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PubMed1991

Violence in general practice: a survey of general practitioners' views.

OBJECTIVE: To survey the extent of abuse and violence directed towards general practitioners during the course of their professional duties and to categorize the characteristics of such aggression. DESIGN: Retrospective survey of the views of a large sample of general practitioners by using a piloted postal questionnaire. SETTING: All medical practices in the west midlands. SUBJECTS: A total of 1093 general practitioners (40.6% of the total sample) who responded to the questionnaire. MAIN OUTCOME MEASURE: Number of incidents of aggression experienced by the general practitioners during a period of 12 months and the incidence of various precipitating factors. RESULTS: Although the response was low at 40.6%, this study is the largest published database on aggression towards family doctors. In all, 687 (62.9%) of the responders had experienced abuse or violence during the previous 12 months, and 191 (17.5%) had experienced some sort of abuse at least once a month and 11 (1%) had experienced verbal abuse every day. Even assuming that all of the non-responders did not experience any violence, then aggression in patients affects 25.5% of general practitioners in the west midlands. For those practitioners who had experienced aggression in patients the annual incidence of an event per general practitioner was 2.42. In all, 96 (14%) of these general practitioners thought that aggression was increasing. A total of 1520 (91.3%) of all incidents comprised verbal abuse or threats with no direct physical act. The surgery was the commonest location for aggression, with 942 (56.6%) incidents; however, 90 (62.5%) of the incidents involving assault or injury occurred during domiciliary visits and 22 (66%) of the injuries were received during night calls. Relatives were the aggressors in 668 (37.6%) cases, anxiety was a precipitant in 435 (25.7%) cases, and a long wait in 183 (10.8%). CONCLUSIONS: Violence towards general practitioners is common and may be increasing. Some of the precipitants of aggression are potentially avoidable and practices should make strenuous attempts to identify such factors and remedy them. Staff training in interpersonal skills and recognising anxious or intoxicated patients is essential and should be supplemented by consideration of surgery layout and repair. Doctors should avoid delays for patients by rearranging booking policies or surgery times and lengths. Victims of aggression must be followed up. A prospective study or centralised recording of incidents should be funded.

Adolescent↗

PubMed1997

Identifying the active general practice workforce in one division of general practice: the utility of public domain databases.

OBJECTIVE: To identify the non-specialist medical practitioner workforce engaged in active general practice in the region served by the Division of General Practice-Northern Tasmania and to determine the usefulness of public domain databases for enumeration of individual non-specialists providing general practice services. METHODS: A masterlist of the active general practice workforce was compiled by obtaining the names and addresses/postcodes of all non-specialist medical practitioners who were listed in at least one of nine public domain databases and who were confirmed by selected local medical practitioners to be in active general practice in the three months prior to 30 June 1994. This masterlist was used in calculating the sensitivity and positive predictive value (PPV) of each of the nine databases for enumerating non-specialist practitioners in active general practice. RESULTS: Combining the databases resulted in a list of 475 practitioners, which was refined to 139 practitioners who, by our criteria, were in active general practice. Databases had a range of sensitivities and PPVs, but those with high sensitivity tended to have low PPVs, and vice versa. The most useful database for enumerating these practitioners was the mailing list for Australian Family Physician (sensitivity, 94%; PPV, 0.79). CONCLUSIONS: When used alone, no single database had both high sensitivity and high positive predictive value for identifying the active general practice workforce. Combining multiple databases may improve precision. Developing methods to identify recent departures from local active practice has the potential to improve the PPV of existing highly sensitive databases.

Australia↗

PubMed2002

Attitude of medical students towards general practice and general practitioners.

BACKGROUND: The stimuli for this work came from the need to identify and understand the origin of students' attitudes towards general practice in the context of undergraduate curriculum reform and concerns about recruitment. AIM: To evaluate attitudes of medical students towards general practice as a specialty and general practitioners (GPs) as doctors and explore factors influencing students' attitudes and intended career choice. DESIGN OF STUDY: Cross-sectional survey. SETTING: Final-year students at two London medical schools. METHOD: Questionnaires were distributed to 984 students and the results analysed using SPSS analysis. RESULTS: The mean response rate was 72% (700/984). Medical students had a positive attitude towards general practice as a specialty (mean Likert score = 3.90/5, 95% confidence interval [CI] = 3.86 to 3.94) and towards GPs as doctors (mean Likert score = 3.62/5, 95% CI = 3.59 to 3.66). They rated personal experience of GPs as the most important factor influencing their attitude. Students' attitudes towards general practice and GPs were more positive (P<0.001) in the fifth year. First-year students perceived the media to have a more important role in influencing their attitude than those in the fifth year(P<0.001). General practice was the only career option to significantly increase in popularity between the first and final year(P < 0.001). CONCLUSIONS: Medical students end their undergraduate years with a more positive attitude towards general practice than has been reported elsewhere recently. This may be partially explained by the greater contact with GPs and suggests that efforts by medical schools to ensure a more balanced, community-based curriculum promotes positive attitudes to general practice. The influence of the media on the first years of medical school requiresfurther investigation.

Attitude of Health Personnel↗

PubMed1998

Audit of populations in general practice: the creation of a national resource for the study of morbidity in Scottish general practice.

STUDY OBJECTIVE: To create a national data resource for studying morbidity in Scottish general practice, complementary to existing information systems and available for management and research purposes at national and local levels. DESIGN: The Department of General Practice, University of Aberdeen has worked since 1988 to collect and analyse computerised information at practice, regional, and national levels by distribution of a floppy disk-based software program, which extracts a predetermined dataset from each general practice computer system. SETTING: Almost 100% of patients in Scotland are registered with a general practitioner. Scotland has a national computer system, General Practice Administration System for Scotland (GPASS), used by over 75% of all Scottish practices. Escalating costs of health care and demographic changes in the national population emphasise the monetary value of the gatekeeper role of general medical practice. General practitioners' increasing involvement in the provision and purchasing of care has raised the importance of the management of populations as well as the care of individual patients. PATIENTS: Collection of major morbidity and prescribing data from up to 2.4 million patients, approximately half the population of Scotland, takes place biannually. A subset of practices (population 282,700 patients; 52 practices) are continuously collecting doctor/patient contact information (symptoms or diagnoses). MAIN RESULTS: The data collected provide information at the level of the individual patient. Morbidity, prescribing, screening, and administrative data can be linked by patient, date or postcode. The sample population studied is representative by age, sex, deprivation, and sparsity (using the postcode) of the national population. Large sub-populations of patients satisfying a selected criteria can be extracted for further study of needs assessment or of epidemiological research. CONCLUSIONS: The gatekeeping role of Scottish general practice and the predominance of GPASS favours standardisation of methods of data capture and the construction of large regional, national, and Continuous Morbidity databases. Analysis by geographical, demographic, and temporal distributions allows the changing patterns of illness and provision of health care to be studied in substantial detail to the benefit of patients, doctors, and the national health service.

Adolescent↗

PubMed1989

Utilization of general anesthesia by general practitioners in Saskatchewan.

A survey of Saskatchewan general practitioners was carried out to investigate the utilization of general anesthesia for the completion of dental procedures. Of the total number of general practitioners (234) surveyed, 61.5 per cent responded that they had done at least one general anesthesia case during their dental career. With respect to current utilization in the province, 38.4 per cent (90) of the respondents did at least five general anesthesia cases per year. Other variables investigated were: number of cases per year, types of patients treated and adequacy of dental school training. Age of practitioner, year of graduation and community population were found to be significant (p less than 0.001) variables in the utilization of general anesthesia by general practitioners in Saskatchewan.

Adult↗

PubMed1997

Differential spatial patterns of Fos induction following generalized clonic and generalized tonic seizures.

The expression of generalized clonic and generalized tonic seizures has been suggested to result from the activation of different and independent neuronal circuits. Using the induction of the c-fos protein (Fos) as a marker of neuronal activity, we identified brain structures that are differentially associated with the expression of electroconvulsive shock-induced generalized clonic and generalized tonic seizures. Expression of either seizure phenotype resulted in a similar bilaterally symmetrical increase in Fos immunoreactivity in many forebrain structures, including the bed nucleus of the stria terminalis, hippocampal dentate gyrus, amygdala, and piriform cortex, compared to controls. However, following tonic hindlimb extension (THE), the degree of labeling in specific thalamic, hypothalamic, and brain stem areas was significantly greater than that of either controls or animals exhibiting clonic seizures. While a greater number of neurons in the hypothalamus (e.g., ventromedial nucleus), subparafascicular thalamic nucleus, peripeduncular area, deep medial superior colliculus, dorsal and lateral central gray, and paralemniscal nuclei were robustly labeled following THE, noticeably fewer cells were immunoreactive following face and forelimb clonic seizure behaviors. These differences were also found to be independent of the stimulus magnitude. In animals stimulated with the same current intensity but expressing either of the two seizure phenotypes, the pattern of Fos induction was consistent with the seizure phenotype expressed. These results demonstrate that specific subsets of neurons are differentially activated following the expression of different generalized seizure behaviors and that activity in discrete mesencephalic and diencephalic structures is more frequently associated with the expression of generalized tonic seizures than with the expression of generalized clonic seizures.

Animals↗

PubMed1999

An investigation of the effects on children of tooth extraction under general anaesthesia in general dental practice.

OBJECTIVE: To describe the morbidity related to general anaesthesia provided in general dental practices for the extraction of teeth in school children. DESIGN: Observational study supported by structured questionnaires and interviews. SETTING: Three general dental practices in a Lancashire health district and children's homes. SUBJECTS: 80 children aged 5-15 years undergoing extractions under general anaesthesia. MAIN OUTCOME MEASURES: Observed demeanour of the children prior to, during and immediately after the surgical procedures. Reported morbidity during the following 24 hours and 1 month later. RESULTS: 92% of the children complained of symptoms associated with the surgery under general anaesthesia. Distress was noted in 16 (20%) patients during the induction of 26 (33%) during recovery. Continued crying was reported for 24 (39%) during the journey home and for 23 (37%) once home had been reached. Other symptoms included nausea, vomiting, sickness and prolonged bleeding. Six reported psychological trauma 1 month after; three had nightmares, two had continuing bad memories and one was depressed for several days. CONCLUSION: Morbidity following extractions under general anaesthesia in general dental practice is common and has distressing consequences for the young patients and their carers.

Adolescent↗

PubMed1998

Do general practitioner hospitals reduce the utilisation of general hospital beds? Evidence from Finnmark county in north Norway.

STUDY OBJECTIVE: To assess whether populations with access to general practitioner hospitals (GP hospitals) utilise general hospitals less than populations without such access. DESIGN: Observational study comparing the total rates of admissions and of occupied bed days in general hospitals between populations with and without access to GP hospitals. Comparisons were also made separately for diagnoses commonly encountered in GP hospitals. SETTING: Two general hospitals serving the population of Finnmark county in north Norway. PATIENTS: 35,435 admissions based on five years' routine recordings from the two hospitals. MAIN RESULTS: The total rate of admission to general hospitals was lower in peripheral municipalities with a GP hospital than in central municipalities without this kind of institution, 26% and 28% lower for men and women respectively. The corresponding differences were 38% and 52%, when analysed for occupied bed days. The differences were most pronounced for patients with respiratory diseases, cardiac failure, and cancer who are primarily or intermediately treated or cared for in GP hospitals, and for patients with stroke and fractures, who are regularly transferred from general hospitals to GP hospitals for longer term follow up care. CONCLUSION: GP hospitals seem to reduce the utilisation of general hospitals with respect to admissions as well as occupied bed days.

Adolescent↗

PubMed1980

The work content of general practice. Based on a survey of selected procedures performed by Victorian general practitioners in 1978.

Much has been spoken about the changing nature of general practice, although little documental evidence is available to identify the nature of these changes. Such changes are said to include provision of some diagnostic services, diminishing involvement in surgical and obstetrical procedures, and a lessening of GP involvement in the hospital care of patients. Information about the range of services provided by the average general practitioner is essential knowledge required by planners of undergraduate, vocational and continuing education programmes. In view of the anticipated rapid increase in general practitioner numbers in the near future, further changes in the nature of the discipline are predicted. A survey of general practitioners was therefore proposed by four bodies concerned with medical education relevant to general practice, viz. -- the Victorian Medical Postgraduate Foundation, the Monash University Department of Social and Preventive Medicine (Section of Community Practice), the Royal Australian College of General Practitioners (Victoria Faculty) and the Victorian Academy for General Practice Limited.

Anesthesiology↗

PubMed1997

Development of a screening questionnaire for the general hospital and general practices.

The purpose of this study was to develop a sensitive as well as brief screening questionnaire by combining the well-known instruments CAGE and the Michigan Alcoholism Screening Test (MAST) in detecting patients with alcohol dependence or abuse in general hospitals and general practices. The number of items was reduced by means of logistic regression and item analysis based on data of 1,167 consecutive admissions of a general hospital who completed both questionnaires. Further data were derived from a sample of 774 patients from 10 randomly selected general practices. A solution with nine items was validated in a second sample of 436 hospital inpatients. In all three samples, cases screening positive were interviewed using the Schedules for Clinical Assessment in Neuropsychiatry to provide ICD-10 and DSM-III-R or DSM-IV diagnosis. In addition, 103 subjects with negative screening results were interviewed in the second general hospital sample. On grounds of the data of all three samples, a solution of seven items was chosen. This instrument comprises two CAGE and five MAST questions (Leubeck Alcohol Dependence and Abuse Screening Test; LAST) and was significantly higher in sensitivity than CAGE and SMAST. Data were robust in all three samples. It is concluded that the LAST is an optimized instrument for use in general hospital and general practice.

Adolescent↗

PubMed1992

The National General Practice Study of Epilepsy. The syndromic classification of the International League Against Epilepsy applied to epilepsy in a general population.

In this prospective, population-based study of 594 cases of newly diagnosed epilepsy, proportions in categories as defined by the International League Against Epilepsy (ILAE) were as follows: (1) localization-related epilepsies: 1.1* idiopathic, 1.2%; 1.2* symptomatic, 16.2%; and 1.3 cryptogenic, 24.6%; (2) generalized epilepsies: 2.1* idiopathic (idiopathic generalized epilepsy) with 3-Hz spike and wave: absence epilepsy, 2.2%; juvenile myoclonic epilepsy, 1.5%; and nonspecific idiopathic generalized epilepsy, 5.6%; 2.3.1* symptomatic generalized epilepsies, 1.5%; 2.3.2* specific syndromes with generalized epilepsy, 0.3%; 3.2 seizures without unequivocal focal or generalized features, 32%; 4.1 situation-related syndromes, isolated seizures, 9.9%; seizures due to acute toxic or metabolic cause,* 4.5%. Only 33.6% were in diagnostic ILAE categories (asterisks) and many rare syndromes were not represented. The remainder (66.4%) were in various nonspecific categories. Only 24% of localization-related epilepsies could be clinically localized to a single ILAE-proposed site of origin and of these best localized cases, 14% had strongly discordant imaging or electroencephalograms. These major problems in applying the ILAE classification to epilepsy in the general population and its underemphasis of modern imaging techniques are discussed.

Cerebral Cortex↗

PubMed1996

A validation study of the Whitely Index, the Illness Attitude Scales, and the Somatosensory Amplification Scale in general medical and general practice patients.

The aim of this study was to assess the reliability and validity of the Whitely Index (WI), the Illness Attitude Scales (IAS), and the Somatosensory Amplification Scale (SAS). The study population consisted of 130 general medical outpatients, 113 general practice patients, and 204 subjects from the general population. The factorial structure of the IAS appeared to consist of two subscales, namely Health Anxiety and Illness Behaviour. The internal consistency and stability of the three questionnaires were satisfactory, and their scores were highly intercorrelated. Scores on the WI and Health Anxiety subscale of the IAS declined significantly from general medical outpatients, through general practice patients to subjects from the general population. This might imply that medical care utilisation is related to hypochondriasis. A prospective study is needed to determine whether health anxiety contributes to the decision to seek medical care or the consultation of a general practitioner or consultant gives rise to worry about possible illness.

Adult↗

PubMed2003

General Surgeons and trauma. A questionnaire survey of General Surgeons training in ATLS and involvement in the trauma team.

OBJECTIVE: To determine the level of training of General Surgeons in the UK in the Advanced Trauma Life Support (ATLS) course and their involvement with hospital trauma teams. METHODS: Postal questionnaire sent to General Surgical Consultants and Higher Surgical Trainees (HSTs). RESULTS: 58% of General Surgeons who responded had attended ATLS, but only 30% of those who had been Consultants for more than 10 years. Eighty-seven percent considered the course 'essential' or 'some value'. Sixty-one percent of hospitals represented had a trauma team. A Consultant General Surgeon was a member of the team in 50% and the General Surgical HST in 82%. CONCLUSION: ATLS has been widely accepted by General Surgical Trainees and recently appointed Consultants. The trauma team approach to resuscitation has yet to become fully established in the UK and there is limited input from Consultant General Surgeons.

Attitude of Health Personnel↗

PubMed1999

Nursing's contribution to general practice: general practitioners' and practice nurses' views.

This study was instigated by the paucity of knowledge relating to the work of nurses employed by general practitioners in Australia and the phenomenal development of the practice nurse role in the United Kingdom. A mailed survey of general practitioners and practice nurses within one Division of General Practice in South-East Queensland, sought, among other things, their views about the current and potential contribution of nursing to general practice. Eighty-four out of 164 (51%) general practitioners and 37 out of 67 (55%) practice nurses responded to the survey. Results indicated that both general practitioners and practice nurses appreciated the value of nursing services in general practice and would sanction the employment of more nurses especially for the purpose of preventive care. The majority of nurses were agreeable to the notion that the nurse's role could, and should, be expanded to include autonomous functioning while most of the doctors were amenable to some extension of nursing practice but reticent or opposed to any independent interventions.

Attitude of Health Personnel↗

PubMed2000

Royal Australian College of Ophthalmologists and Royal Australian College of General Practitioners National GP Eye Skills Workshops: colleges and divisions reskilling general practice.

PURPOSE: Little formal eye skills training has historically been available to Australian general practitioners at undergraduate or postgraduate levels. The development of the National GP Eye Skills Workshop was a joint initiatve of the Royal Australian Colleges of General Practice and Ophthalmology, to enhance the skills of Australian general practitioners in a range of important ocular examination and procedural areas. METHODS: Workshops were run in eight Queensland Divisions of General Practice in 1998. Between two and 10 local ophthalmologists in each divisional area were involved ether in the workshop programme or in the recruitment of patients for the patient assessment module. Workshops were run on weekends and included modules on vision testing and disease screening in children and adults, ophthalmoscopy, assessment for glaucoma and diabetic retinopathy, incision of chalazions, removal of corneal foreign bodies, ocular first aid, implementing eye assessment in busy general practice, and a patient assessment clinic. A questionnaire was administered which was comprised of sections relating to the format of the workshop, new skills and concepts learnt, learning exceptions, and perception of future ability to treat/scan/assess for eye conditions in general practice. The questionnaire was completed by 91% of participants. RESULTS: Participants strongly supported the impact of the workshop on their ability to detect and treat eye problems in their practices, and refer where appropriate to an ophthalmologist. They also rated highly all individual aspects of the programme in terms of impact on their delivery of general practitioner eye care. CONCLUSIONS: The results illustrate the comprehensive success of the workshop programme in format, content, relevance and delivery.

Adult↗

PubMed1998

Quality indicators for general practice: which ones can general practitioners and health authority managers agree are important and how useful are they?

BACKGROUND: The aim of the study was to assess the face validity of quality indicators being proposed for use in general practice by health authorities. METHOD: A national survey of health authorities was carried out to identify quality indicators being proposed for use in general practice. A two-stage Delphi process was used to establish general practitioners' (GPs') and health authority managers' views on the face validity of identified indicators. A total of 240 separate indicators identified by health authorities and the NHS Executive as potential markers of the quality of general practice care were assessed. Indicators related to access, organizational performance, preventive care, care for a small number of chronic diseases, prescribing and gatekeeping. The subjects were a purposive sample of 47 health authority managers and 57 general practice course organizers. RESULTS: Thirty-six indicators received median validity scores of 8 or 9 out of a maximum possible score of 9. Of this set, 83 per cent was rated identically by both groups of respondents. Prescribing and gatekeeping indicators generally received low validity scores. CONCLUSION: Acceptable face valid indicators were identified for all domains except gatekeeping. However, the indicators rated by the sample do not cover all aspects of care. No indicators were proposed for use by health authorities relating to effective communication, care of acute illness, health outcomes or patient evaluation. Although it is possible to develop indicators of general practice care which have face validity in the view of both GPs and managers, these will be very partial measures of quality. In the indicators used in this study, no explicit distinction was made between indicators designed to assess minimum standards with which all practices should comply, and indicators which could be used to reward higher levels of performance. Failure to separate these will result in antagonism from practitioners to quality improvement initiatives in the NHS, and a failure to engage the profession in improving quality of care.

Attitude of Health Personnel↗

PubMed1989

Responses by general practitioners in Avon to proposals for general practice in the white paper Working for Patients.

OBJECTIVE: To determine the views of Avon's general practitioners about the general practice proposals within the government's white paper Working for Patients. DESIGN: Postal questionnaire survey. SETTING: A county in south west England. SUBJECTS: All general practitioner principals (n = 537) under contract with Avon Family Practitioner Committee. MEASUREMENTS AND MAIN RESULTS: 492 doctors (92%) responded to the survey. More than three quarters of the respondents were opposed to the government's proposals on budgets for specific surgical procedures, prescribing, and diagnostic tests; and between 63% and 93% felt negative about advantages that might accrue from the proposals. Over three quarters of general practitioners were in favour of family practitioner committees monitoring work load, prescribing, and referrals. General practitioners in large, potentially budget holding practices held similar views to doctors in smaller practices. CONCLUSIONS: Avon's general practitioners substantially reject most of the government's proposals about general practice in the white paper Working for Patients.

Attitude of Health Personnel↗

PubMed2003

An epidemiological study of migraine with aura in the San Severo general population: a pilot research project of cooperation between neurologists and general practitioners.

OBJECTIVES: (A) To define the lifetime prevalence of migraine with aura (MA) in patients recruited in general practices for an epidemiologic study by the University of Parma Headache Centre from the general population of San Severo, Italy, and (B) to assess the recognition of MA in general practice. METHODS: The study was conducted over a period of 5 consecutive months (January to May 2001) on patients aged 18-65, taken from the following general practice populations: (a) from the patient population of 4 general practitioners (GPs; 3,616 patients) and (b) from the patient population of 12 GPs (12,996 patients). The clinical diagnosis of MA was subsequently confirmed by a headache specialist. RESULTS: For objective A, 648 patients (420 women and 228 men) were interviewed; MA diagnosis was confirmed in 10 patients (7 women and 3 men), lifetime MA prevalence being 1.5%. For objective B, 150 'suspected' MA cases (96 women and 54 men) were reported by the 12 GPs; however, the diagnosis of MA was confirmed in only 3 cases (2 women and 1 man). CONCLUSION: The prevalence of MA observed in our small sample of the general practice patient population was comparable with that observed in the general population of San Severo, Italy. The results also suggest that GPs may be overestimating the number of cases of MA in their patient population.

Adolescent↗