SEARCH · PubMed Health

Results for “General Practitioners”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 721 records · Page 40Linked to original sources

PubMed2002

Unplanned readmission to hospital: a comparison of the views of general practitioners and hospital staff.

OBJECTIVE: to compare the views of general practitioners and hospital staff on the reasons for unplanned readmission of older people. METHODS: we studied 124 patients aged 65 years or over who were readmitted within 28 days of discharge. We determined the views of hospital staff and the patient's general practitioner on the reasons for readmission and compared them using McNemar's test. RESULTS: the crude readmission rate was 13.2%. The commonest agreed reason for readmission was a relapse or complication of the initial illness. Opinions differed most significantly when the reason was poor health or inadequate preparation on discharge. CONCLUSION: hospital discharge policies should take into account general practitioners' views on the causes of unplanned readmission.

Aged↗

PubMed1994

Consultations for women's health problems: factors influencing women's choice of sex of general practitioner.

AIM: This study set out to examine the degree to which women choose to visit a woman doctor for women's health problems and the determinants of this choice. The differences between women and men doctors with regard to treating women's health problems were also studied. METHOD: Data from the Dutch national survey of general practice were used. All group practices with both women and men general practitioners were selected. Analyses were restricted to consultations among women aged 15-65 years about menstruation, the menopause, vaginal discharge, breast examination and cervical smear tests. RESULts. Given the size of their female practice population, women doctors saw considerably more women with women's health problems than did their male colleagues. Women were more likely to consult a woman general practitioner if she was more available (that is, working longer hours), and younger women were more likely than older women to choose women general practitioners. Sex differences in the treatment of women's health problems were small and mainly related to the verbal part of the consultation: counselling and providing information. The doctors' availability and their certainty about the working diagnosis explained differences in the verbal aspects of consultations. Women general practitioners had longer consultations than their male colleagues mainly because more health problems were presented per consultation. CONCLUSION: In order to increase the possibility of patients choosing women general practitioners, policy should be directed towards the education of more women general practitioners and women general practitioners should be encouraged to work more days a week.

Adult↗

PubMed1997

Evaluation of general practitioner referrals to a specialist breast clinic according to the UK national guidelines.

The recently published national guidelines to general practitioners for the referral of patients with breast problems were retrospectively applied to letters of all patients attending the Rapid Access Breast Clinic at the University Hospital of Wales. The patients have all had diagnostic investigations performed at the initial visit with a multidisciplinary review of results and provision of a management plan prior to the subsequent visit. Since its inception in May 1995 until the end of the year when the guidelines were published, 2332 new patients had been seen. Overall, 29% of patients with benign breast disease would not have been referred if the guidelines had been strictly followed. Of the 147 symptomatic carcinomas diagnosed from general practitioner referrals (6.3% of total referrals), no invasive cancers would have been missed. One patient with incidental detection of ductal carcinoma in situ (DCIS) in the asymptomatic contralateral breast would not have been referred. Referral for pain without a discrete lump constituted 63% of the patients with a benign diagnosis who fell outside the guidelines. The guidelines also include comprehensive algorithms for the initial management of benign breast symptoms that do not require immediate referral by the general practitioners. Our general practitioners were significantly better at referring patients over 50 years old but the proportion of appropriate referrals were not related to the number referred by each practice. The present guidelines adequately cover referral for the diagnosis of malignant breast disease to a specialist, and may reduce the benign workload of breast clinics.

Ambulatory Care Facilities↗

PubMed1982

Doctors and alcohol. The responses of a self-selected group of general practitioners to patients with alcohol-related problems.

A postal survey of New Zealand general practitioners gathered information from a self-selected sample about their response to alcohol problems. Responses to a series of attitude statements measured the extent to which doctors held traditional beliefs about alcoholism as a disease, the management of which requires abstinence; emerging concepts of alcohol dependence and more moralistic attitudes. General practitioners who responded to the survey were found to be largely in sympathy with the disease concept of alcohol problems though some of the more recently emerging concepts were also widely accepted. The majority reported that they felt they did have an active role to play in connection with the alcohol problems of their patients, both in terms of treatment or advice giving, and referral to specialist agencies. Over half of the respondents requested guidelines for treatment and advice giving. Only a small proportion of general practitioners reported pessimism about their personal role in relation to their patients' alcohol problems. The results are discussed in the context of recent research evidence showing the relative efficacy of a structured advice-counseling session of the type in which general practitioners might engage.

Alcoholism↗

PubMed1993

New Zealand general practitioner referral patterns.

AIM: The aim of this study was to describe the referral patterns of general practitioners in New Zealand, for a defined list of medical conditions. METHODS: A postal questionnaire was sent to a random sample of 200 general practitioners, selected from the Medical Council of New Zealand list. Responses were made on five point scales to indicate general practitioners' views on the appropriateness of referral. For each medical condition, derived from An Educational Guide for General Practice, respondents also indicated favoured agencies for referral. Cluster analysis was used on an SPSSX dataset. RESULTS: A response rate of 87% (91.5% of eligible contacts) was achieved. The conditions for which referrals were least often made included mild hypertension, rheumatoid arthritis not requiring second line therapy, hypothyroidism, and obesity. Referral was common for rheumatoid arthritis requiring second line therapy, insulin dependent diabetes mellitus, altered bowel habit with rectal bleeding, multiple sclerosis, and postmenopausal bleeding. Seventy seven different referral agencies were indicated by respondents: the most common was the general physician (13% of all agencies indicated). CONCLUSIONS: Although there are a large number of conditions which are routinely managed only in general practice, general practitioners need to be able to refer patients to other health carers, even if only occasionally. There is a high degree of consensus as to the conditions for which referral is usually appropriate. They tend to be conditions requiring well defined investigation, treatment or management procedures which are commonly provided by centralised secondary or tertiary institutions.

Attitude of Health Personnel↗

PubMedDate not supplied

The treatment of psychosomatic disorders by the general practitioner.

Three issues relating to the treatment of psychosomatic disorders by the general practitioner are discussed: 1) the characteristics of the therapeutic relationship in general practice, with more spontaneous intimacy and greater continuity, which often enable the physician to treat psychosomatic disorders more effectively than specialists, 2) the challenging task for the general practitioner of distinguishing a psychosomatic disorder, and 3) the special treatment forms available to the general practitioner in approaching the patient with a psychosomatic disorder.

Continuity of Patient Care↗

PubMed1999

[Many patients treated in the emergency department could be treated by a general practitioner on call].

Misuse of accident and emergency (A&E) departments is a problem throughout the world. Staffing A&E departments with general practitioners has been reported as successful in a few prospective studies. A medical audit of all A&E charts during one week was carried out. The audit-panel included two orthopaedic surgeons and two general practitioners. The charts were divided in two groups: 1) true A&E cases, 2) inappropriate A&E users, who should have visited the general practitioners' acute consultation instead. There was substantial agreement between audit-panel groups that 57% of attenders could visit the general practitioner instead. Ten percent of attenders received no treatment in the A&E department, but were transferred to other departments within the hospital. It is concluded that two-thirds of the A&E department attenders could have visited the general practitioners instead, for treatment or for referral to the relevant hospital department.

Emergency Medical Services↗

PubMed1992

Prescription of hearing aids for the elderly: the views of general practitioners.

A questionnaire survey was carried out to examine the views of general practitioners in one Northern city regarding whether or not they thought that hearing aids should be prescribed from general practice, who they thought should prescribe them and whether or not additional resources and training would be needed if the responsibility for hearing aid prescription for the elderly was placed upon general practitioners. The survey indicated that whereas many general practitioners would be in favour of prescribing hearing aids from Health Centres, many would need extra training and resources to enable them to do so.

Aged↗

PubMed1991

Letters to go: general practitioners' referral letters to an accident and emergency department.

OBJECTIVE: To investigate the content of general practitioners' referral letters to the Accident and Emergency (A&E) Department of a large regional hospital. METHOD: Two hundred and fourteen consecutive identifiable letters from general practitioners presented by patients over a four week period were reviewed. The accuracy and content of the letters was measured by the presence of 10 key items, and checked against the A&E notes when necessary. A further nine items were examined to discover whether the context of the referral had any influence on letter content. RESULTS: Information that was relatively poorly represented in the letters included social and personal background details, vital signs, regional examination findings, a management plan, and investigation results. The presence in the letter of a management plan or a clear presenting problem was found to be significantly associated with appropriate referrals. CONCLUSIONS: Poor referral letters may reflect a professional distance between the general practitioner and A&E staff that is stretched by the anonymity of the relationship, increasing A&E specialisation, or lack of feedback to the general practitioner. Specific information standards for A&E referrals should be developed to ease contact and to establish criteria for referral.

Correspondence as Topic↗

PubMed1991

The attitude of general practitioners towards practice nurses: a pilot study. The Georgian Research Society.

Questionnaires surveying the attitudes of general practitioners towards the role of the practice nurse and its potential extension were distributed to a random 12% sample of Hampshire general practitioners. The response rate was 85%. It was found that practice nurses were performing more tasks of greater complexity than had been previously reported. The general practitioners expressed satisfaction with the role of the practice nurse, but had reservations about the evolution of that role towards that of a nurse practitioner. Inadequate resources were the most commonly cited factors limiting the development of practice nursing. In conclusion, it appears that Hampshire general practitioners wish to retain control of the evolution and extension of the role of the practice nurse.

Attitude of Health Personnel↗

PubMed2005

[The role of the general practitioner in inpatient psychiatric care].

OBJECTIVE: In the light of the increasing importance of the general practitioner as a gatekeeper within the German psychiatric health care system, his/her role needs to be evaluated. METHOD: On the basis of the psychiatric documentation (DGPPN-BADO) of 4066 patients predictors for referral to inpatient psychiatric care by the general practitioner together with outpatient aftercare were analysed by means of logistic regression models. RESULTS: 18.4% of the patients were referred by a general practitioner, mostly those with an affective disorder (Odds Ratio 4.0) or schizophrenia (OR 3.3), and residents of old people's or nursing homes (OR 3.5). In 49.9% of the patients, aftercare by a general practitioner was recommended - more frequently patients with addictive disease (OR 2.0), pensioners (OR = 1.7) and elderly patients (OR 1.03), more rarely patients with schizophrenia (OR 0.4) or affective disorders (OR 0.7). CONCLUSION: In view of the relatively low referral rate, in-hospital quality management should focus on improving cooperation between psychiatric hospital and GP.

Adolescent↗

PubMed1990

Overprescription of cholera vaccine to travellers by general practitioners.

A questionnaire describing five hypothetical patients intending to travel to different countries was sent to 113 general practitioners, who were asked to state which patients they would recommend cholera vaccination to. The response rate was 80%. The general practitioners' recommendations were compared with those of the Liverpool School of Tropical Medicine. Sixty three of 86 respondents recommended cholera vaccination when it would probably have been unnecessary. A review of common sources of information on cholera vaccination showed that general practitioners are given confusing or inappropriate advice. General practitioners should be educated about when cholera vaccination is necessary; alternatively, the vaccine should be available only through special centres.

Attitude of Health Personnel↗

PubMed2000

How accurate are hypertension treatment decisions? Absolute risk assessment and prescribing for moderate hypertension--a study of Cambridge general practitioners.

OBJECTIVE: To determine the factors influencing general practitioners' prescribing for patients with moderate hypertension, and to investigate their ability to assess patients' absolute risk of cardiovascular disease. DESIGN: Decision-making was assessed by a postal questionnaire involving five standardised example patients, send to all general practitioners in the CB-postcode area (Cambridge, UK). Patients varied in age, gender, diabetic and smoking status, blood pressure and total cholesterol, giving 5-year absolute risks ranging from less than 5% to greater than 20%. GP treatment decisions and risk factor influence, age bias, absolute risk calculations and cost-awareness were analysed with SPSS. Absolute risk was calculated using the New Zealand Core Services Committee (NZCSC) Guidelines, 1995. RESULTS: GP response rate was 66%. Sample demographics (mean age 42 years, 39% female) did not differ statistically from local health authority data. High blood pressure alone was the most common reason for instituting therapy (67%), independent of other risk factors. Drug choices did not differ statistically from Prescription Pricing Authority data. This supports the validity of the questionnaire. GP estimations of absolute risk were inconsistent, and there was a significant association between underestimation of elderly patient risk and overestimation of younger patient risk (p = 0.05). CONCLUSIONS: The Cambridge GPs more frequently based treatment decisions on patients' blood pressure level alone, rather than considering absolute risk as recommended by NZCSC and WHO guidelines. The relationship between patient age and risk estimations may indicate a "young age premium" influencing treatment. The data support the need for risk-based guidelines and education in treatment of hypertension.

Adult↗

PubMed1995

Implementation of quality assurance and medical audit: general practitioners' perceived obstacles and requirements.

BACKGROUND: The introduction of quality assurance and medical audit has been an important development in general practice. However, the introduction of such programmes does not necessarily mean they are implemented by general practitioners. AIM: A study was undertaken to describe the problems and requirements perceived by general practitioners in relation to the implementation of quality assurance and medical audit in general practice. METHOD: Interviews were carried out with a stratified sample of 120 Dutch general practitioners. Knowledge, acceptance and application of quality assurance and medical audit activities were investigated, and perceived problems and requirements in implementing quality assurance and audit activities were explored. RESULTS: General practitioners in the Netherlands were generally positive towards quality assurance activities, but had little experience of carrying out such activities. The most frequently mentioned obstacles to implementing quality assurance activities concerned lack of time, colleagues' negative attitudes and fear of assessment and criticism by colleagues. Requirements for implementing quality assurance included having regular meetings with colleagues about quality assurance, having information on the aims and methods of quality assurance, having data from other practices with which to compare performance, having support in data collection, in audit in the practice and in setting up local peer review, and having financial support. The most important factor predicting the actual application of quality assurance activities was found to be knowledge of specific quality assurance activities. CONCLUSION: Well-designed programmes for the implementation of quality assurance and medical audit, using a variety of different interventions, have to be developed. Such programmes should include the training of professionals in the concepts and methods of quality assurance as well as the provision of financial support for quality assurance activities.

Family Practice↗

PubMed1993

HIV infection and Norwegian general practitioners: does fear affect knowledge?

The objective was to study the dimensionality of knowledge among general practitioners in Norway about transmission of HIV and what factors influence the degree of knowledge. Data were collected by a mailed questionnaire. Independent variables were experience of HIV, acquisition of knowledge and confidence in information on HIV from the central authorities and perception of own knowledge, skills of practice and fear of oneself or one's family contracting the HIV infection. Analysis of variance and multiple classification analysis were applied to measure the effect of independent variables on knowledge about transmission of HIV. The general practitioners in three counties (Oslo, Møre og Romsdal and Troms), constituting one-quarter of the Norwegian general practitioner population were selected (n = 578). The response rate was 65%, and the results are assumed to be representative of Norwegian general practitioners. Four dimensions of knowledge about transmission of HIV were identified by factor analysis. The two most important, transmission through 'body fluids' and transmission by 'needle sticks', were subsequently converted into sum scores and used as dependent variables. Forty-five per cent of the respondents were uncertain about ways in which HIV is not transmitted through 'body fluids'. There was an association between knowledge about transmission through 'body fluids' and the variables county background, confidence in the information about HIV and fear of contracting HIV. In the multiple classification analysis these three variables explained 11% of the variation in knowledge about transmission through 'body fluids'. Only confidence and fear significantly predicted the degree of knowledge, and among the 11% who had no confidence in the information received the effect of fear on knowledge increased significantly.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel↗

PubMed1984

General practitioners, court reports, and alcohol related offences.

General practitioners may have to submit medical reports to the courts on patients who have a suspected alcohol problem, 98% of such requests coming from magistrates courts. When, however, a defendant decides to plead "not guilty" to an offence on the grounds of intoxication general practitioners are often asked to prepare a report to support the plea. We present guidelines on preparing such reports and discuss the implications of the contents.

Alcoholism↗

PubMed1999

Can general practitioner referral letters for acute medical admissions be improved?

BACKGROUND: General practitioner (GP) referral letters for emergency medical admissions should contain enough information to ensure that patients are managed safely and effectively. AIM: Our aim was to assess the quality of referral letters for acute medical admissions. METHOD: GP letters from 300 consecutive acute medical admissions were prospectively assessed by the admitting doctor and then independently assessed by a senior house officer (SHO), and a senior registrar. A random sample of 25 were assessed by a general practitioner. Content and legibility were evaluated for demographic details, current history, past history, social history, drugs and allergies, in order to grade the overall quality as "excellent", "good", "adequate" or "inadequate". RESULTS: Two hundred and ninety one letters were received, of which 208 (71%) were from the patients' own GP practice and 83 (28%) from a co-operative or deputising service. The admitting doctor rated 38 (13%) as excellent, 108 (37%) as good, 96 (33%) as adequate and 49 (17%) as inadequate. Kappa values for overall quality between the admitting doctors and the other doctors (senior house officer, senior registrar and our general practitioner) were 0.32, 0.26 and 0.44 respectively, representing fair to moderate interobserver agreement. Co-operatives or deputising services used proformas more often than GP practices (65/83, 78% and 17/208, 8% respectively, p < 0.01). There was no significant difference in overall quality between GP practices and co-operatives or deputising services, or between letters received on headed note paper or proformas. CONCLUSION: Most letters are satisfactory for the individual management of acutely ill patients, but collaborative work could usefully be undertaken to address the factors which result in the production of sub-optimal referral letters.

Acute Disease↗

PubMed1994

Immunisation practices of general practitioners in metropolitan Sydney.

An anonymous postal survey of all known general practitioners in the Northern Sydney Health Area (N = 987) examined the provision of immunisation services in general practice. Questions were asked about knowledge of storage of vaccines, the ages of patients administered measles-mumps-rubella vaccine, the use of reminder systems for subsequent vaccinations and whether maternal and family health was discussed at immunisation visits. There were 394 (40 per cent) respondents. Only 30 per cent used temperature monitors in their vaccine refrigerators, and 26 per cent correctly identified the period after opening that Sabin may be used (eight hours). Forty-one percent correctly injected infants in the anterolateral aspect of the thigh and 40 per cent administered measles-mumps-rubella vaccine by the recommended age of 12 months. Forty-one percent of respondents always used visits for immunisation to discuss other issues of maternal and child health and 16 per cent used reminder systems for follow-up. Sixty-six per cent of general practitioners stated that they were more likely to review the immunisation status of adolescents routinely, compared to 55 per cent who reviewed adults and 44 per cent who reviewed senior citizens. Routine review of all three groups was carried out by 43 per cent. These results must be interpreted with caution because of low response rates, and cannot necessarily be generalised to all general practitioners providing immunisation services. Nevertheless, important deficiencies in knowledge and practice of immunisation have been identified.

Adult↗