse events related to vasodilation. Incidence of postural events (vertigo, postural hypotension/hypotension, headache and dizziness) was low (55 patients, 1.8%) and effects on sexual function were found not significant: no retrograde ejaculation was reported and only 1 patient (0.03%) showed impotence. Blood pressure or heart rate showed no clinically significant changes. All the I-PSS scores decreased significantly during the treatment with alfuzosin, improvement being excellent in 60% of the patients. Symptomatic improvement was associated with a significant improvement in health-related quality of life. CONCLUSIONS: This large study conducted during general practice on Spanish BPH patients confirms the efficacy on LUTS and good safety profile of SR alfuzosin, especially its low incidence of postural symptoms and no deleterious effect on sexual function.

Adrenergic alpha-Antagonists↗
PubMed1978

Diagnosis of gout in general practice.

In a general practice survey of gout, an analysis was made of the criteria relating to the diagnosis in 604 patients. Approximately 60% of diagnoses were made within 1 month of the patient presenting with symptoms; in the remainder, there was often a considerable time lag before diagnosis and half of these patients had been wrongly diagnosed initially. Of the total cases, approximately 8% were diagnosed in hospital and only about 20% of cases were referred for diagnosis or subsequent management advice. Most diagnoses were based on the presentation by the patient of a typical acute arthritis, and a raised serum urate level was used as a confirmatory factor. Few patients presented with tophi and response to colchicine was infrequently used in diagnosis, as were diagnostic X-rays or synovial fluid examination for crystals.

Family Practice↗
PubMed2005

Learning needs analysis--developing a new tool for general practice training.

BACKGROUND: General practice registrars are a diverse group of doctors, each with a unique set of learning needs. This diversity sets training providers the challenge of identifying the learning needs of individual registrars early and then tailoring their educational programs to meet those needs. OBJECTIVE: This article describes the development of a multicomponent learning needs analysis tool designed to better identify registrars' learning needs in both knowledge content and attitudinal areas. DISCUSSION: The accurate identification of registrars' individual and common learning needs allows the creation of more appropriate learning plans and the tailoring of shared educational activities to suit both individuals and the group.

Australia↗
PubMed1991

General practice in Italy.

General practitioners in Italy work as independent contractors in a national health service. There are, however, many differences between Italy and the United Kingdom regarding the status, contract and culture of primary health care. The similarities and differences offer valuable insights into the benefits and disadvantages of the position in the UK, and serve to highlight the significant gains made in the past 30 years. This account of Italian general practice is based on the author's personal experience gained during a one month sabbatical visit to Italy in 1990.

Family Practice↗
PubMed1990

Controlled comparison of the characteristics of long-term benzodiazepine users in general practice.

From three general practices, served by 11 principals, 205 long-term benzodiazepine users were identified and matched for age and sex with controls. Benzodiazepine users had significantly higher rates of previous physical illness, consultation and non-psychotropic drug consumption than controls. The characteristics of those receiving prescriptions for benzodiazepine hypnotics alone, anxiolytics alone and anxiolytics plus hypnotics were also investigated. Significant differences emerged between these three groups. Patients receiving hypnotics only were older, had a history of more physical illness and had received more non-psychotropic medication than patients receiving anxiolytics only. The anxiolytic plus hypnotic group had previously received more hypnotics and were currently receiving more medication than the group receiving anxiolytics alone. The results are discussed in relation to current concerns about benzodiazepine dependence and withdrawal.

Adult↗
PubMed1991

Long to short consultation ratio: a proxy measure of quality of care for general practice.

Eighty five general practitioners in the Lothian region recorded information on all surgery consultations on one day in every 15 for a year. On the basis of their mean consultation times with patients the working styles of the general practitioners were described as 'faster' (n = 24), 'intermediate' (n = 40) or 'slower' (n = 21). The 21,707 consultations which they carried out over this period were defined as 'short' (five minutes or less), 'medium' (six to nine minutes) or 'long' (10 minutes or more). Independent of doctor style, 'long' consultations as against 'short' consultations were associated with the doctor: (1) dealing with more of the psychosocial problems which had been recognized and were relevant to the patient's care; (2) dealing with more of the long term health problems which had been recognized as relevant; and (3) carrying out more health promotion in the consultation. Patients also reported greater satisfaction with longer consultations. The ratio of long:short consultations was found to be 0.28:1 for 'faster' doctors as against 2.3:1 for 'slower' doctors. When doctors in either group had more heavily booked surgeries or were running late, the long:short consultation ratio fell, in some cases by over 50%. This paper suggests that the ratio of long to short consultation length for a general practitioner might become the basis of a simply proxy measure of quality of care; and that its use might help monitor the effect of recent and proposed changes in the way in which general practice care is delivered.

Appointments and Schedules↗
PubMed1990

Acceptance of a psychiatric screening questionnaire by general practice attenders.

The general health questionnaire (GHQ) is a self-reporting psychiatric screening questionnaire which has been tested and validated in a number of languages and cultural settings. The translated and validated 30 item GHQ was given to a selected sample of women between 15 and 49 years attending a suburban general practice, as a part of a study on emotional disorder. The acceptance of the questionnaire was high with a compliance of 91.5% from those who were invited to participate. The majority of respondents showed much interest and willingness in filling in the questionnaire.

Adolescent↗
PubMed1989

Human immunodeficiency virus infection in a Dublin general practice.

A group general practice in Dublin's inner city has had extensive experience of intravenous drug users since the late 1970s. Since 1985 a total of 54 human immunodeficiency virus (HIV) seropositive patients have attended the practice, of whom 48 are intravenous drug users, four are the children of drug users and two have been infected through sexual contacts. Three patients have developed the acquired immune deficiency syndrome and at least eight have symptomatic HIV disease. Sixty per cent of Ireland's seropositive population have been infected through intravenous drug abuse but nationally only 16% of all intravenous drug users tested are seropositive; in the study practice, however, at least 35% (48/137) of known intravenous drug users are seropositive.

Acquired Immunodeficiency Syndrome↗
PubMed1979

An evaluation of the A4 folder system in general practice.

All 63 general practices known to have introduced the A4 folder system were asked to complete questionnaires comparing A4 records with the traditional medical records envelope system. Of the 77 per cent who replied, an overwhelming majority favoured the A4 system and felt that it helped them to obtain higher standards of care for patients.

Family Practice↗
PubMed1983

Consultation length and outcome in two group general practices.

Two group general practices were located which, while similar in a number of important respects, differed in the number of appointment consultations arranged per hour, and data was collected to see if corresponding differences in consultation outcome could be found. Information on all appointment consultations offered during a four-week period was analysed, and the number of patients returning for further attention in a subsequent four-week period was also determined. The practice offering longer consultations had a lower proportion of appointment consultations ending with a prescription, required a lower proportion of patients to return for a follow-up appointment, and had a lower proportion of patients themselves returning to seek a further appointment within four weeks of presenting with a new illness episode.

Appointments and Schedules↗
PubMed1980

Factors contributing to the length of general practice consultations.

Ten general practitioners in a study of general practice consultations were shown to differ significantly in the time they spent in their consultations. Patient demographic characteristics contributed little to differences in consultation time. Consultations in which (a) there was a diagnosis of psychological disorder, (b) the practitioner and the patients focused attention on psychosocial matters, and (c) psychotropic drugs were prescribed, were found to be associated with increased length of consultation time.

Family Practice↗
PubMed1994

Management of collapse in general practice.

In a general practice setting managing the emergency call for a collapsed patient begins with the doctor talking to the caller. This article reviews the steps taken and the equipment needed to ensure a successful outcome when managing a patient who has 'collapsed' outside a practice or hospital setting.

Emergencies↗
PubMed2000

Evaluation of a direct doctor-patient telephone advice line in general practice.

A general practitioner-staffed direct access telephone advice line was made available for 30 minutes every morning at an inner-London practice to advise patients with urgent problems. Users valued the service, but the impact on surgery consultations was too small for this to be advocated as an alternative to emergency consultations.

Family Practice↗
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↗
PubMed2004

[Insomnia and sleeping disorders in the elderly in general practice].

Sleeping disorders in general practice are common, but as the main reason for seeking help they only account for 1% of all consultations in all age groups. The aim of our study was to find out the overall frequency and consulting patterns for sleeping disorders in patients (over sixty years old) in general practices in eastern Austria. In this age group, sleeping disorders accounted for 7% of all reasons for seeking consultation. This percentage increased to 45% if the patients were asked if they suffered from insomnia. Half of the patients reported nycturia, but not every patient interpreted this occurrence as a real sleeping disorder. In accordance with the literature, we found a high prevalence of sleeping disorders in the unselected elderly patients visiting the surgery for highly different reasons.

Aged↗
PubMed1997

Academic general practice comes of age?

Academic general practice in Australia is 21 years old. In coming of age it has had to endure a very obstructed labour into Australian medical schools. Departments of General Practice have changed for the better and are being staffed by a new generation of academics, many of whom may lack historical perspective of the development of academic general practice. This article provides this historical perspective.

Australia↗