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PubMed1988

Implementation of a microcomputer-based opportunistic health maintenance programme in a general practice teaching clinic.

The general practice teaching clinic at the Chinese University of Hong Kong uses a microcomputerbased medical record system. To implement a uniform and up-to-date health maintenance programme, a set of protocols has been written for a list of health maintenance items, and the computer has been programmed to identify the items which should be carried out at each patient encounter. Over a period of 16 months, after the start of this programme, 99% of the 1120 clinic patients had a minimum of two items performed. Of a selected sample of 203 patients 119 attended the clinic more than once in the same period and 47% of these patients had all of the health maintenance items recommended for their age and sex group completed. Abnormal screening results led to action by the general practice team. The process of implementing a health maintenance programme has helped the team to discuss current recommendations and to agree on standards. The programme has also helped with undergraduate teaching. The automated opportunistic health maintenance programme is a practical tool for improving patient care.

Adolescent↗

PubMed2005

Impediments to higher degree training for Australian clinical researchers in general practice.

CONTEXT & OBJECTIVE: Evidence-based general practice requires skilled researchers in the field. This study explores the issues faced by professionals from the Australian general practice sector who were considering higher degree training in research. METHOD: Sixteen participants were interviewed by telephone during October 2002. All were purposively selected across general practice-related professions and had expressed an interest in research. Interviews were audio-taped, transcribed and analysed independently by two researchers. RESULTS: Three main themes emerged: (1) "The Specialist Gap"--a perceived lack of training options providing research skills that were relevant to general practice, particularly mixing quantitative and qualitative methods. (2) "Career Changes"--the ability to expand career opportunities through research was highly desirable, particularly the potential to combine clinical skills with population health roles. (3) "Career impediments"--perceptions of current degree options implied that their currency was limited by lack of career advancement. Course selection was often by affiliation and personal recommendation rather than career pathways yet students face large financial costs for little career gain. CONCLUSION: Training for clinical researchers in the Australian general practice sector may be limited by lack of career opportunities for graduates. If a stronger culture of research is to develop, career development strategies need to be further explored.

Australia↗

PubMed1974

Extension of family planning service in general practice.

All general practitioners on the list of a single executive council were contacted and 91% were interviewed. They were asked about the type of family planning service currently provided and their willingness to extend the service. Only 3% said that they were not providing any service at the time of interview, but only 4% stated that they provided a complete range of techniques to all patients; almost two thirds of practitioners only provided advice and the "pill". Lack of training in family planning techniques emerged as the most important factor in determining the type of service provided. At the time of interview 64% of doctors stated that they would like further training, and 35% of all doctors asked for a full course of clinical training. Many general practitioners (81%) were willing to extend their family planning services but 65% wanted financial reimbursement and 50% needed additional administrative support as prerequisites.

Comprehensive Health Care↗

PubMed2002

Doing qualitative research in general practice: methodological utility and engagement.

General practice uses an eclectic range of research methodology. This includes increasing reliance upon qualitative research methods. There seem to be two distinct treatments of qualitative research within primary care and, in particular, within general practice research. The first is characterized by a purely utilitarian and technical focus, using a qualitative method because it is the most appropriate means of realizing the aims of the research, while the second is characterized by in-depth engagement with the philosophical and paradigmatic aspects of qualitative methodology. In-depth engagement with methodology and theory, and theory building, is an important aspect of masterate and doctoral research within social sciences such as education and anthropology, and in the discipline of nursing, but has not been a feature of qualitative research in medicine. A practical difficulty encountered within postgraduate programmes such as the one in which the author teaches is that when innovative qualitative techniques are used by GPs in their postgraduate research dissertations and theses, it is often beyond GP examiners' own knowledge and experience, yet it fails to measure up to standards established in social sciences, particularly in sociology and anthropology where in-depth reflexive engagement with the theory and philosophy of qualitative methodology is expected. This paper suggests that the value of in-depth engagement with methodology when conducting qualitative research results in creative and innovative ways of conducting research that are consonant with the nature of general practice itself, and strengthens research findings. Therefore, as teachers of research methods and supervisors of research theses, it is important to encourage students conducting qualitative research to engage fully with theoretical and methodological issues.

Family Practice↗

PubMed1995

Adolescent suicide attempts: a general practice perspective.

General practitioners have a vital role in recognising, assessing and managing the suicidal adolescent. The GP's knowledge of the local community and services allows them to intervene effectively to prevent future suicidal behaviour. This may also involve the care and follow-up of survivors of youth suicide.

Adolescent↗

PubMed1991

Field trials of the Baby Check score card in general practice.

Sixteen general practitioners (GPs) used the Baby Check score card to assess illness severity in 86 babies under 6 months old. Their reactions to Baby Check were positive: in 79 (92%) it gave an accurate assessment of the baby's illness and 16 (100%) said they would trust it. Fifteen (94%) found it useful, and most of those who did not said the baby was not ill or had an obvious diagnosis. Thirteen (81%) said they would use it and wanted their health visitors and midwives to use it and 15 (94%) wanted the mothers in their practice to use it. The majority (64%) of babies scored 0-7; 31% scored 8 to 19; and only 5% scored over 20. Well babies had low scores, while the two sickest babies, needing urgent hospital treatment, scored 29 and 33. The use of Baby Check by GPs would help them assess babies thoroughly and quantify illness severity objectively.

Family Practice↗

PubMed2006

[Gynecological and obstetric aspects of general practice].

The general practitioner called upon to provide medical care to the older woman for diseases other than gynecological or obstetric illness, should not neglect to recommend gynecological cancer screening, which is of particular importance in this group. In many differential diagnoses, the general practitioner must also give consideration to gynecological-obstetric aspects. Thus, for example, when a patient presents with lower abdominal pain, gynecological pathology must always be taken into account. Numerous preparations with differing actions and applications used in contraception or hormone therapy in the post-menopausal woman, require individual counseling by the gynecologist.

Adult↗

PubMed1997

Adrenaline degradation in general practice.

The general practitioner's (GP's) doctor's bag is exposed to extreme temperatures that may affect the stability of the drugs it contains. Adrenaline (1:1000 solution) is more stable than previous studies would suggest. GPs carry out-of-date drugs despite stating that they regularly check expiry dates.

Ambulatory Care↗

PubMed1989

The management of emergencies in general practice.

The general practitioner must be prepared and equipped to cope with the unexpected. As we do not choose our patients--they choose us--we may be confronted with an urgent or potentially lethal problem at any time. It is vital to remain alert to the possibilities, keep equipment stocked and ready, and maintain the basic skills of ABC: airway, breathing, circulation.

Accidents, Traffic↗

PubMed1995

[Training counseling in general practice].

The general practitioner is increasingly confronted with questions of sports medicine due to the increasing importance of exercise and sport in our society. This article gives a short summary of important knowledge concerning the components of physical activity, the possibilities for testing and training and the planning of training. Some simple ways of exercise counselling for patients are shown. According to its importance, most emphasis is put on the discussion of endurance capacity.

Counseling↗

PubMed1992

[Is it possible to change long-term benzodiazepine consumption by counseling in general practice?].

Twelve general practitioners in a community offered 576 long-term consumers of benzodiazepines interviews in order to discuss possible reduction in medication. A total of 175 accepted the offer. Consumption of benzodiazepines was registered in the local pharmacy before and after the intervention. The total average reduction occurred in 20% and a definite reduction in consumption of sedatives by 30-49 years in 60%. The consumption of benzodiazepines by patients aged over 70 year remained the same as before the intervention.

Adult↗

PubMed2002

[Reduced use of restricted-prescription preparations in general practice].

BACKGROUND: General practitioners in our community found that the use of drugs with restrictions on prescription was twice that of a neighbouring community, and made an effort at cutting down on the prescription of such drugs. MATERIAL AND METHODS: A retrospective analysis of this reduction is presented. RESULTS: The reduction observed was 33% over one year. The number of prescriptions in the neighbouring community remained unchanged. INTERPRETATION: The comparison with the neighbouring community was a good starting point for change. The most important contributing factor was probably the consistent approach of the doctors involved.

Drug Prescriptions↗

PubMed1978

Difficulties in consultations reported by doctors in general practice.

General-practitioner trainers in Scotland responded to a questionnaire on difficulties in consultation significantly more readily than did non-trainers. Their answers to some questions were significantly different.Trainer and trainee views of difficulties in communication with different types of patients and situations are broadly similar. Because of this similarity of views, the experienced doctor can plan an approach to training which is valid for the inexperienced trainee. He may, however, modify his estimate of the degree of difficulty for the trainee of consultation by involving some categories, for example, adolescents (easier for the trainee), dying patients (more difficult), patients of socioeconomic status which is different to that of the doctor (more difficult).SOME ASPECTS OF THE CONSULTATION MERIT SPECIAL ATTENTION: techniques such as those appropriate to ending the interview and discovering the patient's reasons for seeking medical help.While trainees' problems associated with lack of familiarity with patients and their circumstances are likely to decrease with time spent in the teaching practice, adequate records can help to diminish the trainees' insecurity.This survey confirms the need to continue to focus attention on patient management as a component of training as relevant as the detailed diagnosis and treatment of disease.

Adolescent↗

PubMed1991

Cancer and health screening in Canterbury general practices.

The general practitioners in the Canterbury Area Health Board area were surveyed for their screening policies for cancer and medical conditions. Responses were obtained from 210 (79%), 55% of whom had age/sex registers. Ninety-seven percent provided cervical smears, usually at 1-2 year intervals; 62% offered a female smear taker. Smears were initiated opportunistically by 76%, by age/sex register (47%) or on request by 27%. Breast cancer was screened by 69% using mammography and by 59% using breast physical examination; 73% taught breast self examination. Mammography was recommended every two years for women aged 50-64 years by 45% of responders, and annually to women aged 40-50 years by 19%. Mammography was initiated opportunistically by 88%, on request by 70% and using an age/sex register by 21%. Melanoma was screened by 66%, colorectal cancers in those at high risk by 42%. Testicular self examination was promoted by 43%. Ninety-one percent screened for hypertension, and 51% for hyperlipidaemia, 54% for diabetes mellitus in people without risk factors. Smoking (97%) and alcohol intake (82%) were usually inquired for, and safe sex practices by 59%. Established screening modalities were recommended by most practitioners, but the frequency exceeded current guidelines in many cases; opportunistic screening predominated.

Family Practice↗

PubMed1980

Doxycycline and amoxycillin in respiratory infections: a comparative assessment in general practice.

A general practitioner survey was carried out to compare the efficacy of doxycycline and amoxycillin in the treatment of 267 patients with respiratory tract infections requiring antibiotic therapy. The findings, based on clinical observations, suggest that both antibiotics were equally effective in providing prompt improvement and complete resolution of the infection, only 7 of the 134 receiving doxycycline and 13 of the 133 patients receiving amoxycillin failing to show a satisfactory response. There was a statistically significant better response in those patients with acute and acute-on-chronic bronchitis who were treated with doxycycline. It is possible that this may have been related to a local upsurge in mycoplasma infection at the time of the study.

Adolescent↗

PubMed1997

Cholesterol management in general practice.

Ninety general practitioners from the Fylde coast of Lancashire responded to a questionnaire regarding lipid management, revealing that only 22% aim for a target total cholesterol of < or = 5.2 mmol/l in patients with established ischaemic heart disease. One third are reassessing the cholesterol in these patients at yearly intervals or less frequently, and 36% select 65 years or less as the upper age limit for screening. Approximately 50% of GPs screen for hypercholesterolaemia in patients with cerebral or peripheral vascular disease. Primary screening and treatment of hypercholesterolaemia within the 'at risk' asymptomatic population is well established with 72% of GPs screening hypertensives, 88% screening diabetics and almost all screening patients with an adverse family history, but the therapeutic cholesterol targets vary widely between individual practitioners.

Age Distribution↗

PubMed2005

The Hospital Anxiety and Depression Rating Scale: a cross-sectional study of psychometrics and case finding abilities in general practice.

BACKGROUND: General practitioners' (GPs) diagnostic skills lead to underidentification of generalized anxiety disorders (GAD) and major depressive episodes (MDE). Supplement of brief questionnaires could improve the diagnostic accuracy of GPs for these common mental disorders. The aims of this study were to examine the usefulness of The Hospital Anxiety and Depression Rating Scale (HADS) for GPs by: 1) Examining its psychometrics in the GPs' setting; 2) Testing its case-finding properties compared to patient-rated GAD and MDE (DSM-IV); and 3) Comparing its case finding abilities to that of the GPs using Clinical Global Impression-Severity (CGI-S) rating. METHODS: In a cross-sectional survey study 1,781 patients in three consecutive days in September 2001 attended 141 GPs geographically spread in Norway. Sensitivity, specificity, optimal cut off score, and Area under the curve (AUC) for the HADS and the CGI-S were calculated with Generalized Anxiety Questionnaire (GAS-Q) as reference standard for GAD, and Depression Screening Questionnaire (DSQ) for MDE. RESULTS: The HADS-A had optimal cut off > or =8 (sensitivity 0.89, specificity 0.75), AUC 0.88 and 76% of patients were correctly classified in relation to GAD. The HADS-D had by optimal cut off > or =8 (sensitivity 0.80 and specificity 0.88) AUC 0.93 and 87% of the patients were correctly classified in relation to MDE. Proportions of the total correctly classified at the CGI-S optimal cut-off > or =3 were 83% of patients for GAD and 81% for MDE. CONCLUSION: The results indicate that addition of the patients' HADS scores to GPs' information could improve their diagnostic accuracy of GAD and MDE.

Adult↗

PubMed2003

Acquisition of clinical skills in postgraduate training for general practice.

BACKGROUND: Postgraduate training in general practice aims to develop clinical competence. However, little is known about its effect on trainees' development of clinical skills. AIM: To assess the acquisition of clinical skills during a 3-year training programme and to evaluate whether a satisfactory level is achieved towards the end of training. DESIGN OF STUDY: Cross-sectional design. SETTING: Dutch postgraduate training in general practice from 1995 to 1998. METHOD: Clinical skills were assessed using a written knowledge test of skills and by an Objective Structured Clinical Examination (OSCE). The written test was administered to trainees in all 3 years. Trainees at completion of their training took the OSCE. The results of both tests were compared with a standard of adequacy and to a reference group of general practitioner (GP) trainers. RESULTS: An increase in the level of clinical skills and pass rate was found throughout the training, being most prominent during the first 6 months. At completion of their training, trainees scored higher than the GPs on the written test (48% versus 39%) and on the OSCE (69% versus 63%). Eighty-eight per cent of the trainees would have passed the written test against 70% of the GPs and 94% would have passed the OSCE against 80% of the GPs. CONCLUSION: A 3-year postgraduate training period in general practice contributes to a satisfactory acquisition of clinical skills. Further research into when and where acquisition takes place, and the role of the GP trainer, is needed.

Clinical Competence↗