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PubMed2002

Video-conferencing: under-used by rural general practitioners.

The objective was to investigate the use of and value General Practitioners place on video-conferencing as a tool in providing rural health care. The participants were 8 rural general practitioners in rural Victoria towns. I found that six out of the eight GPs did not value video-conferencing as a tool to assist with patient care, and the other two GPs were interested in the technology only for certain aspects of support with patient consultations and continuing education. In conclude that there needs to be a review of whether video-conferencing equipment should continue to be implemented in the same way that it has been so far in Victoria, and of the cost-effectiveness of providing video-conferencing facilities in rural health services. In particular, there needs to be a review of whether more training and support for rural general practitioners is needed to increase the uptake of video-conferencing. Alternatively, analysis can be undertaken of the intrinsic value of using video-conferencing as an interactive tool for obtaining specialist support for patient care or undertaking continuing education via video-conferencing, and the program discontinued if it is found to be unwarranted.

Attitude of Health Personnel↗

PubMed1977

An analysis of 3,199 patients booked for delivery in general-practitioner obstetric units.

The outcome of 3,199 women booked for delivery in six general-practitioner obstetric units in one year was analyzed.Five per cent cancelled their bookings, 26 per cent were transferred to a consultant unit after referral for routine problems of pregnancy (mainly postmaturity), and 14 per cent were transferred for problems arising in labour (principally uterine inertia). One per cent were transferred after confinement.Fifty-four per cent were delivered successfully in the general-practitioner units.There were 3,037 live births, 27 stillbirths and 22 neonatal deaths. Nine stillbirths and nine neonatal deaths resulted from congenital abnormalities, while two stillbirths and 11 neonatal deaths were due to immaturity. There were 25 sets of twins and one set of triplets. Seventy-five babies were abnormal, 105 weighed less than 2,500g, and 198 over 4,000g.In this series almost 60 per cent of eventual perinatal deaths were transferred during pregnancy, and over 85 per cent before delivery.The perinatal mortality of all women initially booked for a general-practitioner unit who delivered was 15.. The perinatal mortality of the 1,795 births in the six general-practitioner obstetric units was 3.9.

Delivery, Obstetric↗

PubMed2003

Use of antidepressants by general practitioners and psychiatrists in Australia.

OBJECTIVE: To examine the antidepressant prescribing patterns of psychiatrists and general practitioners (GPs) in Australia, focusing specifically on: the prescribed daily dose, the relative proportions (from subsidized dispensing data) of prescriptions written, and how these proportions change over time for a newly listed antidepressant drug (using paroxetine as an example). METHOD: Retrospective analyses of subsidized claims data (comprising nearly 90% of the community supply of antidepressants) and prescriber surveys. RESULTS: General practitioners prescribe 86% of subsidized antidepressants in Australia. Almost three-quarters of the antidepressant prescriptions prescribed in primary care management are also initiated by a GP. Psychiatrists prescribed higher doses than general practitioners for all the antidepressants examined. For paroxetine, a higher than average proportion of scripts were written by psychiatrists when the drug was initially available and it only reached the GP/psychiatrist split seen with an established drug in the same therapeutic class (fluoxetine) four years after marketing. The most prominent type of depression that GPs believed they were treating was 'chronic mild depression', which contrasts with the subsidized indication for all newer antidepressant classes of 'major depressive disorders'. CONCLUSIONS: General practitioners are the major providers of treatment for depression in Australia. When writing prescriptions for tricyclic antidepressants GPs use doses lower than those recommended for major depression, however, most management in primary care is not for conditions regarded by the GP as major depression. A significant number of prescriptions for the newer antidepressants may not accord with the Pharmaceutical Benefits Scheme (PBS) restrictions for use.

Antidepressive Agents↗

PubMed1990

Comparing the quality of referrals of general practitioners with high and average referral rates: an independent panel review.

The quality of referrals of four general practitioners, two with high and two with average rates of referral to the department of internal medicine, was judged by an independent expert panel. The panel, consisting of two general practitioners and one specialist, reviewed a set of information about the referrals blindly and in random sequence. The same distribution of quality of referrals was found among the referrals of the two high referring general practitioners (n = 192) as among those of the general practitioners with average rates (n = 88); that is, 57% and 55% respectively, of the cases had clear medical indications for referral, while the data did not permit a conclusion in 15% and 10%, respectively, of the cases. Controlling for sex, age and status of the referral (first or repeat referral) did not alter the results. We conclude that using referral rates to judge referral quality is misleading. However, a blind and randomly performed panel review of referrals is a time consuming but feasible method of quality assessment.

Humans↗

PubMed1983

Effect of nicotine chewing gum as an adjunct to general practitioner's advice against smoking.

This study was designed to see whether the offer and prescription of nicotine chewing gum would enhance the efficacy of general practitioners' advice to stop smoking. A sample of 1938 cigarette smokers who attended the surgeries of 34 general practitioners in six group practices were assigned by week of attendance (in a balanced design) to one of three groups: (a) non-intervention controls, (b) advice plus booklet, and (c) advice plus booklet plus the offer of nicotine gum. Follow up was done after four months and one year. The results show a clear advantage for those offered the nicotine gum (p less than 0.001). After correction for those who refused or failed chemical validation and those who switched from cigarettes to a pipe or cigars, the proportions who were abstinent at four months and still abstinent at one year were 3.9%, 4.1%, and 8.8% in the three groups, respectively. These percentages are based on all cigarette smokers who attended the surgeries including those who did not wish to stop and those in the gum group who did not try the gum (47%). The effect of the offer and prescription of gum was to motivate more smokers to try to stop, to increase the success rate among those who tried, and to reduce the relapse rate of those who stopped. The self selected subgroup of 8% who used more than one box of 105 pieces of gum achieved a success rate of 24%. It would be feasible and effective for general practitioners to include the offer of nicotine gum and brief instructions on its use as part of a minimal intervention routine with all cigarette smokers. A general practitioner who adopts such a routine with similar success could expect to achieve about 35-40 long term ex-smokers a year and so save the lives of about 10 of them. If replicated by all general practitioners throughout the country the yield of ex-smokers would be about one million a year.

Adolescent↗

PubMed1998

The effects of depression awareness seminars on general practitioners knowledge of depressive illness.

The Royal Colleges of Psychiatry and General Practice wish to increase knowledge of depressive illness among patients and professionals. This study reports the results of a series of depression education seminars in a Health Board in Northern Ireland. Seminars lasted 2 1/2 hours and included didactic teaching and interactive case management vignettes. 88 general practitioners took part (39% of those eligible). Seminars increased knowledge as measured by questionnaire immediately, but this did not appear to be sustained at one year, when compared to a group of general practitioners with no access to such seminars. Educational programmes as described do not appear to have a sustained effect on general practitioners' knowledge of depressive illness.

Depressive Disorder↗

PubMed2003

[General practitioners' approach to relapsing multiple sclerosis].

Management of multiple sclerosis depends on close multidisciplinary collaboration but general practitioners play a particularly important role, especially in case of relapse, due to their close relationship with the patient. The purpose of this work was to conduct a survey of general practitioners' knowledge of relapsing multiple sclerosis and ascertain their main difficulties in patient management. One hundred seventy-seven practitioners answered a written questionnaire with two headings, diagnostic criteria for relapse and therapeutic approaches. Analysis of the results showed that this common event is under recognized. While 55.9 p.cent of the general practitioners stated they diagnosed relapse by themselves, only 2.8 p.cent knew its exact definition. Differential diagnosis accounted for a large number of mistakes. Our survey also underlined the use of certain therapeutic options (low-dose oral corticosteroid therapy) for which the effectiveness has not been demonstrated. It would be important to propose specific education on relapsing multiple sclerosis for general practitioners and improve cooperation with specialists. An integrated care network might be useful.

Adrenal Cortex Hormones↗

PubMed2002

[The Dutch College of General Practitioners' practice guideline, "Vaginal bleeding"; reaction from a general practice perspective].

The most important changes in the first revised version of the Dutch College of General Practitioners' practice guideline 'Vaginal bleeding' are the passages about the progesterone-containing 'intra-uterine device' (IUD), the combination of progesterone and oestrogen by prescribing, for example, a sub-50-pill for the treatment of menorrhagia, and advising the patient to undergo a transvaginal ultrasound to determine the amount of build-up in the endometrium. Vacuum aspiration of the endometrium to establish the cause of menorrhagia is not mentioned. This first revised version can contribute to the quality of care in general practice.

Female↗

PubMed2000

Systematic review of the effect of on-site mental health professionals on the clinical behaviour of general practitioners.

OBJECTIVES: To review the published literature concerning the effects of on-site mental health professionals on general practitioners' management of mental health. DESIGN: Systematic review of controlled trials. SETTING: Primary care. PARTICIPANTS: General practitioners and mental health professionals. MAIN OUTCOME MEASURES: Consultation rates, prescribing of psychotropics, and referrals to secondary care mental health services by general practitioners. RESULTS: The effect of on-site mental health professionals on consultation rates was inconsistent. Referral to a mental health professional reduced the likelihood of a patient receiving a prescription for psychotropics or being referred to secondary care, although the effects were not consistent. An on-site mental health professional did not alter prescribing and referral behaviour towards patients in the wider practice population. CONCLUSIONS: The secondary effects of mental health professionals on the clinical behaviour of general practitioners are comparatively modest and inconsistent and seem to be restricted to patients directly under the care of the mental health professional.

Community Mental Health Services↗

PubMed1991

Where have all the doctors gone? (2). Intraurban trends: changes in the geographic distribution of general practitioners in Auckland, 1980-7.

During the 1980s the Auckland metropolitan area increased its share of all general practitioners in New Zealand at a much faster rate than its share of the population, resulting in a high level of availability by 1987. In the light of such trends, neoclassical theory would predict a diffusion of general practitioners into areas with fewer doctors where there is less competition for patients. Data for 1980-7, however, indicates that for every FTE general practitioner who located in doctor poor areas of the city, 1.87 general practitioners continued to open practices in areas already well provided for. Or, for every extra consultation that took place in low income suburbs, 1.51 extra consultations occurred in more affluent localities. These results do not provide strong support for a market led diffusion of doctors into areas of need and any gains in increased equity appear to have been achieved at the expense of considerable inefficiency given the likely presence of induced demand.

Catchment Area, Health↗

PubMed1992

Patient access to general practitioners by telephone: the doctor's view.

Few general practitioners have extensive daytime telephone contacts with patients. Forty nine general practitioners responding to a postal survey who reported handling a mean of nine or more calls a day were interviewed about their experiences. The nature of telephone contacts with patients and the organizational strategies employed to minimize disruption to surgeries were explored. Views on the rewards and frustrations of being accessible by telephone and its impact on other aspects of workload were also sought. Recommendations are made for practices contemplating extending telephone access for patients.

Adult↗

PubMed1998

The value of autopsy from a clinical point of view. A survey of 250 general practitioners and hospital clinicians in the county of Sør-Trøndelag, Norway.

An enquiry into clinicians' attitudes to autopsies was conducted by questionnaire sent to 166 general practitioners in the county of Sør-Trøndelag in Norway and to 186 clinicians working at the University Hospital of Trondheim. It was considered especially important for us to include general practitioners. As the result of a government decision taken at the end of 1994, autopsies requested by general practitioners on patients dying outside hospitals have from January 1995 been covered by national health insurance. Answers were obtained from 250 doctors: 110 general practitioners and 140 hospital physicians. One hundred and seventy-nine (73.1%, n=245) felt that the possibility of having autopsies performed was of great importance in their daily work. Autopsy was considered to be a very important means of quality assurance in the health care system by 158 (66.4%, n=238). One hundred and two (41.2%, n=247) answered that improvements in medicine and technology during the last decades had not reduced the importance of autopsy. One hundred and twenty-two (81.3%, n=150) felt that especially computer tomography (CT) had reduced the value of autopsy. Among the general practitioners, 73 (68.9%, n=106) welcomed the opportunity to have non-forensic autopsies performed on patients who died outside hospitals. Our study showed differences in the attitudes of clinicians towards autopsies, but our results still indicate that the value of autopsy for furthering clinical knowledge is acknowledged by most clinicians.

Attitude of Health Personnel↗

PubMed1988

Serum cholesterol and coronary heart disease: Auckland general practitioners' attitudes and practices in 1986.

The relationship between elevated serum cholesterol and coronary heart disease, is now generally accepted as being causal. To examine current attitudes and practices regarding the treatment of high serum cholesterol, questionnaires were sent to a randomly selected sample of general practitioners in the Takapuna health district during 1986. The response rate among the 92 doctors in general practice at the time of the study was 80%. The majority of general practitioners (82.5%) believed that there was a casual relationship between high serum cholesterol and coronary heart disease and that reducing levels would help prevent coronary heart disease. Almost all general practitioners (96%) were screening some groups of patients for high serum cholesterol, with most screening those with symptomatic coronary heart disease or associated risk factors, and 15% screening all patients. Although almost 90% of general practitioners had patients on diet therapy and one third had patients on drug treatment, there was wide variation in attitudes regarding the serum cholesterol levels meriting dietary or drug treatment. This suggests that there is still considerable confusion as to when and how to treat high cholesterol levels and that specific national guidelines for the detection and management of high serum cholesterol are required as part of a comprehensive programme to prevent coronary heart disease.

Adult↗

PubMed1971

The American general practitioner in hospital.

In the U.S.A. and Canada full access of general practitioners to hospital beds and facilities is regarded as an essential privilege of their work. All hospital constitutions require a review of the credentials of staff applicants and continuing evaluation of their performance. Staff appointment carries administrative as well as clinical responsibilities and hospital work occupies a considerable proportion of the general practitioner's day. The disciplinary machinery for safeguarding standards is strict by comparison with British hospital practice.This system produces an obvious excellence of clinical standards, postgraduate education, and communication between specialist and general practitioner and is attractive to the more able young British graduate. A pilot experiment of hospital staffing on North American lines in one of our new district general hospitals would be a worthwhile proposition.

Accreditation↗

PubMed1993

[Perception of cancer by general practitioners. Development over 15 years].

Fifteen years after two surveys among general practitioners in the Southwest of France, concerning their attitudes towards cancer patients, a new survey was made using the same questions. In the spring of 1991, 731 general practitioners in Gironde were asked by a written questionnaire sent by mail: 261 answers (36%) forming a fair sample, were analyzed. Though incidence of cancer in physician's practice is low, these patients represent an important burden. Difficulties in coping with these patients during relapse or at the end of life are mainly psychological in relation to the importance of moral burden and the time spent. These psychological difficulties have increased during the past 15 years whereas technical medical problems have decreased. According to 80% general practitioners, cancer patients know their diagnosis. This knowledge is independent of practitioner's age and the working place, and it does not alter the difficulties for practitioner.

Attitude to Health↗

PubMed1991

Designing a deprivation payment for general practitioners: the UPA(8) wonderland.

OBJECTIVE: To analyse critically the deprived area payment introduced in the new general practitioner contract. The payment formula is based on the Jarman underprivileged area index (UPA(8)) and aims at compensating general practitioners for increases in workload. DESIGN: Evaluation of the deprived area payment against the stated policy objective with a set of criteria for developing resource allocation formulas. MAIN OUTCOME MEASURES: The degree to which the components of the Jarman index predict the workload of general practitioners; whether construction of the index is sensible and comprehensible; and how the formula incorporates the index and is likely to work in practice. RESULTS: The fact that the index relies on census data and the way the weighting was derived means that the formula will not accurately reflect the workload. The use of statistical transformations obscures the original policy intent. There has been no validation to support the application of the index as part of a national policy. The payments are not linked to the quality of service provided and may have the perverse effect of increasing list size. CONCLUSION: The formula used as the basis of the deprived area payments is poorly suited to the policy objective of compensating general practitioners for increases in workload. More research is urgently needed to enable the effect of the payment to be monitored and a more empirically sound set of incentives to be developed.

Family Practice↗

PubMed2000

Interpractitioner communication: telephone consultations between rural general practitioners and specialists.

The results of a study that sought to investigate the utility of and satisfaction with telephone consultations from the perspective of general practitioners and specialists are reported. Semi-structured interviews with rural general practitioners and specialists were used to elicit information about their most recent telephone consultations. The telephone was found to be an important means of communication for rural practitioners, primarily in terms of organising referrals. General practitioners tended to called specialists who they knew and appeared to have fairly well-formed networks of specialists who they called for most of their concerns. Trust is an important element of interpractitioner communication as it increases understanding and confidence in the reliability of the information exchanged. Good working relationships ensure that rural general practitioners have an accessible source of acceptable specialist support.

Attitude of Health Personnel↗

PubMed1989

Factors affecting the level of interest and activity in primary care research among general practitioners.

This paper presents the results of a state-wide survey of general practitioners in Victoria, Australia. The survey assessed their level of interest in general practice research as well as factors influencing the decision to participate in research. The study was conducted during the formation of a general practice research network which was being linked to a new primary care research unit in the Department of Community Medicine at Monash University. Of the 3350 general practitioners surveyed 1116 responded. One third expressed a high degree of interest in general practice research. Previous research experience and barriers to general practice research were also studied. The areas in which the doctors felt most research was required were identified. The results are compared with another study of Canadian family physicians, which is the only study of a similar nature previously published. The implications of the results are discussed with reference to the future direction of research by general practitioners.

Choice Behavior↗