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Several side effects of drugs observed in an office of a general practitioner are described. The cause of these side effects, their prevention and their treatment are discussed.
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Explore the source record for details and available documents.
BACKGROUND: Anti-smoking advice from general practitioners has proven efficacy. However, general practitioners do not exploit a large proportion of opportunities to discuss smoking with patients. AIM: A study aimed to explore general practitioners attitudes towards discussing smoking with patients and to assess how these influence the quantity of anti-smoking advice that general practitioners report giving during routine consultations. It also aimed to determine the extent to which general practitioners report using evidence-based interventions against smoking and to discover the problems they experience when discussing smoking with patients. METHOD: A postal survey of all 468 general practitioners on the Leicestershire Family Health Services Authority list was conducted. General practitioners' attitudes were assessed by scoring 13 attitude statements using a six-point Likert-type scale. They were also asked to rank (from a list of 12 items) the five approaches that they found most productive and (from a list of 11 items) the five problems that they most commonly encountered when giving anti-smoking advice to patients. RESULTS: A total of 327 questionnaires (70%) were returned. Most respondents (97%) thought that their advice was more effective when linked to patients' presenting problems and 65% reported that linking their anti-smoking advice to patients' presenting complaints was one of their three most preferred approaches to discussing smoking. Advising all presenting smokers to quit was considered by 40% of respondents to be an appropriate use of time but 76% reported that patients' lack of motivation was one of the three most commonly encountered problems. An analysis of the ratings of the 13 statements suggested that general practitioners who reported the greatest smoking cessation activity during routine consultations held more positive attitudes towards discussing smoking with patients. CONCLUSION: This study suggests that general practitioners believe that their anti-smoking advice is more effective when linked to patients' presenting complaints, and this belief appears to be reflected in the way in which general practitioners approach smoking cessation with patients. The findings may indicate that general practitioners are unlikely to accept a role in a population-based anti-smoking strategy which demands that they discuss smoking with all presenting smokers.
The objectives of this open-labeled study were to assess the clinical uroselectivity of alfuzosin in a long-term follow-up study in general practice. A total of 3,228 patients with clinical benign prostatic hyperplasia (BPH) from 812 centers were included in a prospective 3-year open-labeled study and treated with alfuzosin (immediate-release formulation) at the recommended dosage. Symptom score (Boyarsky, modified) and a 20-item BPH-specific health related quality of life (HRQL) score (Urolife BPH QoL 20), which included three questions on sexuality, were self-administered at baseline, 3, 6, 12, 18, 24, 30 and 36 months. Symptom score was significantly reduced by 54% at 3 months and this reduction was maintained up to 36 months; the HRQL score was significantly improved by 45.4% at 12 months and this improvement was also maintained up to 36 months. Alfuzosin was well tolerated: the quantitative and qualitative distribution of adverse events (AEs) was similar to that previously observed in placebo-controlled studies. 4.2% of the patients dropped out due to AEs. This study confirms the long-term safety profile of alfuzosin in general practice and highlights the need to measure HRQL in the context of clinical uroselectivity.
General practitioners' prescribing habits were studied using encounter forms during a period of three years. Analysis of the first year's forms revealed examples of inappropriate prescribing, so an audit was undertaken on the treatment of fungal skin infections and coughs and colds in children. Data collection was continued for a further year to measure any changes in prescribing. Analysis after audit showed that more appropriate prescribing had reduced the number of drugs prescribed as well as the number of repeat consultations needed before resolution of the problem. These findings suggest that the continuous use of encounter forms can accurately reveal the prescribing habits of general practitioners. Self-audit can then be performed on a continuing basis with little disruption of the general practitioner's normal routine.
General practitioners provide 50% of childhood vaccination services in Australia. The routine schedule has been relatively stable for over 20 years, but new vaccine developments and an improved understanding of the epidemiology of the vaccine-preventable diseases will soon result in several major changes. General practitioners should review vaccination documentation and storage of vaccines, to ensure that the service they provide is of the highest standard. National targets for "age-appropriate" vaccination could be the basis for individual practices to assess their own performance.
General practitioners (GPs) possess a wealth of information on the health of their patients. Hence, they are in a unique position to gather information for research, education or management. The chief goal of the Registration Network Family Practices is to establish a computerized database containing certain patient characteristics and all relevant health problems excluding minor, temporary illnesses. The database can be seen as a dynamic population sampling frame of chronic and/or severe morbidity, also including risk factors and psychosocial problems. The best way to make use of the Registration Network Family Practices is by researchers identifying and sampling patients with particular health problems. The database contained patient characteristics and problemlists of 61,887 persons, on September 1, 1995. At that time 214,389 health problems had been entered in the database. The database is increasingly being used as a source of information for studies by researchers and students. Researchers find the database a useful tool, but they have to keep in mind that data on the process of care are not directly available. Furthermore, there is a limit to the number of studies which can be performed in the network practices, due to time limitations and the burden on the doctors and patients.
General medical patients can be easily screened for alcohol dependence on a routine basis. The Michigan Alcoholism Screening Test (MAST) is a 24-item yes-no questionnaire concerning alcohol-related behavior. When it was included in the history self-administered to new patients in an internal medicine faculty-resident outpatient practice, it uncovered unsuspected alcohol dependence. The combined questionnaire (health history plus MAST) was given to 351 consecutive new outpatients. Thirteen (4%) were found to have positive MAST scores (greater than 7), indicating alcohol dependence. Nine patients were in the mild dependence range (7 to 20), two in the moderate range (20 to 30), and two in the severe range (30 to 53). All patients with significant MAST scores had complaints related to active drinking. The MAST score directed the physicians' therapeutic efforts in nine of 13 patients; in four the significant MAST score was ignored. The MAST is useful to detect unsuspected alcohol dependence in office practice. When used by faculty and residents trained in recognizing alcohol-related behavior, the test will properly direct therapeutic and rehabilitative efforts for those patients with the primary diagnosis of alcohol dependence.
General practitioners are in prime position for promoting primary, secondary and tertiary HIV prevention. Counselling is an integral part of their work and a key step towards behavioural change of their patients. Particular attention must be given to counselling before and after the HIV antibody test. So far, the extraordinary potential of general practitioners to educate patients about HIV infection has been used insufficiently. The primary barriers to providing health education are lack of knowledge and discomfort with initiating discussions of sexuality or drugs use rather than lack of time or 'other health priorities', etc. These findings show the need to implement education programmes for physicians and other members of their medical practice. Additionally, patients should be encouraged to take the initiative in starting discussions about HIV. In Switzerland, an education programme for physicians is currently under way.
General practitioners complete approximately 26% of death certificates themselves but have considerable difficulty obtaining prompt and accurate information about their other patients who die. A random survey of district health authorities in England revealed that all were able to compile death lists but none included general practitioner details. This paper reviews the flow of information on patient deaths and describes a project to assess the feasibility of providing Newcastle general practitioners with comprehensive death registers. With the collaboration of the family health services authority and the district health authority, and with data from the regional perinatal mortality survey the creation each week of complete lists of patient deaths, broken down by general practitioner, is feasible. Death registers allow general practitioners to undertake audit of the quality of death certification and of the care of the recently deceased, and to improve the continuing care of the bereaved.
General practitioners who secure the collaboration of a clinical psychologist in treating patients, especially in a community setting, are likely to benefit the patients and themselves. Transfer of skills may be an important way for the two professions to collaborate. Health promotion could be a fruitful field for collaboration but has so far been little explored.
General practitioners (GPs) in Tayside, with higher weekly surgery workloads, tended to have a greater proportion of return consultations compared with GPs with smaller workloads. By reducing the number of return consultations, GPs could have a notable effect on their workload and alleviate the, oft-quoted, stress induced by the perceived increase in demand for patient care.
General practitioners are responsible for about 90% of all prescriptions for psychotropic drugs which benzodiazepines account for approximately 75%. In order to obtain a quantitative and qualitative assessment of the consumption in Svendborg, all benzodiazepine prescriptions were registered during a two-month period (February and March 1990). A total of 3364 prescriptions were issued to 6% (2262 persons) of the population. Of these, 1837 (54.6%) were prescriptions for tranquillizers, 1272 (37.8%) for hypnotics and 255 (7.6%) for both tranquillizers and hypnotics. The prevalence of benzodiazepine users increased with age and women were responsible for about 2/3 of the total consumption. Small but frequent prescriptions were issued to the younger users of benzodiazepines while older users generally received prescriptions for greater quantities at longer intervals. One in four persons over 80 years of age used sedatives. On account of the pharmaceutical, social and economic consequences of the widespread use of benzodiazepines in the elderly population, restrain should be observed in prescribing benzodiazepines.
General practitioners (GPs) in the United Kingdom are central to the commissioning of health care services. A qualitative study of their views was therefore designed, which incorporated an in-depth (open) interview technique carried out on a 20% sample of all GPs (n = 100) in one United Kingdom Health District. The data from these interviews indicated that GPs were aware of, but had mixed feelings about the need for rationing. They expressed disquiet about the dilemma faced in rationing health care at the time of the consultation and readily associated issues of cost in their practice with rationing. Some of the currently adopted methods of rationing (waiting lists, co-payments and ability to pay) were commented upon. The respondents also made suggestions on how rationing could be carried out, which included: maximizing efficiency to reduce the need for rationing; using a third party committee to make rationing decisions, with a membership of clinicians, managers, and possibly public representatives, and; being explicit about how rationing is done. Fundholding brought rationing decisions to the fore, and worried most who discussed it in the context of rationing. The conclusion of this paper is that current implicit rationing policies in the National Health Service are flawed as they assume that GPs will ration health care at the time of the consultation. The involvement of GPs in the rationing process is important (particularly given the present expansion of GP fundholding), so there is a need for an alternative to the present system.
General practitioners will, in the near future, have several choices of how to treat patients with peptic ulcer disease, as there will be many treatment guidelines that present different combinations of acid-inhibitory drugs, such as omeprazole, and antibiotics. However, they will still be left with the problem of who to treat, because patients do not present with a confirmed diagnosis; rather, they present with dyspeptic symptoms.
General practitioners are the custodians of large quantities of confidential information, and they are often asked to use this to furnish reports for third parties. The implications of consenting to the disclosure of information for such purposes are frequently ill understood by patients. If there is a possibility that such disclosure may disadvantage the patient, the doctor should discuss the matter personally with the patient before releasing any information.