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PubMed1990

The management of suspected myocardial infarction by Scottish general practitioners with access to community hospital beds.

General practitioners working in 20 community hospitals in Scotland participated in a survey of the management of myocardial infarction. During one year they suspected acute myocardial infarction in 451 patients. Of these patients, 278 (62%) were admitted to a community hospital, 125 (28%) to a district general hospital and 48 (11%) were kept at home. The main reasons given for admission to a community hospital were for monitoring and investigation, while the main reasons for admission to a district hospital rather than a community hospital were the relative youth of the patient and the severity of the illness. Acute myocardial infarction was confirmed in 323 (72%) cases, but in 26 (6%) cases the final diagnosis was other than ischaemic heart disease. Patients with acute myocardial infarction who entered a community hospital did so a median of two hours 25 minutes after the onset of symptoms. Among 18 patients admitted to a community hospital in whom resuscitation was attempted after cardiac arrest four (22%) were subsequently discharged from hospital. The mortality rate from acute myocardial infarction in the community studied was 171/418 (41%), of whom 95 died suddenly before coming under medical care. It is concluded that in rural areas of Scotland an acceptable standard of care for patients with acute myocardial infarction, including the administration of thrombolytic therapy, could be provided rapidly by general practitioners working in community hospitals.

Adult↗

PubMed1995

The carrot, the stick and the general practitioner: how have changes in financial incentives affected health promotion activity in general practice?

BACKGROUND: Financial incentives for increasing health promotion activity in primary care, introduced with the 1990 contract for general practitioners, were amended in 1993 and are now focused on cardiovascular disease. Payments for health promotion clinics were abolished and target payments were introduced. AIM: The study aimed to evaluate the effect of the change, in June 1993, in financial incentives for health promotion activity in primary care on the distribution of health promotion payments in two family health services authorities. METHOD: A retrospective study was undertaken in which data from two family health services authorities were used to determine the annual level of health promotion payments per 1000 practice population before and after the contractual amendment. Health promotion clinic payment data were analysed for 78 practices in Bedfordshire Family Health Services Authority and 85 practices in Kensington, Chelsea and Westminster Family Health Services Authority. Changes in health promotion payments were calculated and related to two measures of relative need: all cause standardized mortality ratios, for patients aged 74 years or less, of the electoral ward in which the practice is located; and the Jarman underprivileged area score. High relative need was defined as a standardized mortality ratio of over 100 or more than 25% of the practice population living in electoral wards with a Jarman score of over 30. RESULTS: Health promotion payments were more evenly distributed after the change in June 1993 than before between the two family health services authorities and between general practices. Single-handed practices were carrying out more clinics in 1992 than multi-partner practices and consequently were one of the greatest financial losers as a result of the change. In addition, practices located in electoral wards with high relative needs lost proportionally more than those in electoral wards with lower needs. CONCLUSION: Changes in the general practitioner health promotion contract have created new financial winners and losers. It now appears that health promotion payments are more evenly distributed but that the distribution is unrelated to need or treatment given. More evidence on the effectiveness of health promotion interventions is required before policies aimed at promoting better health through primary care can be fully evaluated.

England↗

PubMed1977

[Cancer information of the general practitioner].

Inquiries among more than 1 000 general practitioners in the South-West area of France permitted us to precise their needs and wishes about information in the cancer field. The aim of these data is to adapt in a better way the teaching for students and graduates on the base of a close collaboration between general practitioners and cancer specialists.

Antineoplastic Agents↗

PubMed2000

General practitioners in North Wales: current experiences of palliative care.

Much work on the role of general practitioners within palliative care has focused on those working in densely populated inner city areas. This study was undertaken to evaluate the provision of palliative care and training needs of general practitioners in North Wales, a predominantly rural area. Questionnaires were sent to all 240 GPs and 94 responded (40%); those GPs responding were younger and mainly worked within partnerships. During the preceding year a median of four terminally ill patients had been cared for by each GP (range 0-21). General practitioners believed that palliative care was an important part of their role and applicable to patients with all end stage diseases. Use was made of community hospital beds as these were perceived as being more convenient for the patients and allowed the GPs to continue their involvement in patient care. Where services--e.g. palliative care consultants, day care and Marie Curie care--is available this was perceived as being very useful and of benefit. General practitioners believed they would benefit from further education and teaching on all aspects of palliative care, and this was supported by just over 50% of doctors knowing the correct breakthrough doses of morphine and many stating they would not prescribe more than a certain dose of opiates. Training in palliative care during vocational training was poor or non-existent and a preference was expressed for experiential teaching.

Bereavement↗

PubMed1990

General practitioner minor surgery facilitated by a Fife District General Hospital. Evaluation of a pilot project.

Large waiting lists for elective surgical operations in Fife stimulated a pilot project to encourage general practitioners (GPs), to undertake more minor surgery operations. A three part evaluation of the work was designed which looked at medical and patient satisfaction aspects of the project; views of the Local Medical Committee (General Practice) and Division of Surgery were sought. All parts of the evaluation appeared satisfactory and health service managers have been provided with sufficient information to make decisions on the implementation of further minor surgical schemes in Fife.

Consumer Behavior↗

PubMed1979

The relationship between the general practitioner and the clinical psychologist.

There is a growing tendency among general practitioners to pay more attention to the psychological factors involved in patients presenting with physical symptoms. A working relationship between a general practitioner and a clinical psychologist is described, with specific reference to the role of the clinical psychologist. Procedures used by the latter and by the general practitioner to diagnose and treat 7 female and 5 male patients are discussed. We suggest that this programme can be valuable for psychosomatic and minor psychiatric problems in patients presenting with somatic symptoms.

Adult↗

PubMed1993

Why do patients change their general practitioner? A postal questionnaire study of patients in Avon.

The aim of this confidential postal questionnaire study was to determine why patients change their general practitioner. Among 1423 patients who changed their general practitioner without changing their address the reason most commonly given for leaving a general practitioner was distance (41%)--three quarters of these patients mentioned only distance. Just over one third of respondents (35%) mentioned dissatisfaction with the personal care given by the general practitioner and 36% mentioned dissatisfaction with practice organization. Specific patient requirements, such as a woman doctor, were not commonly mentioned. Convenience was the commonest reason given for choosing a new doctor (53%), with recommendation or reputation mentioned by 36% of respondents and positive expectations of service by 37%. The proportion of patients that changed from any one practice was small. This type of survey may prove a useful method for family health services authorities to identify practices with a higher than normal level of patient dissatisfaction.

Choice Behavior↗

PubMed1997

Do general practitioners act consistently in real practice when they meet the same patient twice? Examination of intradoctor variation using standardised (simulated) patients.

OBJECTIVE: To assess the variation within individual general practitioners facing the same problem twice in actual practice under unbiased conditions. DESIGN: General practitioners were consulted during normal surgery hours by a standardised patient portraying a patient with angina pectoris. Six weeks later the same general practitioners were consulted again by a similar standardised patient portraying a similar case. The patients reported on the consultations. SETTING: Trondheim, Norway. SUBJECTS: Of 87 general practitioners invited by letter, 28 (32%) agreed to participate without hesitation; nine others (10%) wanted more information before consenting. From these 24 were selected and visited. MAIN OUTCOME MEASURES: Number of actions undertaken from a guideline in both rounds of consultations. Duration of consultations. RESULTS: The mean (range, interquartile range) guideline score, total score, and duration of consultation were not significantly different between the first and second patient encounters for the group as a whole. For individual doctors the mean (SD) difference was -0.09 (3.36) for the guideline score, 0.30 (8.1) for the total score, and -0.87 (9.01) for consultation time. CONCLUSIONS: The study shows that assessment of performance in real practice for a group of general practitioners is consistent from the first round of consultations to the second round. However, significant variation occurs in performance of individual physicians.

Family Practice↗

PubMed1976

The role of practice manager--changes in attitudes promoted by the Royal College of General Practitioners.

Because of the roles traditionally required of them, and because of the insularity of ancillary staff in general medical practice, many senior ancillary staff may not have been giving their doctors the most effective support of which they are capable. This is changing as a result of the change-promoting activities of the North of England Faculty of the Royal College of General Practitioners.A survey of ancillary staff and general practitioners in the North of England has shown that the Royal College of General Practitioners has assisted ancillary staff to a greater consensus of more progressive views about the emerging role of practice manager than is the case amongst general practitioners. The results also show that differences in the size of practices have determined whether or not a need for a practice manager is perceived.The focus of interest created by this faculty of the Royal College of General Practitioners has resulted in the formation of special interest groups of senior ancillary staff in the North of England. These groups form a valuable resource for exploration and innovation to discover more effective means of organising and managing general medical practice.

Allied Health Personnel↗

PubMed1990

A survey of doctorates by thesis among general practitioners in the British Isles from 1973 to 1988.

Doctors who were general practitioners in the period 1973-88 and had written a successful MD or PhD thesis were identified. Of 96 doctorates, 64 were MDs and 32 PhDs. Fourteen doctors had obtained their MD before becoming general practitioners and the remaining 50 after becoming general practitioners. Twenty of the 64 doctors were full time or part time members of a university department of general practice; six of these were professors. In this 16 year study the mean annual number of MDs written by doctors while in general practice was three, compared with five in the previous 15 years. Of the PhDs, 11 were obtained before starting a medical course, six during the pre-clinical period, three after qualifying but before entry into general practice and 12 after entry into general practice. Ninety two per cent of the 50 doctors who obtained their MDs while in general practice and 84% of all the doctors with MDs continued to do research afterwards. Further research was carried out by 81% of doctors with a PhD. The best way of producing good researchers in general practice is to encourage doctors to accept the challenge of writing a PhD or an MD thesis. This study has shown that writing such a thesis encourages rather than discourages a doctor to undertake further research.

Academic Dissertations as Topic↗

PubMed1993

Gender differences in practice style: a Dutch study of general practitioners.

The differences between female and male general practitioners (GPs) were studied regarding three different factors: 1) Do female GPs see more female patients than their male colleagues in the same practice?; 2) Are female GPs confronted with different types of health problems from their male colleagues?; and 3) Do female GPs provide different services to their patients? Data from the Dutch National Study on Morbidity and Interventions in General Practice were used. All practices in this study with both female (n = 23) and male (n = 27) GPs were selected. This resulted in detailed data on 47,254 consultations, 62% of which were with female patients. The three research questions all received an affirmative response: 1) female patients tend to choose female general practitioners; 2) female GPs see different health problems from their male colleagues, and that is only partly because the patient so chooses; and 3) besides the expected differences in female-specific problems, there is a clear GP-gender effect in the presence of 'social' and 'metabolic' problems in the female GP's consultations. Some differences in the provision of services between male and female GPs occurred, with female GPs spending more time on their patients and having a stronger tendency to provide continuity of care. In addition to a gender effect (both physician and patient) a part-time effect in most issues studied was observed.

Adolescent↗

PubMed1985

Language skills of general practitioners in Sydney.

Nearly 50% of the general practitioners in nine representative local-government areas of Sydney spoke one of 27 languages other than English. The most common languages were Chinese dialects, Indian dialects, Italian, German and French. Bilingual and multilingual doctors tended to practise in local government areas with relatively large non-English-speaking populations. Nevertheless, some language groups would not have easy access to a general practitioner, particularly to a female doctor, who speaks their language.

Australia↗

PubMed1989

Survey of general practitioners' advice for travellers to Turkey.

Fifty general practitioners replied to a survey of the advice that they would offer to a tourist planning a package holiday in western Turkey. The range of prophylactic immunizations and other medication recommended by the respondents was wide, suggesting that some tourists travel without adequate protection, while some receive unnecessary injections. Most of the doctors would offer little other health advice to the traveller. General practitioners receive conflicting guidance on prophylactics for travellers, and it is suggested that the disagreements should be resolved. Wider availability of written advice for the traveller would also be valuable.

Data Collection↗

PubMed1989

Can general practitioners counsel?

It has been suggested that general practitioners are in a prime position to counsel patients presenting with psychosocial problems. While many doctors use counselling skills in their consultations few have received training in counselling and the difference between the use of counselling skills and the process of counselling is not always understood. This paper examines the differences between counselling and counselling skills and compares the role of doctors and counsellors. It is concluded that there is a need for trained counsellors to work alongside general practitioners and that this is of benefit to patients and all members of the primary care team.

Counseling↗

PubMed1994

Herpes zoster: a comparative study of general practitioner and patient experience.

A study was carried out to compare attitudes, perceptions and experiences of general practitioners and patients who had treated/suffered from herpes zoster, or shingles, in the recent past. Randomized samples of 224 general practitioners and 236 patients were drawn from different locations in Italy, Germany and the United Kingdom, and interviews were undertaken as semi-structured face-to-face discussions with the subjects. Most of the discussion questions were the same for both samples but specifically targeted either towards the professional or the patient group. Analysis of the findings showed that although there was a high level of correlation between the two groups on opinions and attitudes on a number of issues, there were significant, important differences on others. For example, prodromal symptoms acknowledged by patients were not always recognized by general practitioners and there appeared to be an inability of some to diagnose early enough to take advantage of appropriate anti-viral therapy whilst they acknowledged the need to do so. This in turn led to a number of patients either not receiving specific therapy or having inadequate therapy. Similarly, whilst general practitioners mainly reflected the current medical view that shingles is a benign and self-limiting condition, patients tended to consider shingles and post-herpetic neuralgia as a painful and serious condition that adversely affected their quality of life and to a greater extent than appreciated by many doctors. The findings of the survey indicate that there is need for improved understanding of the disease and its effects by both doctors and patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Antiviral Agents↗

PubMed1993

Why do general practitioners recognize major depression in one woman patient yet miss it in another?

The aim of this study was to establish whether psychiatric patient characteristics and the presence of physical illness affected general practitioners' recognition of major depressive illness in women patients. The 30-item general health questionnaire was used as a first stage screening instrument for psychiatric morbidity and each patient selected was interviewed, usually within three days of consulting their general practitioner, using the combined clinical interview. A sample of 72 women with major depressive disorder was obtained from patients consulting 36 general practitioners mainly from the south west Thames region of England, each general practitioner providing one patient he or she had correctly recognized as being depressed and one patient whose depression had not been recognized. Few differences were found between the groups with recognized and unrecognized depression in their psychiatric or physical features. More patients with unrecognized depression experienced physical illness and were tired. Patients with serious physical disease were five times more likely not to be recognized as depressed than those without physical disease. Patients with recognized depression described a more distinct quality to their depressed mood. Women with unrecognized major depression are similar to those women whose major depression is recognized by their general practitioner. These findings require further elaboration by process and content analysis of the women's consultations.

Adolescent↗

PubMed1992

List size, composition of practice and general practitioners' workload in The Netherlands.

Workload of general practitioners plays an important role in discussions about list size and remuneration in health care systems with fixed patient lists and capitation payments, such as in the Netherlands and in the United Kingdom. Against the background of the fairness of differences in income level between GPs the question is posed to what extent differences in list size reflect differences in workload and to what extent differences in patient characteristics influence workload. Both list size and practice composition relate to the demand led character of general practice. Data collected in the National Study of Morbidity and Interventions in General Practice are used. Central to this study is a three month recording of all contacts of 161 general practitioners (and their locums, assistant GPs and trainees) in the Netherlands. For each practice a patient register has been made to relate contacts to the practice population. The participating GPs kept a detailed diary covering 24 hr a day during one week. As indicators of workload several contact rates, hours worked in practice per week (in direct patient care and in other activities) and average length of office consultations are used. Demand related characteristics have the strongest relation to the number of hours worked by GPs, particularly the number of hours spent in patient-related activities. Rates of contacts, with the exception of the office contact rate, are not related to list size, but mainly to practice composition. The average length of consultations is negatively related to list size and some characteristics of the practice population.

Capitation Fee↗

PubMedDate not supplied

[The referral system: a study on relations between general practitioners and specialists].

BACKGROUND: To describe the general practitioners referral patterns. There is special emphasis in the delay between the referral and the first consultation with the specialist. Also we consider other aspects of the coordination between both levels of care. METHODS: Cross-sectional study upon 8.095 referrals from 242 spanish doctors. RESULTS: The referral rate was 6.63%, higher in the 15-44 age group and also for men. We find a huge variability in the referral rates among doctors. The referral rates are higher to surgical specialties. The mean delay between referral and specialist appointment was 11 days. The general practitioners didn't receive communication from the specialists in 23.5 of the referrals. CONCLUSIONS: A considerable range of referral rates has been identified. There is a poor continuity and coordination in the patient care.

Adolescent↗