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PubMed2003

[Job satisfaction and burnout in general practitioners].

OBJECTIVE: To describe job satisfaction in general practitioners (GP) in the province of Barcelona, and to analyse its relationship with their job burnout, and social and professional characteristics. DESIGN: Transversal observational study.Setting. Province of Barcelona, Spain. PARTICIPANTS: 603 General Practitioners had participated in ninety three primary care centers. MEASUREMENT: Through a direct interview (individual or in group) a validated questionnaire was administered in three parts: general data (social, demographic and professional), job satisfaction (Font Roja-9 dimensions) and job burnout (Maslach Burnout Inventory-3 scales). RESULTS: The job satisfaction questionnaire (score ranging from 1-5) showed a global satisfaction level of 3.02 (95%CI, 2.98%-3.05%) and we obtained a 18% non response rate. There was a positive association between overall satisfaction and the following variables: less years working in primary health, working in centres providing instruction, and willingness to receive information from the survey. Low levels of satisfaction were associated to high scores in emotional exhaustion and depersonalisation scales, and low scores in personal accomplishment scale. CONCLUSIONS: Overall satisfaction has a medium score in the Font-Roja questionnaire. Age seems to lead to a significant tendency to decrease satisfaction as practitioners grow older. Job satisfaction and job burnout present a closely linked behaviour, inversely, as satisfaction increases when job burnout presents low scores.

Adult↗

PubMed1997

The shortage of rural general practitioners in north-western New South Wales.

The objective of this study was to provide the Tamworth Rural Training Unit with a clear understanding and practical strategic directions for contributing to an equitable distribution of rural general practitioners in the New England Area Health Service. A survey was sent to all 139 general practitioners practising in this region. The best and worst features of rural practice, both professionally and personally, were surveyed, as well as ways to attract more general practitioners to rural areas. It was found that this region required an additional 46 full-time general practitioners in 1995 if equity and social justice principles were to be met. Projecting to the year 2005, the total shortfall of full-time general practitioners in the New England Area Health Service amounts to 90. It is recommended that this critical shortage of rural general practitioners be assessed within two distinct time frames, namely short-term strategies (1996-1998) and medium-term strategies (1999-2005).

Adult↗

PubMed1995

Membership of the Royal College of General Practitioners by assessment: attitudes of members and non-members in one faculty area.

BACKGROUND: Fewer than half of the principals in general practice in the United Kingdom are members of the Royal College of General Practitioners. As the membership examination is closely linked to the endpoint of vocational training, a case can be made for another method of entry to the RCGP for established principals. Such a method could be membership by assessment. AIM: A study was undertaken to examine the attitudes of existing members and fellows of the RCGP to membership by assessment and to determine whether there was any demand from general practitioner principals who were not RCGP members to join by this route. METHOD: One questionnaire was sent to all RCGP members and fellows in the Vale of Trent faculty area and another questionnaire was sent to those principals in general practice in the Vale of Trent faculty area who were not RCGP members. RESULTS: In total, 396 (83%) of the 480 RCGP members and fellows responded, as did 543 (81%) of the 671 non-members in the faculty area. When asked if they were in favour of the concept of membership by assessment, 245 of the members and fellows replied yes (62%) and 138 replied no (35%). Of the non-members, 91 (17%) ahd previously been members of the RCGP; the main reason given by these general practitioners for relinquishing membership was that the annual subscription was too high (65% of 91 general practitioners). When the 451 general practitioners who had never been members were asked if they would be interested in joining the RCGP by an assessment method, 271 replied positively (60%). CONCLUSION: There was widespread support from the members and fellows of the Vale of Trent faculty of the RCGP for the concept of membership by assessment. Principals in general practice in this area who had never been members of the RCGP showed a high degree of interest in joining by this method. Despite the caveats that must be applied, for example, to ensure that the standards are set appropriately, these results indicate that membership by assessment should be explored by the RCGP, and indeed a working party on the meaning of membership of the RCGP has been convened.

Family Practice↗

PubMed1993

Cystic fibrosis carrier testing in early pregnancy by general practitioners.

OBJECTIVE: To assess the feasibility of genetic counselling in general practice by using cystic fibrosis carrier screening at the booking appointment as an integral part of routine antenatal care and as a paradigm for the wider participation of general practitioners in medical genetics. DESIGN: Maternal testing (male partner tested only if woman screens positive) and couple testing for cystic fibrosis carrier status in the antenatal population attending one general practice and, later, in a further six (outreach) practices also. SETTING: Two partner urban training practice (pilot practice) in south Manchester, and six north west practices (two inner city, three urban, one rural dispensing). SUBJECTS: Total practice population of 50,000 (pilot practice plus six outreach practices) with an estimated 500-800 pregnancies per year. MAIN OUTCOME MEASURES: (a) Proportion of carriers of cystic fibrosis identified, counselled, and appropriately managed within the first trimester of pregnancy; (b) questionnaire and interview measures of patient satisfaction and stress. RESULTS: Eleven carriers of cystic fibrosis were detected including one carrier couple. This carrier couple, after extensive counselling, elected to have prenatal diagnosis by chorionic villus biopsy. The fetus was homozygous normal. CONCLUSIONS: General practitioners can successfully integrate genetic counselling and cystic fibrosis carrier screening into the first antenatal booking appointment. When a carrier couple is identified clinical geneticists can help with the discussion of reproductive options, and prenatal diagnosis by chorionic villus biopsy can be completed within the first trimester. The results suggest that general practitioners will have an increasingly important role in medical genetics, subject to continuing evaluation of patient acceptability and stress.

Anxiety↗

PubMed1999

General practitioners' beliefs and attitudes about how to respond to death and bereavement: qualitative study.

OBJECTIVES: To investigate the perceptions of general practitioners when they are notified or hear of a death or bereavement in their practice; to explore doctors' accounts of their relationships with their patients in the context of bereavement; and to explore the concerns of general practitioners in managing themselves and bereaved patients. DESIGN: Semistructured interviews followed by qualitative content analysis. SETTING: London borough of Redbridge. PARTICIPANTS: 25 general practitioners. RESULTS: Almost all the doctors had felt guilty about issues relating to the death of patients. These feelings were based on their expectations of not making mistakes and diagnostic precision. They described a culture gap existing between hospital and general practice and a need to develop new models and methods to explain and manage the causes of illness presented to them. In the absence of useful teaching on bereavement, many devised strategies which relied more on their personal experiences. General practitioners used various methods to contact bereaved patients, especially if they had been involved in the terminal care or if the death was particularly shocking. The doctor was also bereaved by the death of well known patients and sometimes needed to grieve and express emotion. CONCLUSION: General practitioners may need support and learning methods to manage their own and their patients' bereavement.

Attitude of Health Personnel↗

PubMed2005

SARS and biothreat preparedness--a survey of ACT general practitioners.

In late 2003 and early 2004 the ACT Division of General Practice and ACT Health conducted two concurrent surveys designed to identify knowledge, attitudes and practices of Australian Capital Territory (ACT) general practitioners around severe acute respiratory syndrome (SARS) and biothreat preparedness. One survey asked individual general practitioners (GPs) about how they gathered information about SARS in 2003, how they preferred to receive information, current practices, and how they perceived the threat of SARS and other infectious agents. The second survey asked practice principals how they organised their practice to respond to the SARS threat in 2003, any difficulties they had with implementing this response, use of SARS infection control guidelines and current policies. The response rate for the individual GP survey was 48 per cent (184/381) and the response rate for the practice organisation survey was 54 per cent (74/136). GPS used many sources of information on SARS during the 2003 outbreak. Facsimiles from the ACT Division of General Practice were the primary source (17%) and facsimile was the preferred method of receiving information in future outbreaks. The majority of GP respondents felt adequately informed about SARS during the 2003 outbreak, but many general practices did not follow the national guidelines on telephone screening of patients, warning signs and having infection control kits available. The majority of practices reported that they had policies or procedures in place to isolate potentially infectious patients from others in the waiting room. GPs rated an influenza pandemic as a threat to themselves and their patients much more highly than SARS or bioterrorism. Suggestions and comments on how ACT GPs could be better prepared to respond to future outbreaks included the need for timeliness of information, information delivery mechanisms, communication issues, education, the availability of guidelines and protocols, planning, role delineation, the use of response teams, provision of equipment, and vaccination. Planning for future infectious disease outbreak events in the Australian Capital Territory should incorporate general practitioners so that the plans reflect what is a feasible response in the general practice setting.

Adult↗

PubMed1977

General practitioners in the Western Metropolitan Health Region of Sydney.

A comprehensive survey of the number of general practitioners in the Western Metropolitan Health Region of Sydney identified 753 general practitioners with one or more practice locations in the region; this was the equivalent of 711 full-time general practitioners, and represented a general practitioner-population ratio of 1:1533.

Australia↗

PubMed2000

Randomised controlled trial of non-directive counselling, cognitive-behaviour therapy, and usual general practitioner care for patients with depression. II: cost effectiveness.

OBJECTIVE: To compare the cost effectiveness of general practitioner care and two general practice based psychological therapies for depressed patients. DESIGN: Prospective, controlled trial with randomised and patient preference allocation arms. SETTING: General practices in London and greater Manchester. PARTICIPANTS: 464 of 627 patients presenting with depression or mixed anxiety and depression were suitable for inclusion. INTERVENTIONS: Usual general practitioner care or up to 12 sessions of non-directive counselling or cognitive-behaviour therapy provided by therapists. MAIN OUTCOME MEASURES: Beck depression inventory scores, EuroQol measure of health related quality of life, direct treatment and non-treatment costs, and cost of lost production. RESULTS: 197 patients were randomly assigned to treatment, 137 chose their treatment, and 130 were randomised only between the two psychological therapies. At four months, both non-directive counselling and cognitive-behaviour therapy reduced depressive symptoms to a significantly greater extent than usual general practitioner care. There was no significant difference in outcome between treatments at 12 months. There were no significant differences in direct costs, production losses, or societal costs between the three treatments at either four or 12 months. Sensitivity analyses did not suggest that the results depended on particular assumptions in the statistical analysis. CONCLUSIONS: Within the constraints of available power, the data suggest that both brief psychological therapies may be significantly more cost effective than usual care in the short term, as benefit was gained with no significant difference in cost. There are no significant differences between treatments in either outcomes or costs at 12 months.

Adult↗

PubMed2004

Revalidation for general practitioners: randomised comparison of two revalidation models.

OBJECTIVE: To compare two models of revalidation for general practitioners. DESIGN: Randomised comparison of two revalidation models. SETTING: Primary care in Tayside, Scotland. PARTICIPANTS: 66 Tayside general practitioners (principals and non-principals), 53 of whom completed the revalidation folders. Interventions Two revalidation models: a minimum criterion based model with revalidation as the primary purpose, and an educational outcome model with emphasis on combining revalidation with continuing professional development. MAIN OUTCOME MEASURES: Feasibility and acceptability of each approach and effect on the doctor's continuing professional development. The ability to make a summative judgment on completed models and whether either model would allow patient groups to have confidence in the revalidation process. RESULTS: The criterion model was preferred by general practitioners. For both models doctors reported making changes to their practice and felt a positive effect on their continuing professional development. Summative assessment of the folders showed reasonable inter-rater reliability. CONCLUSIONS: The criterion model provides a practical and acceptable model for general practitioners to use when preparing for revalidation.

Accreditation↗

PubMed2003

Screening for prostate cancer: a survey of New Zealand general practitioners.

AIM: To determine the views of general practitioners (GPs) in relation to screening for prostate cancer. METHODS: A questionnaire was sent to a random, national sample of 575 New Zealand general practitioners, stratified to include equal numbers of rural and urban GPs. RESULTS: The response rate to the questionnaire was 66.3%. A 55-year-old man presenting for an annual checkup or requesting advice about screening for prostate cancer would be given a prostate specific antigen (PSA) test by 74% of GPs. If the same man had a family history of prostate or breast cancer, 93% of GPs would carry out a PSA test. Most GPs overestimated the effectiveness of screening tests for prostate cancer and were uncertain about the importance of associated risk factors. Some form of screening for prostate cancer is performed by 97.5% of GPs, and 50% of GPs support a national population-screening programme. 'Watchful waiting' is considered to be a reasonable treatment option for a man with localised prostate cancer and less than 10 years' life expectancy by 40% of GPs compared with 2% for a man with more than 10 years' life expectancy. CONCLUSIONS: Most GPs undertake screening for prostate cancer, even though there is no evidence that screening improves life expectancy and quality of life.

Adult↗

PubMed1995

Does a reduction in general practitioners' use of diagnostic tests lead to more hospital referrals?

BACKGROUND: Individual feedback on general practitioners' requests for tests can improve the quality of their test ordering behaviour. Little is known of the side effects on hospital referral behaviour when the use of tests is reduced through feedback. AIM: A study was undertaken to explore changes in general practitioners' hospital referral rates in a region where their use of diagnostic tests is reduced through feedback. METHOD: Trends in test requests and of first referrals to specialists were compared among 64 general practitioners in the Maastricht region of the Netherlands where routine feedback on test ordering behaviour is provided by the diagnostic coordinating centre. RESULTS: Reduction in diagnostic test use was not accompanied by a higher hospital referral rate, not even for specialties related to tests discussed in feedback. Good responders to feedback had decreased hospital referral rates in contrast to increased rates for poor responders (P < 0.01). CONCLUSION: Reducing the volume of general practitioners' diagnostic tests through feedback does not lead to more specialist referrals. Together with lower test use, fewer hospital referrals were seen.

Diagnostic Tests, Routine↗

PubMed2000

Optimizing the care of patients with depression in primary care: the views of general practitioners.

Depression is a very common mental illness within the general population and in-patients consulting in general practice. General practitioners are well placed to provide care for patients with mental health problems, as these disorders are often connected with family and social problems, and GPs can provide their patients with long-term follow-up and support. While there are theoretical reasons for the important role of the family doctor, there is limited evidence about how general practitioners view their roles and their capacity to cope with the mental health needs of their patients. This paper explores the experience of 15 general practitioners from Scotland, who were interviewed during the spring of 1998, about how they approached the care of patients with depression in relation to their skills, knowledge and attitudes. The following four key categories of interest are presented which underpin the emergent themes of the study: (1) organizational issues; (2) referral and the use of other professionals; (3) treatment and management issues; (4) stigma. These themes reveal some interesting issues in relation to GPs' recognition and management of depression and it is also clear that the perception of collaboration within primary care and between primary and secondary care is an integral part of the process. The implications of what has been learned from this study may include the development of educational opportunities for GP trainees and established principals, in addition to brief multidisciplinary training opportunities and shared learning events between primary and secondary care.

Journal Article↗

PubMed2003

[Summary of the Dutch College of General Practitioners' practice guideline 'Anemia'].

The Dutch College of General Practitioners' practice guideline concerning anaemia advises the general practitioner to carry out additional laboratory tests in patients with a decreased haemoglobin level (Hb) in order to establish the cause of the anaemia. In specified cases (premenopausal women with excessive vaginal bleeding and in some children with mild anaemia) these tests may initially be omitted. In these cases iron can be prescribed and, if a child has had an infectious disease within the previous month, to wait one month to see if levels return to normal. In older patients with iron-deficiency anaemia subsequent investigations should be performed in order to rule out gastro-intestinal neoplasm, even if the history and physical examination give no indication of this. In an anaemic patient at risk of thalassaemia trait, haemoglobin electrophoresis or chromatography should be performed if there is microcytosis and a serum ferritine level > 15 micrograms/l.

Adult↗

PubMed2004

[Summary of the practice guideline 'atrial fibrillation' from the Dutch College of General Practitioners].

The practice guideline 'Atrial fibrillation' from the Dutch College of General Practitioners provides the general practitioner with guidelines for the diagnosis and management of patients with atrial fibrillation. Atrial fibrillation can be detected by observation of the cardiac rhythm during every measurement of the blood pressure. The diagnosis 'atrial fibrillation' must be made on the basis of an ECG. Atrial fibrillation must not be looked upon as an isolated phenomenon: possible comorbidity (cerebral infarction ('transient ischaemic attack'; TIA), hypertension, diabetes mellitus, heart failure, coronary heart disease, hyperthyroidism) should be taken into consideration in the evaluation. Particular attention should be given to determining whether heart failure is also present. An important goal of treatment is the prevention of thromboembolic complications. Cardioversion is not generally recommended. The symptoms may be an indication that an attempt should be made to restore sinus rhythm. This constitutes one of the indications for referral for specialised treatment.

Anticoagulants↗

PubMed1984

General practitioners' use of a mobile coronary care unit in a non-urban setting.

The use that general practitioners made of the mobile coronary care unit operating from a district general hospital was monitored. Over half of the patients referred by their general practitioners to hospital with suspected acute myocardial infarction were removed by the mobile unit rather than by an ordinary ambulance. However, general practitioner selection of the more compromised patient for admission via the mobile unit indicated that the chance of this category of patient being admitted by the proven best means could be improved. Of the definite cases of infarcts removed to hospital by whatever means, the high proportion which were uncomplicated raises the question whether the general practitioner is attempting to select such patients for home rather than hospital care. The figures for the use of the mobile coronary care unit also indicate that education of the public remains an important task.

Coronary Care Units↗

PubMed2002

[What do general practitioners expect from internal medicine? Results of postal survey].

SUBJECT: The place of internal medicine in the French health care system is a matter of debate. In the process of writing down a project for the department of internal medicine of a University hospital, we decided to assess the expectations of general practitioners toward internal medicine in general, and toward this department in particular. METHODS: We carried out a postal survey over a population of general practitioners working in the referral area of our University hospital. The answers of physicians familiar or not with our department were compared with a chi 2 test. RESULTS: 852 questionnaires were sent over and 49.5% were returned. The general practitioners as a whole acknowledge the classical features of internal medicine: medicine dealing with diagnosis and taking in charge unexplained symptoms; holistic medicine in cases of multiple illnesses; medicine dealing with systemic diseases as well as medicine of "niches" (incidentalomas, orphan diseases). The specific orientations of this department of internal medicine are also well known by most physicians: a great majority (94%) of them are satisfied with the help they receive; they stress the need on swift sending of letters (74%); above all, 94% of them wish to obtain rapid appointments for their patients at their request. CONCLUSION: These results are in complete accordance with our aim of setting a general internal medicine department at the disposal of general practitioners. They do confirm that outpatient consultation is the hardcore of internal medicine that must be readily available to the patients referred by their general practitioner.

Attitude of Health Personnel↗

PubMed1991

General practitioners' experiences of patients with drug and alcohol problems.

Convergent focus groups, a qualitative research methodology, were used to determine what general practitioners considered to be the main obstacles and disincentives to the effective management of persons with drug and alcohol problems. Seven groups were conducted, involving 44 general practitioners whose practices were based in representative parts of metropolitan Sydney and a rural area of New South Wales. The study revealed that most doctors are not as threatened, resistant or pessimistic about drug and alcohol intervention as much of the previous work in the area would suggest. However, they held different views according to the drug in question. General practitioners were more sympathetic to patients with alcohol problems but only some agreed that it was a legitimate area for medical involvement and one in which they were prepared to become involved. The prescribing and use of minor tranquillisers was widely tolerated and perceived to present few problems for individuals or the community. Opiate users, by contrast, were least favoured, with hostility expressed by most towards them. A provisional typology of general practitioners was developed with three distinct groupings ('interactive problem-solvers', 'traditionalist healers' and 'technologists'), according to the model of medical practice assumed. This scheme, whilst not definitive, provides a structure for targeting general practitioners for medical education and has implications for tailoring medical training programs at both the undergraduate and postgraduate levels. General issues relating to the development of typologies are discussed.

Adult↗

PubMed2005

Impact of a general practitioner educational intervention on osteoarthritis treatment in an elderly population.

PURPOSE: We examined whether a continuing medical education intervention increased general practitioners' ability to select the proper pharmacological treatment for patients with osteoarthritis. SUBJECTS AND METHODS: Eight towns in Quebec, Canada were randomly allocated to one of four intervention options, workshop and decision tree, workshop, decision tree, or no intervention. All general practitioners practicing in each town were eligible to participate. We evaluated all dispensed prescriptions for either a cyclooxygenase (COX)-2 inhibitor, nonselective nonsteroidal anti-inflammatory drug or acetaminophen written by eligible general practitioners between May 2000 and June 2001 to elderly patients suffering from osteoarthritis. We used a multi-level Bayesian hierarchical model to assess the impact of the interventions on prescription adequacy. RESULTS: We analyzed 5318 dispensed prescriptions written by 249 general practitioners in the five-month preintervention period and 4610 dispensed prescriptions written by the same physicians in the five-month postintervention period. A score of zero or one was given to every prescription, with one indicating prescription adequacy according to guidelines provided during the interventions. Bayesian hierarchical models showed some improvement in scores in the post- versus preintervention periods in all four groups. The probability of an improvement in the towns allocated the workshop and decision tree over the control was 94%, compared with 74% in the workshop group and 55% in the decision tree group. CONCLUSION: An interactive approach offered by peers and complemented by easy to use guidelines may enhance the general practitioner's ability to manage osteoarthritis patients.

Acetaminophen↗